Is pale the way to go to understand adenomyosis

Thomas T. Tapmeier, Christian M. Becker, M.D.

Volume 104, Issue 6, Page 1378


Adenomyosis (AM) remains one of the unsolved conundrums of gynecology. After decades of debate and numerous studies it is now well accepted that adenomyosis does not represent a sub-entity of endometriosis, although some symptoms appear to overlap. One of the few established facts about AM is the descriptive diagnosis of endometrial glandular epithelial and stromal cells surrounded by hypertrophy and hyperplasia in the myometrial compartment of the uterus (1). Unfortunately, even the most fundamental clinical details including reliable data about the true prevalence, possible familial accumulations or risk factors are sparse and are either based on retrospective studies using hysterectomy specimen or, more recently, on ultrasound or magnetic resonance imaging (MRI) reports without internationally agreed diagnostic standards (2).

  • Having followed research on the topic of adenomyosis with great interest over the last few years, especially as it relates to reproduction, I agree that this study could be a potential breakthrough in the understanding of this enigmatic disease. However one problem that remains unsolved is that neither the criteria for imaging diagnosis nor for histopathologic diagnosis of adenomyosis are completely standardized. The findings regarding the pale cells have the potential to improve histopathologic diagnosis, and our understanding regarding the pathophysiology. But for the purposes of research on the role of adenomyosis and reproduction, maybe the real breakthrough will be improvements in non-invasive diagnosis?

  • Martin Quinn

    Adenomyosis (AM) in China varies considerably from its presentation in UK and other Western countries. In Chinese AM it presents with painless, mass effects at 500-1000g; there are no nerves at the endometrial-myometrial (em) interface. Western AM presents at 150-250g with pain; there are aberrant nerves at the em interface.

    In China there is often bilateral avulsions of the uterosacral ligaments associated with previous “late” or recurrent, surgical abortions. In the West they may be intact though attenuated; the woman may have had a “difficult” first labour.

    Injuries to the nerves at the em interface may be important in the pathogenesis of the condition.

    Visiting Professor,
    University of Wenzhou

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