Endometriosis and Adenomyosis

Posted by e-Medical PPT Wednesday, August 10, 2011
Endometriosis
Abnormal growth of endometrial tissue outside the uterine cavity.

Pathogenesis:
Implantation  Theory -Retrograde Menustration Theory 
Lymphatic and Vascular Dissemination Theory 
Coelomic  Theory
Genetic Theory
Immune System Dysfunction(immunologic theory)

Genetic factors:
Familial clustering of endometriosis is a common clinical observation.
In families with endometriosis,the disease is often confined to the maternal line,and is 7 times more common in first-degree relatives than in the general population.
In future studies,evaluation of DNA polymorphism may identify specific genes involved in the development of endometriosis.

Clinical Manifestation
Pain
   progressive dysmenorrhea
   dyspareunia
   painful defecation
Menstrual disturbance
infertility....

Adenomyosis
A benign uterine condition in which endometrial glands and stroma are found deep in the myometrium
Basal endometrial hyperplasia invading a hyperplastic myometrial stroma.
Four primary theories:
Heredity
Trauma
Hyperestrogenemia
Viral transmission

Pathology— gross appearance:
Usually hyperemic with thickened walls
The foci are frequently scattered diffusely throughout the myometrium.
Occasionally,may be more circumscribed,with the formation of a distinct nodule,an adenomyoma.

Clinical features
Symptomatic adenomyosis occurs primarily in parous women over the age of 40 .
Classic symptoms:
     secondary dysmenorrhea
     abnormal uterine bleeding
Most common physical sign: 
          a diffusely enlarged uterus ,
       (rarely exceeds 12 weeks’ gestation in size)
   particularly tender during menstruation

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