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Related to endometriosis interna: adenomyosis uteri
endometriosisA condition affecting up to 50% of women, which is defined as the presence of functioning endometrial glands and stroma outside of uterine cavity, occurring (in descending order of frequency) in: ovaries, broad ligaments, rectovaginal septum, umbilical scars, intestine, lungs, breast; laparoscopic resection or ablation of minimal lesions increased fecundity.
Often accompanied by dysmenorrhoea, cyclical pain, low back pain, thigh pain, hypermenorrhoea, repeated miscarriages, infertility, bleeding per rectum or bladder. Regional swelling with vicarious ectopic bleeding parallels menses.
Surgery if anatomy is distorted; TAH-BSO is definitive therapy.
Endometriosis is associated with future development of cancer.
Malignancy in endometriosis
Malignancy can arise in the epithelium (e.g., clear-cell or endometrioid carcinomas), stroma (e.g., endometrial stromal sarcoma, MMMT, adenosarcoma), or in other lesions (e.g., borderline tumours, endometrioid adenofibroma). Cancer allegedly occurs in up to 10% of cases.
Endometriosis, criteria and comments
• Active (functional) or inactive.
• Metaplastic changes—ciliated, hobnail, mucinous or squamous.
• Usually readily apparent.
• May be inconspicuous cuff.
• Spiral arterioles, haemosiderin, CD10.
• Myxoid change.
• Smooth muscle metaplasia/elastosis.
• Pigmented histiocytes.