Morphological aspects of internal endometriosis

Clinical and morphological analysis of 59 cases of internal endometriosis (adenomyosis) was carried out. It was established, that adenomyosis develops predominantly in women during perimenopausal period (after 40 years) on the background of multiple pregnancy interruptions. In 90 % of patients ademomyosis is accompanied with the development of multiple leuomyomatous nodules, 60 % - of glandular hyperplasia of endometrium, in 100 % of cases - fibro-cystic transformation or fibrous degeneration of the ovaries. Two morphogenetic variants of adenomyosis were described: invasion of cytogenic stroma to underlaying myometrium with formation of endometrial glands and invasion of cytogenic stroma along connective tissue bundles without formation of endometrial glands, but accompanied by expressed neoangiogenesis. Migration and mitogenic activities of endometrial stromal cells induce also leuomyomatous transformation of the myometrium, the most pronounced near the foci of adenomyosis. It was shown the simultaneous presence in the samples of the uterus active and inactive foci of adenomyosis and leuomyomatous nodules, indicating metachrony of their development.