Adenomyozis
Özet
Adenomyozis, endometrium ektopik odaklarının miyometrium derinliklerine yerleşmesi ve çevre düz kas dokusunda hipertrofi ile hiperplazi oluşturmasıyla karakterize, uterusun küresel büyümesine yol açan benign bir patolojidir. Kadınların %20-35'inde görüldüğü tahmin edilen bu jinekolojik hastalığın kesin tanısı histopatolojik histerektomi incelemesine dayanmakla birlikte, transvajinal ultrasonografi (TVUS) ve manyetik rezonans görüntüleme (MRG) gibi pelvik görüntüleme yöntemleriyle de klinik ön tanı konulabilmektedir. Klinik olarak hastaların yaklaşık üçte biri asemptomatik kalırken, semptomatik vakalarda özellikle 40-50 yaş grubundaki kadınlarda proglastandin artışına ve damarlanma bozukluklarına sekonder gelişen ağır adet kanamaları (menoraji), dismenore ve kronik pelvik ağrılar tipik semptomlar arasında yer alır. Patogenezi kesin olarak bilinmeyen hastalıkta endometriyal invajinasyon ile Müllerian kalıntı teorileri öne çıkmakta, östrojen, progesteron ve prolaktin gibi steroidal ile hipofiz hormonlarının patofizyolojide rol oynadığı düşünülmektedir. Ayırıcı tanısında leiomyomlar, endometriozis ve endometrial polipler yer alan adenomyozisin yönetiminde, fertilite istemi ve yaygınlığa göre tedavi planlanır. Doğurganlığını tamamlamış semptomatik kadınlarda kesin tedavi diffüz formu tamamen ortadan kaldıran cerrahi yöntem olan histerektomi iken; çocuk istemi olan veya cerrahi istemeyen hastalarda semptomları hafifletmek amacıyla levonorgestrel salan rahim içi araç (LNG RİA) gibi hormonal seçenekler veya uterin arter embolizasyonu tercih edilmektedir.
Adenomyosis is a benign pathology characterized by the implantation of ectopic endometrial tissue deep into the myometrium, causing hypertrophy and hyperplasia of the surrounding smooth muscle, which leads to a global enlargement of the uterus. Estimated to affect 20-35% of women, the definitive diagnosis of this gynecological disease relies on histopathological hysterectomy examination; however, clinical pre-diagnosis can be established through pelvic imaging modalities such as transvaginal ultrasonography (TVUS) and magnetic resonance imaging (MRI). While approximately one-third of patients remain asymptomatic, symptomatic cases—typically women aged 40-50—present with heavy menstrual bleeding (menorrhagia), dysmenorrhea, and chronic pelvic pain secondary to increased prostaglandin production and abnormal vascularity. Although the exact pathogenesis remains unknown, theories involving endometrial invagination and de novo development from Müllerian remnants are prominent, with steroidal and pituitary hormones like estrogen, progesterone, and prolactin thought to play roles in its pathophysiology. The management of adenomyosis, whose differential diagnosis includes leiomyomas, endometriosis, and endometrial polyps, is tailored based on fertility desires and disease extent. Hysterectomy remains the definitive treatment to entirely eradicate diffuse adenomyosis in symptomatic women who have completed childbearing, whereas hormonal options like the levonorgestrel-releasing intrauterine system (LNG-IUS) or uterine artery embolization are preferred to alleviate symptoms in patients desiring future pregnancy or avoiding major surgery.
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