Adenomyosis. Facts and treatments

Foreword I
Foreword II
Contents
List of Contributors
About the Editors
1: The Incidence and Clinical Impact of Adenomyosis
	1.1	 The Clinical Impact of Adenomyosis
	References
2: The Pathogenesis of Adenomyosis
	2.1 Endometrial Invasion (Into the Myometrium) Theory
		2.1.1	 Endometrial Basal Layer Injury
		2.1.2	 Enhancement of Endometrial Invasion and Adhesion Ability Theory
		2.1.3	 Abnormal JZ Between Endometrium and Myometrium
		2.1.4	 The Proliferation of Ectopic Endometrial Cells and Unbalanced Apoptosis: [16]
	2.2 Epithelial to Mesenchymal Cells Transformation
	2.3 Differentiation of Embryonic Multipotent Müllerian Duct Remnant
	2.4 Endometrial Stem Cell Theory
	2.5 Abnormal Uterine Nerve
	2.6 The Theory of Increased Angiogenesis
	2.7 High Estrogen and High Prolactin Theory
	2.8 Immune Factors
	2.9 Genes and Genetic Factors
	2.10 Inflammation or Infection Factors
	2.11 Others
	References
3: The Pathology of Adenomyosis
	3.1	 Macroscopic Appearance of Adenomyosis
	3.2	 Microscopic Appearance of Adenomyosis
	3.3	 Malignant Transformation of Adenomyosis
	3.4	 Pathological Changes After Focused Ultrasound Treatment
	References
4: The Clinical Features and Diagnosis of Adenomyosis
	4.1 Pathology Diagnosis
	4.2 The Clinical Diagnosis
	4.3 History
		4.3.1	 Age
		4.3.2	 Multiparity
		4.3.3	 History of Uterine Surgery
		4.3.4	 Smoking
	4.4 Symptoms
		4.4.1	 Pain
		4.4.2	 Abnormal Uterine Bleeding
		4.4.3	 Infertility
		4.4.4	 Imaging
		4.4.5	 Laboratory Test
		4.4.6	 Hysteroscopy
	4.5 Conclusion
	References
5: Adenomyosis and Pain
	5.1 Clinical Characteristics
	5.2 Pain Mechanisms of Adenomyosis
		5.2.1	 Related to Endometriosis
		5.2.2	 Related to Anatomical Factors
	5.3 Related to Molecular Mechanisms
		5.3.1	 Prostaglandins and Cyclooxygenase 2
		5.3.2	 Abnormality of Uterine Contraction and Oxytocin/Vasopressin Receptors
		5.3.3	 Other Inflammatory Factors
		5.3.4	 Nerve Fibers
		5.3.5	 Neurogenic Factors
	References
6: Adenomyosis and Abnormal Uterine Bleeding
	6.1 Clinical Manifestation
	6.2 Recent Progress
	6.3 Treatment Options for AUB Due to Adenomyosis
		6.3.1	 Removal of the Endometrium
		6.3.2	 Uterine Artery Embolization (UAE)
		6.3.3	 MRg/USg High-Intensity Focused Ultrasound (HIFU) Ablation
		6.3.4	 New Medical Treatment
	References
7: Adenomyosis and Infertility
	7.1 Factors Influencing Fertility in Adenomyosis
	7.2 Pregnancy Outcomes in Adenomyosis
	7.3 Adenomyosis with Endometriosis
	References
8: Ultrasound Manifestation and Classification of Adenomyosis
	8.1 Ultrasound Technology
		8.1.1	 Transabdominal Ultrasound
		8.1.2	 Transvaginal Ultrasound
		8.1.3	 Transrectal Ultrasound
	8.2 Comparison of Transvaginal Ultrasound and Magnetic Resonance Imaging
	8.3 Ultrasound Findings Reflect Histopathological Features
	8.4 Ultrasound Features of Adenomyosis
		8.4.1	 The Uterus Is Enlarged, with the Asymmetry of the Anterior and Posterior Walls of the Uterus
		8.4.2	 Heterogeneity of the Myometrium
		8.4.3	 Small Cysts or Microcysts in the Affected Myometrium
		8.4.4	 Fan-Shaped Sound Shadow in the Uterus
		8.4.5	 Linear, bud, or Island-like Hyperechoic Nodules under the Endometrium
		8.4.6	 The Endometrial-Myometrial Junctional Zone (JZ) Is Thickened, Irregular, Interrupted or Difficult to Distinguish
		8.4.7	 Increased Blood Flow Signal in the Lesion, with Penetrating Vascular Feature
		8.4.8	 Ultrasound Scanning Skill for Adenomyosis
		8.4.9	 Ultrasound Uterine Sliding Sign
		8.4.10	 Ultrasound Classification of Adenomyosis
		8.4.11	 Diffuse Adenomyosis
		8.4.12	 Focal Adenomyosis
		8.4.13	 Differential Diagnosis of Adenomyosis
			8.4.13.1	 Uterine Fibroids
			8.4.13.2	 Myometrial Contraction
			8.4.13.3	 Myometrial Infiltration of Endometrial Cancer
	8.5 Application of New Ultrasound Technology in the Diagnosis and Treatment of Adenomyosis
		8.5.1	 Application of 3D Ultrasound
		8.5.2	 Application of Elastography
	References
9: Magnetic Resonance Imaging Manifestations and Classification of Adenomyosis
	9.1 The Basic MRI Manifestations and Classification of Adenomyosis
	9.2 MRI Appearances of Different Subtypes of Adenomyosis
		9.2.1	 Internal Adenomyosis
		9.2.2	 External Adenomyosis
		9.2.3	 Adenomyoma
	9.3 The Progressive Development of MRI Technology that Might Be Related to Study Adenomyosis
		9.3.1	 Cinema Magnetic Resonance Imaging (Cine-MRI)
		9.3.2	 Diffusion-Weighted Imaging (DWI)
		9.3.3	 T2 Mapping
		9.3.4	 MRI Diffusion Tensor Imaging (DTI)
	References
10: The Medical Treatment of Adenomyosis
	10.1 Types and Options of Drug Therapy
		10.1.1	 Combined Oral Contraceptive (COC)
		10.1.2	 Progestins and Anti-Progestins
			10.1.2.1	 Levonorgestrel Intrauterine System (LNG-IUS)
		10.1.3	 Dienogest
		10.1.4	 Mifepristone
	10.2 Anti-Estrogen Drug
		10.2.1	 GnRH-a
		10.2.2	 Aromatase Inhibitor
	10.3 Androgenic Derivatives
	10.4 Anti-Prostaglandin Drugs
	10.5 Hemostatic Drugs and Iron Supplements
	10.6 Chinese Medicine and Herbs
	10.7 Combination of Treatments
		10.7.1	 The Combined Use of Drugs
		10.7.2	 The Combined Use of Drugs and Surgery
		10.7.3	 High-Intensity Focused Ultrasound (HIFU) and Drug Combination
	References
11: The Surgical Treatment of Adenomyosis
	11.1 Indications of Surgery
	11.2 Preoperative Assessment
		11.2.1	 Age
		11.2.2	 Infertility
		11.2.3	 Laboratory Examinations
		11.2.4	 Preoperative Imaging
		11.2.5	 Preoperative Pelvic Ultrasound Evaluation
	11.3 Preoperative MRI Evaluation
	11.4 Surgical Treatment
		11.4.1	 Total Hysterectomy
	11.5 Conservative Surgery
		11.5.1	 Types of Conservative Surgeries for Adenomyosis
		11.5.2	 Adenomyomectomy
		11.5.3	 Cytoreductive Surgery for Diffuse Adenomyosis
		11.5.4	 Symptom Relief After Conservative Surgery
		11.5.5	 Recurrence of Symptoms After Conservative Surgery
		11.5.6	 Uterine Rupture After Conservative Surgery
	11.6 Conservative Surgery Improves Adenomyosis-Related Infertility
	11.7 Conclusion
	References
12: Uterine Artery Embolization Treatment for Adenomyosis
	12.1	 The Principle of UAE Treatment of Adenomyosis
	12.2	 Indications and Contraindications of UAE
		12.2.1	 Indications of UAE
		12.2.2	 The Contraindications for UAE [2]
	12.3	 Preoperative Assessment and Examination
	12.4	 Operation Procedure of UAE
	12.5	 Postoperative Treatment of UAE
	12.6	 Complications of UAE
	12.7	 Follow-Up Time and Efficacy Evaluation after UAE Treatment
	12.8	 Other Issues
	References
13: Principles and Protocols of HIFU Ablation for Adenomyosis
	13.1 The Principles of HIFU Treatment
		13.1.1	 Indications
		13.1.2	 HIFU Ablation Procedure
		13.1.3	 Matters That Need Attention During HIFU Ablation
		13.1.4	 Importance to Communication with Patients
		13.1.5	 Clinical Effect
	13.2 HIFU Treatment Protocol for Adenomyosis
	References
14: HIFU Ablation
	14.1	 USgHIFU Treatment Procedure
		14.1.1	 Preoperative Preparation
		14.1.2	 Treatment
			14.1.2.1	 Administration of Sedation and Analgesia
	14.2	 Therapeutic Equipment
	References
15: The Therapeutic Effect of HIFU on Adenomyosis
	15.1	 Short-term Efficacy of HIFU in the Treatment of Adenomyosis
	15.2	 Medium to Long-Term Efficacy of HIFU Treatment for Adenomyosis
	15.3	 The Complications of HIFU Treatment
	References
16: Adjuvant Therapy of HIFU Ablation for Adenomyosis
	16.1	 Mifepristone
	16.2	 Gonadotropin-releasing Hormone Agonist (GnRH-a)
	16.3	 Levonorgestrel-Releasing Intrauterine System (LNG-IUS)
	16.4	 Other Single Adjuvant Therapy with HIFU
	16.5	 Combined Adjuvant Therapies with HIFU
	References
17: The Pregnancy Outcomes After Uterine Preservation Surgery and HIFU Treatment for Adenomyosis
	17.1	 Uterine Preservation Surgery
	17.2	 Pregnancy Outcomes After Surgical Treatment of Adenomyosis
	17.3	 Pregnancy Outcome After Surgery for Focal Adenomyoma Is Superior to Diffuse Adenomyosis
	17.4	 Surgery or Combined Drug Treatment Can Improve the Pregnancy Rate of Patients
	17.5	 Limitations of Conservative Surgery to Preserve Fertility
	17.6	 HIFU Treatment of Adenomyosis
	17.7	 The Impact of HIFU on the Reproductive Functions
	17.8	 Pregnancy Outcomes After HIFU Treatment in Patients with Adenomyosis
	17.9	 Comparison of Pregnancy Outcomes of HIFU and the Conservative Surgery for Adenomyosis
	References
18: Conclusion