Ultramicro trauma in the endometrial myometrial junctional zone and pale cell migration in adenomyosis

Capsule:
Adenomyosis uteri showed a unique nonhematopoietic cell population migrating from the basal endometrial glands into the stroma, and microtraumata at the junctional zone.

Authors:
Mohamed G. Ibrahim, M.Sc., Vito Chiantera, M.D., Sergio Frangini, M.D., Shadi Younes, M.Sc., Christhardt Köhler, Ph.D., Eliane T. Taube, M.D., Johanna Plendl, Ph.D., Sylvia Mechsner, Ph.D., M.D.

Volume 104, Issue 6, Pages 1475-1483

Abstract:

Objective:
To determine if ultrastructural tissue trauma occurs in the junctional zone in uteri in adenomyosis.

Design:
A case-control experimental study.

Setting:
Endometriosis research center.

Patient(s):
Twelve uteri with adenomyosis, and 9 uteri without adenomyosis, were gained during laparoscopy-assisted vaginal hysterectomy.

Intervention(s):
Transmission electron microscopic study of the junctional zone, as well as immunohistochemical staining for epithelial cadherin, and van Gieson staining and immunofluorescence for CD45 and CD68.

Main Outcome Measure(s):
Analysis of the electron microscopy photos and the immunoreactive scores of the staining.

Result(s):
The inner myometrial muscle fibers were diversely arranged in adenomyosis; they were parallel to the basal endometrial glands in nonadenomyosis. Nuclear membrane infolding of the basal glandular epithelium and the disruption of the interface between basal endometrium and inner myometrium in adenomyosis (but not in nonadenomyosis) were evident. Intraepithelial pale cells were seen in the basal endometrial glands in both groups, but they lacked CD45 and CD68 expression. They were seen actively migrating into the stroma in adenomyosis only.

Conclusion(s):
The myofiber disarray in the inner myometrium, and the nuclear membrane irregularities in adenomyosis, are evidence for ultramicro-trauma in adenomyosis. The migrating nonleukocytic pale cells may be involved in pathogenesis of adenomyosis.

  • I read this study with great interest, since it is the first study on the topic of adenomyosis in a while with potentially fundamentally novel findings. One problem with research on adenomyosis is that neither the imaging diagnosis nor the histopathological diagnosis are 100% standardized. For this study, can the authors comment on how “histopathologically proven adenomyosis” was defined?

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