Estrogen and progesterone receptors in Adenomyotic and eutopic endometrial tissue
Fatma Mohamed Ahmed Abdallah;
Abstract
Adenomyosis is a common gynecological disorder characterized by the presence of the endometrial tissue into the myometrium. It preferentially affects multiparous women in their reproductive or perimenopausal years, ranging from 14% to 66% in hysterectomy specimens (Vercellini, 2006).
However the precise etiology and pathophysiology of adenomyosis is still unclear. Several studies have been taken to form explanations.
Invasive tissue growth; the most widely held opinion is that adenomyosis develops as a result of down-grow than invagination of the basalis endometrium into the myometrium(Benacerraf, 2014).
Developmental origins; denovo synthesis of adenomyotic foci from embryologically misplaced mullerian remnant. This explains the presence of adenomyosis in extrauterine regions such as rectovaginal septum (Cockerham, 2012).
Uterine inflammation related to childbirth; another theory suggests a link between adenomyosis and childbirth. An inflammation of the uterine lining during the postpartum period might cause a break in the normal boundary of cells that line the uterus. Surgical procedures on the uterus may have a similar effect (Benagiano, 2014).
Stem cell origins; as regards the role of adult stem cells in pathogenesis of adenomyosis. It has been postulated that chronic peristaltic myometrial contractions involved in sperm transport cause microtrauma to the endometrial myometrial junction, setting up a cycle of tissue injury and repair adult stem cells are frequently activated in tissue injury and it is possible that these have a role in establishing the ectopic lesions, and their abnormal differentiation ((Stewart, 2015, Benagiano, 2012).
It was recently shown that stromal cells cultured from adenomyotic tissue undergo multiline age mesodermal differentiation and expressl mesodermal stem cells (MSC) surface phenotypic markers (Chen and Li, 2010).
Adenomyotic tissues have been investigated for the characters of stem cells as self-renewal, colono-genicity and differentiation (Hung et al., 2015). In this study Side-population (SP) cells, referred to a stem-like cells subpopulation; have been identified from adenomyotic tissue and it was proven that these SP cells display stem cell-like properties and may be involved in the pathogenesis of adenomyosis (Hung et al., 2015).
The clinical presentation of women with adenomyosis are variable and non-specific as it can also be observed with disorders such as dysfunctional uterine bleeding, leiomyomas and endometriosis (Wallwiener et al., 2013), this explain that the preoperative diagnosis rates of adenomyosis based on clinical findings are poor, ranging from 3 to 26 % (Weaver, Coddington,2012).
Symptoms of adenomyosis typically include menorrhagia, chronic pelvic pain, dysmenorrhea, spotting between periods and dyspareunia (Taran, Kabashi, 2012).
Diagnosis of adenomyosis is very difficult as adenomyosis is an extremely common condition, but it is not always readily identified by many doctors, the only way to definitively diagnose adenomyosis is by having a pathologist examine the uterus after a hysterectomy has been completed (Inacker et al, 2015). Imaging studies can be used to suggest adenomyosis but are not completely accurate. Detecting adenomyosis can only be done with an MRI, and it is confirmed after surgery through pathology. The initial imaging of the uterus is often conducted by an ultrasound, commonly used to detect fibroids but is less sensitive than an MRI (Bilgicyildirim, 2015).
Treatment for adenomyosis depends in part on the severity of the symptoms and condition, and also whether the patient has completed childbearing. For all types of chronic pelvic pain, non-surgical therapy can assist greatly and even have good cure rate although not as high as hysterectomy (Kuan-Hao Tsuil, 2014).
Hormonal therapy commonly used for those women who have no history of blood clots or stroke and who can tolerate hormones safely, and who wish to potentially conceive. Two forms of hormonal therapy can be used; local method in the form of hormone treated intrauterine device (IUD) and oral hormonal therapy.
However the precise etiology and pathophysiology of adenomyosis is still unclear. Several studies have been taken to form explanations.
Invasive tissue growth; the most widely held opinion is that adenomyosis develops as a result of down-grow than invagination of the basalis endometrium into the myometrium(Benacerraf, 2014).
Developmental origins; denovo synthesis of adenomyotic foci from embryologically misplaced mullerian remnant. This explains the presence of adenomyosis in extrauterine regions such as rectovaginal septum (Cockerham, 2012).
Uterine inflammation related to childbirth; another theory suggests a link between adenomyosis and childbirth. An inflammation of the uterine lining during the postpartum period might cause a break in the normal boundary of cells that line the uterus. Surgical procedures on the uterus may have a similar effect (Benagiano, 2014).
Stem cell origins; as regards the role of adult stem cells in pathogenesis of adenomyosis. It has been postulated that chronic peristaltic myometrial contractions involved in sperm transport cause microtrauma to the endometrial myometrial junction, setting up a cycle of tissue injury and repair adult stem cells are frequently activated in tissue injury and it is possible that these have a role in establishing the ectopic lesions, and their abnormal differentiation ((Stewart, 2015, Benagiano, 2012).
It was recently shown that stromal cells cultured from adenomyotic tissue undergo multiline age mesodermal differentiation and expressl mesodermal stem cells (MSC) surface phenotypic markers (Chen and Li, 2010).
Adenomyotic tissues have been investigated for the characters of stem cells as self-renewal, colono-genicity and differentiation (Hung et al., 2015). In this study Side-population (SP) cells, referred to a stem-like cells subpopulation; have been identified from adenomyotic tissue and it was proven that these SP cells display stem cell-like properties and may be involved in the pathogenesis of adenomyosis (Hung et al., 2015).
The clinical presentation of women with adenomyosis are variable and non-specific as it can also be observed with disorders such as dysfunctional uterine bleeding, leiomyomas and endometriosis (Wallwiener et al., 2013), this explain that the preoperative diagnosis rates of adenomyosis based on clinical findings are poor, ranging from 3 to 26 % (Weaver, Coddington,2012).
Symptoms of adenomyosis typically include menorrhagia, chronic pelvic pain, dysmenorrhea, spotting between periods and dyspareunia (Taran, Kabashi, 2012).
Diagnosis of adenomyosis is very difficult as adenomyosis is an extremely common condition, but it is not always readily identified by many doctors, the only way to definitively diagnose adenomyosis is by having a pathologist examine the uterus after a hysterectomy has been completed (Inacker et al, 2015). Imaging studies can be used to suggest adenomyosis but are not completely accurate. Detecting adenomyosis can only be done with an MRI, and it is confirmed after surgery through pathology. The initial imaging of the uterus is often conducted by an ultrasound, commonly used to detect fibroids but is less sensitive than an MRI (Bilgicyildirim, 2015).
Treatment for adenomyosis depends in part on the severity of the symptoms and condition, and also whether the patient has completed childbearing. For all types of chronic pelvic pain, non-surgical therapy can assist greatly and even have good cure rate although not as high as hysterectomy (Kuan-Hao Tsuil, 2014).
Hormonal therapy commonly used for those women who have no history of blood clots or stroke and who can tolerate hormones safely, and who wish to potentially conceive. Two forms of hormonal therapy can be used; local method in the form of hormone treated intrauterine device (IUD) and oral hormonal therapy.
Other data
| Title | Estrogen and progesterone receptors in Adenomyotic and eutopic endometrial tissue | Other Titles | مســتقبلات الاســتروجين والبروجســتيرون في بطانـة الرحـم والعضـال الغـدي | Authors | Fatma Mohamed Ahmed Abdallah | Issue Date | 2017 |
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