Atypical changes in endometrial tissue that occur against the background of a hyperplastic process lead to uterine cancer in 40% of cases. Endometrial adenomatosis is an obligate precancer that requires urgent treatment: timely surgery will help prevent a fatal disease.

At the first stage of pathology, hyperplasia occurs - thickening of the uterine mucosa

Hyperplastic processes of the endometrium

A malignant tumor of the uterine body never occurs unexpectedly - in most cases, in the first stages of the disease, hyperplastic changes and endometrial adenomatosis occur, which include:

1. Typical endometrial hyperplasia (simple and complex);
2. Atypical hyperplastic process (simple and complex adenomatosis, adenomatous polyp).

The main differences between typical and atypical hyperplasia are the following changes in the tissue:

• structural (disturbances in the structure and relationship of glandular cells);
• cellular (internal pathological changes in the membrane and contents of endometrial cells);
• nuclear (increase in the number of cell nuclei, change in shape and size).

The more diverse and complex the disorders, the higher the risk of developing a malignant tumor. Any typical hyperplasia is a background change that can become the basis for precancer. Endometrial adenomatosis is an extremely high risk of oncopathology (in some cases it is impossible to reliably exclude cancer against the background of pronounced atypical changes).

Endometrial adenomatosis - pathogenetic variants

Depending on the cause, there are 2 types of precancerous lesions in endometrial tissue:

1. Exchange-endocrine pathogenetic variant (60-70% of all cases);
2. Atrophic type of precancerous changes (30-40%).

In the first case, the basis of pretumor pathology are the following factors:

• an increase in the concentration of estrogen in a woman’s blood (hyperestrogenism), caused by severe hormonal imbalances;
• disorders of fat metabolism (excess weight, metabolic syndrome);
• problems with carbohydrate metabolism (impaired glucose tolerance, diabetes mellitus).

In the second case, the provoking factors for the development of the disease are:

• inflammatory processes in the reproductive organs (endometritis, cervicitis, adnexitis);
• consequences of mechanical trauma (abortion, diagnostic curettage, long-term wearing of an intrauterine device).

Endometrial adenomatosis is one of the steps leading to uterine cancer. The processes of tumor growth are slow, but inexorable: having discovered a precancerous process, it is necessary to carry out all the necessary examinations as soon as possible and begin full-fledged treatment of the pathology.

The basis of the tumor in the uterus is adenomatosis in the endometrium

Symptoms of pathology

One of the first signs of a hyperplastic process may be. A woman should always monitor the rhythm and abundance of her periods, noting the beginning and end of her period every month. You should consult a doctor if the following symptoms appear:

• rhythmic but heavy menstruation;
• acyclic uterine bleeding;
• prolonged scanty bleeding on the days of expected menstruation;
• change in rhythm (frequent periods, delays in the arrival of menstrual periods);
• lack of desired pregnancy.

It is advisable not to delay your visit to the doctor, especially if your cycle is shortened (menstruation twice a month) or your period comes with heavy blood loss.

Basic diagnostic methods

After a standard gynecological examination, the following doctor’s prescriptions must be completed:

• Transvaginal;
• Aspiration biopsy with cytological examination;
• with taking a biopsy.

With a transvaginal ultrasound, the doctor will see hyperplasia or polyp

If an endometrial polyp is identified, removal of the intrauterine formation will be required using hysteroresectoscopy. Treatment tactics completely depend on the histological conclusion, on the basis of which the doctor will choose an effective method of therapy.

Treatment tactics

Identified endometrial adenomatosis requires active treatment measures - it is unacceptable to delay therapy or use ineffective and pointless folk remedies. The age of the patient is of great importance - in young women, preference is given to organ-preserving techniques; in older women, the uterus must be removed. The main surgical treatment methods include:

• total curettage of the uterine cavity;
• endometrial ablation (radio wave, laser);
• simple hysterectomy.

Hormone therapy is effective only in the metabolic-endocrine variant of the hyperplastic process, when the hormonal sensitivity of endometrial tissue is confirmed. If an atrophic type of precancer is detected, surgery should be performed without trying to use drug treatment.

Polyps in the uterus come in different types; they are a localized manifestation of hyperplasia of the endometrial mucosa. Adenomatous polyp differs little from other types, given the clinical and macroscopic symptoms. But there is also something that sets it apart from other species. Adenomatous endometrial hyperplasia is a dangerous neoplasm that tends to degenerate and become malignant.

Uterine adenomatosis: what is it?

It is not so often that women who undergo a control gynecological ultrasound find out that they have endometrial adenomatosis. Therefore, you need to know what it is, what the signs of the disease are and how to treat it.

Adenomatous endometrial polyp is a benign neoplasm. Pathology appears in the form of cells that grow inside the uterine cavity. Namely, with the threat that a benign formation can easily degenerate into a malignant one, treatment cannot be delayed.

Adenomatosis of the uterus, as a rule, is one overgrown neoplasm or numerous growths. It is then that the polyposis enters the anedomatous stage. No matter how many formations there are in the cavity, the threat they pose is equally unfavorable.

Quite often, women between the ages of 30 and 50 face such a delicate problem; there are more risks starting from the age of 50. But there are cases when adenomatous polyp is diagnosed in young girls.

The shape of such a polyp looks like a mushroom; it has legs and a body. The dimensions are not particularly large from 5 to 10 mm, but sometimes it can block the exit to the cervical canal when the size is up to 30 mm. Adenomatous polyps are usually localized in the corners or at the bottom of the uterus, closest to the mouth of the fallopian tubes.

In gynecological practice, ademonatous polyps are found not only on a thin stalk, but also on a large base. As a rule, those formations that are located on a thick base become cancerous.

The risks of degeneration into a malignant tumor directly depend on the size of the polyp. In about 2% of cases, this happens when the tumor is 1.5 cm. And also in 2-10%, when the size is up to 2.5 cm. If the size is more than 5 cm, then the risks are already more than 10% .

It is also believed that children whose parents suffered from adenomatous polyp are 50% predisposed to the pathology.

Adenomatous polyp: causes and symptoms

There are many reasons for the formation of these types of polyps. The most common reason is a disregard for one’s body and reproductive organs, including.

Possible reasons:

• hormonal imbalance;
• problems in the functioning of the endocrine system;
• as a consequence after surgery - abortion, cleansing;
• spontaneous miscarriage in early pregnancy;
• regular, not fully treated inflammatory diseases in the reproductive organs;
• venereal diseases – recurrent;
• regular depression, stress and psycho-emotional changes;
• failure of the immune system;
• intrauterine device and its long-term wearing;
• diseases of a protracted nature in the absence of appropriate treatment;
• genetics, heredity.

With adenomatosis, heredity is not an unimportant thing. In fact, in 50% of patients the diagnosis is confirmed by the fact that it was inherited from relatives or parents.

Therefore, if there is a predisposition to the formation of polyps in the family, the younger generation should monitor their health. Polyps can be not only in the uterus, but anywhere.

When the growth becomes large, symptoms immediately appear that should not be ignored.

Symptoms in the presence of uterine adenomatosis:

• profuse vaginal bleeding that is not associated with menstruation;
• pain in the lower abdomen, impulsive type, painful sensations may intensify after intimacy;
• systematic bleeding after sexual intercourse;
• excessively heavy menstruation, especially at a young age (dangerous uterine bleeding);
• problems with conception.

Also, a large polyp limits space in the uterus, which reduces the chances of carrying the fetus to term.

How to diagnose adenomatous polyp?

It is necessary to visit a doctor who will prescribe a series of laboratory and medical examinations in order for the clinical picture to become clear.

To begin with, standard research:

• biochemistry and general blood test;
• study of hormones contained in the blood;
• routine gynecological examination and smear collection;
• ultrasound examination.

Only after all the tests, taking into account the results, complaints and clinic, the correct diagnosis is made.

When combined with other diseases of the uterus or genital organs, a biopsy may be prescribed.

Also today there is a quick way to recognize the problem - this is hysteroscopy. A special contrast enzyme is injected into the uterus. Then he installs a hysteroscope through the cervix, through which you can clearly see all the changes, as well as their size.

Adenomatous polyp: how is treatment done?

Polyps in the uterus of this type are treated through surgery. Because uterine adenomatosis is a precancerous condition. Either surgery or cleaning (curettage) is performed using a hysteroscope.

After the growth is removed, its location is cauterized with current or liquid nitrogen; such manipulations are necessary to prevent relapse of the disease.

If an adenomatous type polyp occurs in a woman who is postmenopausal or premenopausal, the doctor may decide to remove the uterus completely. In cases where disruptions in the endocrine system are detected and cancer is possible, the uterus and appendages are removed.

After surgical treatment, hormone replacement therapy is prescribed. It is advisable to follow a diet, eat right and lead a healthy lifestyle, and abstain from sexual intercourse.

In some cases, to avoid complications after surgery, a course of treatment with antibacterial drugs may be prescribed.

Endometrial adenomatosis is called atypical (focal or diffuse) endometrial hyperplasia; in fact, it is a precancerous condition. A precancerous process is a certain pathology that, with varying degrees of probability, can turn into cancer. Precancerous hyperplastic process has the possibility of reverse development, only 10% actually turns into oncology. Uterine adenomatosis should be taken very seriously by doctors.

Description of the disease

Hormonal dysfunction is directly related to hyperplastic processes in the endometrium. In this case, uterine bleeding and infertility often occur. They appear for the reason that hyperestrogenism occurs. An excessive amount of estrogen in the endometrium leads to quantitative and qualitative structural changes, which provokes growth and thickening of its internal structures. This is how cervical adenomatosis occurs.

Hyperplastic processes are of several types, depending on the type of cells that implement these processes in the body: - glandular hyperplasia; - diffuse hyperplasia; - focal hyperplasia. Let's look at each of them in more detail.

Glandular hyperplasia

When the glandular structures increase, glandular hyperplasia of the endometrium develops. Sometimes this leads to cystic-enlarged formations in the lumens of the glands, then glandular-cystic hyperplasia is diagnosed. Atypical cells appear and grow in the endometrium, which is characteristic of adenomatosis. It is important to understand that when brain function is impaired, especially if the hypothalamus is affected, as well as weakened immunity and metabolic syndrome, cancer occurs in the case of glandular hyperplasia. And regardless of age.

Diffuse hyperplasia

In some cases, the spread of hyperplastic processes occurs over the entire surface of the endometrium, then specialists identify diffuse hyperplasia. That is, a diffuse hyperplastic process leads to diffuse adenomatosis.

Focal hyperplasia

In addition, there is a focal form of hyperplasia. The proliferation of endometrioid tissue occurs in a limited area. Then this growth disappears into the uterine cavity, becoming similar to a polyp. Focal adenomatosis is a polyp that contains atypical cells. Uterine adenomatosis is treated mainly surgically. The further prognosis is determined by several factors: - the patient’s age; - the nature of hormonal disorders; - concomitant neuroendocrine diseases; - state of immunity. Some women are interested in the question of what is the difference between uterine adenomatosis and endometrial adenomatosis? After all, this is the same atypical process. The term "adenomatosis of the uterus" is not entirely correct, since atypia affects only the inner layer, which is the endometrium. And in the uterus itself there are several layers.

Fibrosis and adenomatosis

Fibrous adenomatosis does not exist as a diagnosis. Fibrosis is a pathology in which connective tissue grows, adenomatosis - glandular tissue grows. The pathology can also have a mixed nature, which will be called fibrocystic hyperplasia.

Adenomatosis can occur not only in the uterus. It happens in the mammary glands, but in essence these pathological processes are completely different. Adenomatosis of the mammary glands is Reclus disease, when benign formation of small cysts occurs. We looked at cervical adenomatosis. What it is has become clearer.

What are the causes of endometrial adenomatosis?

The causes of atypical cellular transformation are the same factors that provoke hyperplastic processes in the endometrium. The exact causes of adenomatosis are not known. Of course, provoking factors are constantly being studied, but today it is not yet possible to say for sure that this is the trigger for the atypical process in the endometrium. But the more different unfavorable conditions there are, the greater the likelihood of developing pathology. The first place among all provoking factors of endometrial adenomatosis is occupied by hormonal imbalance. The neurohumoral regulation of the entire human body is disrupted. Estrogens and gestagens take part in physiological cyclic changes in the uterus. First of all, thanks to estrogen, the internal mucous layer increases. But the work of gestagens is to stop the growth of the endometrium in time and allow it to be rejected. With an excessive amount of estrogen, the growth of the endometrium occurs uncontrollably. Hyperestrogenism can occur for various reasons: - hormonal function of the ovaries is disrupted; - anovulation occurs; - the cycle becomes single-phase; - endometrial hyperplasia occurs.

With polycystic ovary syndrome, anovulation is chronic. This is also a kind of provoking factor in the development of hyperplasia. If a woman takes hormonal drugs uncontrollably, her hormonal levels may suffer from this. This will trigger the hyperplastic process in the endometrium. If there is simultaneously hyperestrogenism, extragenital pathology and neuroendocrine disorders in the body, the likelihood of developing adenomatosis increases. An obese woman with hypertension is 10 times more likely to develop endometrial cancer than one with normal weight and blood pressure.

For what other reasons can hyperestrogenism develop? Often diseases of the liver and biliary tract lead to this pathology, since it is the liver that utilizes estrogens. Consequently, uncontrolled growth of the inner layer of the uterus occurs, which leads to the formation of atypical cells. This is endometrial adenomatosis. When diagnosed with cervical adenomatosis, treatment? More on this later.

Signs of endometrial adenomatosis

As a rule, there are no obvious symptoms of adenomatosis, since atypical cells can only be detected in a laboratory way. First, the hyperplastic process is identified, after which it is necessary to clarify its nature.

There are some symptoms of hyperplasia that you definitely need to pay attention to: - the nature of bleeding has changed - menstruation becomes heavy, blood appears outside the cycle; - painful sensations in the lower abdomen and lower back before and during menstruation; - manifestation of metabolic syndrome - excess weight, excessive male-pattern hair growth, increased insulin levels in the blood; - fertility is impaired - it is impossible to conceive and bear a child; - presence of mastopathy; - inflammation of the genitourinary system; - pain during sexual intercourse, bleeding after it.

It turns out that there is adenomatosis of the uterus on ultrasound?

Using ultrasound scanning, the thickness and structure of the endometrium is determined. The transvaginal sensor copes well with this study. What kind of hyperplastic process is observed - focal or diffuse - will be shown by this scan. As a result, if diffuse hyperplasia is detected, then the presence of diffuse adenomatosis can be assumed. It is impossible to visualize it using a sensor, since there are no distinctive features. Focal adenomatosis of the uterus is easy to detect because it is visualized as a polyp. Although the nature of the cellular changes cannot be revealed. Atypia cannot be traced by ultrasound scanning. A scraping of the uterine mucosa is made, after which this material is sent for histological examination. This diagnostic method is very important for adenomatosis. The composition of the cell, its structural changes, as well as to what extent and severity it is atypical are studied. If atypia is not detected, then this indicates a benign course of hyperplasia. Often, surgical curettage of the uterine cavity is performed, and then the resulting material is examined. Hysteroscopy can help with this for visual control during total evacuation of the uterine mucosa.

Uterine adenomatosis: treatment

The presence of adenomatosis in a woman can cause infertility, but even with successful conception, premature termination of pregnancy can occur due to the disease. Treatment primarily consists of mechanically removing the altered endometrium. Thus, the source of pathological changes is surgically eliminated, in addition, a scraping is obtained for histological examination. When the results are obtained, the treatment plan is determined depending on this. Hormonal therapy and surgery are prescribed on an individual basis. If the girl is young, then specialists limit themselves to treatment with hormonal drugs. The patient, who is close to menopause, undergoes a radical surgical operation along with hormone therapy - removal of the uterus and appendages. This significantly reduces the likelihood of adenomatosis turning into cancer. You can save a woman's life. It is important to understand that early diagnosis of adenomatosis is most desirable, in this case the risk of cancer is minimal. Therefore, it is necessary to regularly visit a gynecologist, undergo a comprehensive examination, and take all necessary tests. We examined in this article adenomatosis of the endometrium of the uterus. Take care of your health!

Adenomatosis and adenomyosis, the names of these two diseases sound almost the same, but in reality they are two completely different pathologies. The only thing that unites them is the organ that they affect to one degree or another.

For example, adenomyosis is a form of endometriosis in which the endometrium grows into the submucosal and muscular layer of the uterus. Adenomatosis is a special condition of the uterus that precedes the development of a cancerous tumor. Both diseases require immediate treatment.

With adenomyosis, active growth of endometrial tissue occurs, but it is considered benign, although in this case the cells penetrate into the structures of other tissues. This process is accompanied by inflammation of the myometrium. Adenomyosis is also called internal uterine endometriosis.

And at the same time, doctors say that endometriosis and adenomyosis are not exactly the same thing. There are some differences between these two conditions that make it possible to distinguish adenomyosis as a separate pathology, and not just a special form of endometriosis.

The first difference is that, spreading to other organs and tissues, the endometrium continues to exist, obeying the same laws as the endometrium located in the uterus.

Source: vrachmatki.ru

The process of penetration of the endometrium into the myometrium is accompanied by severe inflammation, which can ultimately lead to the destruction of uterine tissue and transition to adenomatosis, which is the same precancerous condition.

Adenomyosis can take one of three forms: diffuse, nodular and mixed. For example, with the diffuse form, pockets of endometrial tissue are formed, which can penetrate into the myometrium to varying depths.

In advanced forms, fistulas leading into the pelvis are formed in place of such pockets. In the nodular form of adenomyosis, the growth of predominantly glandular epithelium occurs.

In this case, a large number of fluid-filled nodes form. In the first case, when pockets form, adenomyosis spreads throughout the uterus. In the nodular form, the foci of endometrial tissue have a clear demarcation. In this case, treating the pathology is much easier.

Adenomatosis

A completely different picture is observed with adenomatosis. In this case, there is an uncontrollable growth of cells that form the endometrium. With the same adenomyosis, endometrial cells have a high degree of predisposition to degeneration.

In this case, doctors have to deal with endometrial hyperplasia. With this pathology, glandular and diffuse forms are also distinguished. In the diffuse form, hyperplasia covers the entire mucous membrane of the uterus. In this case, the disease progresses much more slowly than with the glandular form and less often turns into cancer.

In the diffuse form, accelerated division of cells occurs, and at the same time their structure almost completely changes. With glandular hyperplasia, the uterus thickens and increases in size. A feature of this form of adenomatosis is the disappearance of a clear distinction between the layers, which is present in a healthy uterus.

Reasons

The reasons why the endometrium begins to grow into the adjacent layers of the uterus during adenomyosis are still unknown, although the study of this pathology has been going on for a long time. This pathology can be detected in women of different age categories. But more and more doctors are inclined to believe that the growth of the endometrium is due to changes in hormonal levels, while the patient almost always has a severely weakened immune system.

Less commonly mentioned among the causes of adenomyosis are hereditary predisposition, pathological changes in the menstrual cycle, excess weight and problems arising from difficult childbirth. In each specific case of disease, doctors will have to conduct a thorough examination to determine the causes of this pathology.

Adenomatosis primarily occurs when the hormonal balance changes towards an increase in estrogen. Under the influence of this hormone, the menstrual cycle fails, uterine bleeding appears, and infertility develops. With adenomatosis, doctors first of all look for atypical cells in order to thus assess the ability of tissues to degenerate.

Symptoms

With adenomyosis, there is a greater increase in bleeding during menstruation, as well as an increase in its duration, although cases of uterine bleeding between menstruation also occur. With both the first and second diseases, anemia can develop. Only with adenomatosis its appearance is explained by bleeding that occurs during the intermenstrual period.

Anemia leads to weakness and drowsiness. A lack of hemoglobin in the blood is accompanied by pallor of the skin and mucous membranes. For the same reason, performance decreases.

With adenomyosis, spotting appears a few days before menstruation, and the same discharge may occur after menstruation ends. With adenomyosis, pain syndrome is pronounced. The pain intensifies significantly before menstruation and completely disappears after its completion. All symptoms of adenomyosis begin to appear in the later stages of the disease, when the pathological process has sufficiently spread throughout the uterus.

Adenomatosis is much more difficult to detect than adenomyosis. In this case, a full comprehensive examination of the patient will have to be carried out. The symptoms that occur with this pathology are indirect in nature and require confirmation when making a diagnosis.

Among the symptoms of adenomatosis, the first thing noted is the appearance of nagging pain in the lower abdomen. This pathology is characterized by the appearance of bloody discharge between menstruation. But such discharge is a symptom of many pathologies associated with the uterus. Therefore, their presence is clearly not enough to make a diagnosis.

The same can be said about an irregular monthly cycle. An additional cause for concern may be the presence of excess weight, hair growth in places uncharacteristic for the female body.

Another indirect sign of adenomatosis may be an increase in insulin levels in the blood. Therefore, an accurate diagnosis is established after ultrasound and histology of the endometrium. At the same time, doctors determine the existing thickness of the uterine mucosa and identify the type of hyperplasia. Additionally, blood sugar levels are checked.

Treatment

The main drugs in the treatment of adenomatosis are gestagens and oral combined contraceptives. But not in all cases, conservative treatment gives the desired effect. Then surgical removal of the hyperplastic epithelium is performed.

Treatment of adenomyosis should also take into account the causes of its occurrence. Treatment should also prevent recurrence of the pathology. Therapy begins after receiving ultrasound results, as well as checking the mucous membrane for the presence of atypical cells.

Adenomyosis very quickly becomes chronic, so treatment tactics must be well thought out. The choice of drugs depends on the form of adenomyosis and the degree of spread of foci of pathology. Hormonal drugs are selected for treatment. In severe cases, surgical treatment is performed.

Description:

Familial polyendocrine adenomatosis (FPEA) is a disease characterized by the development of tumors in two or more endocrine glands, most often in the islets of Langerhans of the pancreas and the parathyroid gland (source - chief cells).

Symptoms:

There are 3 types of SPEA:
- Type I (Wörmer syndrome, 131100, 1C13, MEN1, R gene):: parathyroid glands, islets of Langerhans of the pancreas and pituitary gland are involved
- occurs in approximately 90% of patients (a quarter of them have hyperplasia of all parathyroid glands)
- Tumors of the islet tissue of the pancreas are found in 80% of patients (usually gastrinoma, glucagonoma or insulinoma)
- observed in 65% of cases
- Stomach ulcers caused by pancreatic gastrinoma.
- Type II (Sipple syndrome, #171400, 10qll.2, RET oncogene, , R): the disease should be suspected in any relative of the patient who has medullary
- Medullary thyroid carcinoma is found in all patients
- observed in approximately 40% of patients. The tumors are usually bilateral and sometimes malignant. In most cases, symptoms of pheochromocytoma occur later than signs of thyroid cancer
- Hyperplasia of the parathyroid glands appears in 60% of patients.
- Type III (#162300, 10qll.2, oncogene RET, R)) is regarded as a variant of type II (sometimes referred to as type lib, then Sipple syndrome is designated as type IIa)
- As with SPEA type II, medullary thyroid gland and pheochromocytoma develop. The most characteristic signs: skeletal deformities and multiple mucous membranes
- SPEA III manifests itself at a younger age (usually up to 20 years) and is much more aggressive; early diagnosis is necessary.

Causes:

The disease has a hereditary etiology.

Treatment:

For treatment the following is prescribed:

SPEA I
The first step is to eliminate the hyperparathyroid state. As a result, gastrin secretion may be reduced, which favors the healing of stomach ulcers. Subtotal parathyroidectomy is necessary because the disease usually involves hyperplasia of all four glands. If hypergastrinemia does not respond to treatment, the gastrin-producing tumor must be removed. If the pancreatic tumor cannot be removed, and the use of H2 blockers does not lead to healing of the ulcers, gastrectomy or gastrectomy is performed. Pituitary tumors are removed by transsphenoidal hypophysectomy.

SPEA II
Medullary thyroid carcinoma (treatment is effective at the precancer stage [C-cell hyperplasia], total thyroidectomy is indicated). Pheochromocytoma or hyperplasia of the adrenal medulla: first of all, they are treated (before thyroidectomy), otherwise, when performing surgery on the thyroid gland, a hypertensive crisis is possible. Hyperparathyroidism can be cured by total thyroidectomy.

SPEA III. Treatment is similar to type II. Because type III is particularly aggressive, early and definitive treatment is necessary.