PATHOMORPHOLOGICAL AND CLINICAL CHARACTERISTICS OF THE UTERUS IN COMBINED ADENOMYOSIS AND MYOMA.

Abstract

The aim of the study: to examine the pathomorphological and clinical characteristics of the uterus in the combined form of fibroids and adenomyosis.

Methods: The research work was conducted within the framework of the scientific program of the Department of Obstetrics and Gynecology II at Azerbaijan Medical University for the years 2021-2024. In the course of this study, a comprehensive clinical, laboratory, and instrumental prospective examination was conducted on 113 patients aged 30 to 50 years (mean age 42,0±1,8 years) with combined adenomyosis and uterine fibroids. These patients formed the main study group. The patients in the main group were divided into two subgroups depending on the form of adenomyosis: Group 1 - diffuse form (60 women) and Group 2 - nodular form (53 women). The control group consisted of 24 relatively healthy women of reproductive age, with regular ovulatory menstrual cycles and no history of gynecological diseases. All patients had 2D (two-dimensional) transvaginal ultrasound examination. Based on indications, 3D transvaginal ultrasound of the pelvic organs was performed. Statistical processing of the results was carried out using commonly used methods of parametric and non-parametric statistics on a personal computer with the standard software package for applied statistical analysis (Statistica for Windows v.6.0). The critical level of significance for the null statistical hypothesis was set at 0.05.

Results: The ultrasound data in the patients showed that the most common combination was diffuse adenomyosis with uterine fibroids - in 60 (56.60±4.8%, p<0.01) patients, compared to the nodular form of adenomyosis with uterine fibroids - in 53 (44.93±4.6%) patients. The study of the localization of fibroid nodes in combination with different forms of adenomyosis revealed that the most common combination was diffuse adenomyosis with intramural fibroid nodes (4-type according to FIGO) - in 64 (60.4%) patients. The next most common combination was diffuse adenomyosis with intramural- subserosal (5-type according to FIGO) fibroid nodes - in 18 (16.9%) patients. In cases of nodular forms of adenomyosis, the combination with intramural fibroid nodes (i.e., 4-type according to FIGO) was most common - in 8 (7.5%) and 5 (4.7%) patients, respectively. In rare cases, 0-type (submucosal fibroid on a stalk) was found - in 1 (0.9%) patient, and 2-type (intramural fibroid protruding into the uterine cavity less than 50%) - in 2 (1.9%) patients. The number of nodes (multiple/single nodes) in combination with different forms of adenomyosis was also studied. We found a predominance of the combination of multiple fibroid nodes with adenomyosis - in 58 (54.7%) patients, and a single node with adenomyosis - in 48 (45.3%) patients.

Conclusion: Ultrasound examination performed on expert-class equipment not only allows for the correct diagnosis but also helps identify the type of fibroid (simple or actively proliferating) and assess the degree of adenomyosis in the uterine wall. Pathomorphological studies are crucial for confirming and accurately diagnosing combined forms of fibroids and adenomyosis, determining the proliferative activity of fibroid nodules, and, when adenomyosis is combined with endometrial hyperplasia, assessing the risk of malignant transformation of the endometrium.