Kuliah ADENOMYOSIS
Kuliah ADENOMYOSIS
Kuliah ADENOMYOSIS
Kanadi Sumapraja
(kanadisuma@yahoo.com)
30%
25%
20%
15%
10%
5%
0%
Fibroids Genital Cervical Ca Endom etrial Ovarian Ca Ovarian cyst
prolapse Ca
Vercellini et al, 1996
The difference between myoma vs adenomyosis
Myoma Adenomyosis
HLA
Macrophages
B cells T cells
Clinical features (1)
Metrorrhagia
Menorrhagia
Dysmenorrhea
Poor contractibility
MENORRHAGIA Compression of the endometrium
Arachidonic acid metabolism
(PGF2a)
Hypercontractility
DYSMENORRHEA
Clinical features (3)
Auto-immune response
Activation of immune
components
Secretes variety of
cytokines
Over-expression of COX-
2
Prostaglandin increased
Ota et al, 2001
Clinical features (4)
Late Follicular Mid Secretory
Control
Patients
Fertility
Dr SM Ascher
Ultrasound
Trans-abdominal US relatively poor to differentiates between
adenomyosis and uterine myoma
Conservative treatment
Wood, 1998
Hormonal treatment (2)
Before After
Wood, 1998
Surgical (2)
Cyto-reductive surgery
Impaired fertility might be due to smooth muscle cell
hyperplasia and hypertrophy secondary to ectopic
endometrial proliferation interfere gamete transportation
and/or implantation process
Removing a relatively poor blood supply tumor
Enhancing immune function of the host
Enhancing the response of remaining tumor to chemotherapy
Microsurgical technique
To avoid extensive injury of the uterus
Pre-operative treatment :
Decrease the difficulty of surgical procedure; decrease post-operative
symptoms; improve pregnancy rate