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"The incidence of endometriosis is estimated to be between 6 and 10% of all women, and 35 and 50% of women with pelvic pain and infertility. On the other hand, the incidence of adenomyosis is under discussion since different imaging criteria are used. Kunz et al, found a prevalence of adenomyosis in 70% of women with endometriosis, compared with 9% in healthy controls. This is in contrasts to a previous study by Bazot et al, in which only 27% of women with pelvic endometriosis had adenomyosis on preoperative MRI. Using this technique, De Souza et al. detected discrete and diffuse patterns of adenomyosis in 54% of young women with infertility and dysmenorrhoea or menorrhagia."
" today a clinical diagnosis of adenomyosis is considered almost impossible.....over a total of 528 cases, an incidence of histologically certified adenomyosis of 11.2% [Cocuzzi E, Cocuzzi L, Benagiano G, Unpublished Data]. Of these 59 patients, only in one woman did the clinical, surgical and microscopic diagnosis coincide.... it is today widely accepted that the only two practical ways to reach a valid diagnosis are transvaginal sonography (TVS) and MRI."
" After this, Kunz et al, using MRI, established a significant correlation between increased JZ thickness and peritoneal endometriosis. As previously mentioned, they calculated a prevalence of diffuse and focal adenomyosis in 79% of all patients with endometriosis; this reached 90% in women younger than 36 years, a prevalence of 28% in their total control group (women without endometriosis) and only 9% in their healthy control group.
These data support the hypothesis that JZ hyperplasia precedes adenomyosis and endometriosis. However, this did not explain why JZ hyperplasia may develop in some women at a young age. Recently, a new link seems to have been found in a common predisposing factor: an alteration of spiral arterioles' angiogenesis."
"Further evidence linking adenomyosis to abnormal angiogenesis comes from a study by Tokyol et al. who investigated the expression of COX-2 and matrix metalloproteinase (MMP)-2 in patients with this condition. They observed that, while the quantity and intensity of COX-2 expression in endometrium did not vary during the menstrual cycle in normal women, in patients with adenomyosis it was higher both during the follicular and secretory phases."
"Therefore, zone hyperplasia, adenomyosis and endometriosis may be related to an aberrant angiogenesis in the myometrial JZ. In this respect, histological examination shows that the subendometrial halo, as observed by TVS, is a distinct compartment of the myometrium comprising tightly packed muscle cells with increased vascularity.
"Under the circumstances, a hypothesis can be formulated that ovulatory menstrual cycles during early reproductive life have an angiogenic priming effect that will permit successful deep placentation, but under certain circumstances can also lead to uterine disorders."