Imaging and molecular features of adenomyosis after menopause

Silvia Vannuccini; Silvia Gabbrielli; Francesca Castiglione; Eleonora Nardi; Margherita Rossi; Gretha Orlandi; Elisa Wu; Francesca Bertoli; Vittorio Miele; Chiara Donati; Felice Petraglia

doi:10.1016/j.maturitas.2024.107996

Imaging and molecular features of adenomyosis after menopause

Maturitas. 2024 Apr 12:185:107996. doi: 10.1016/j.maturitas.2024.107996. Online ahead of print.

Authors

Affiliations

¹ Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Largo Brambilla, 50134 Florence, Italy; Department of Maternal and Child Health, Careggi University Hospital, Largo Brambilla, 50134 Florence, Italy. Electronic address: silvia.vannuccini@unifi.it.
² Department of Radiology, Careggi University Hospital, Largo Brambilla, 50134 Florence, Italy.
³ Section of Pathology, Department of Health Sciences, University of Florence, Careggi University Hospital, Largo Brambilla, 50134 Florence, Italy.
⁴ Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Largo Brambilla, 50134 Florence, Italy.
⁵ Department of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Florence, Largo Brambilla, 50134 Florence, Italy; Department of Maternal and Child Health, Careggi University Hospital, Largo Brambilla, 50134 Florence, Italy.

PMID: 38657487
DOI: 10.1016/j.maturitas.2024.107996

Abstract

Objectives: To explore the imaging features and the molecular characterization of adenomyosis after menopause.

Study design: An observational cross-sectional study was performed in a group of postmenopausal patients undergoing a transvaginal ultrasound (TVUS) (n = 468). Among those presenting the US criteria for adenomyosis, also confirmed by magnetic resonance imaging (MRI), previous menstrual symptoms, gynecological and obstetric history were reviewed. In a subgroup undergoing hysterectomy, uterine specimens were analyzed by histology and expression of genes implicated in the epithelial-mesenchymal transition, inflammation and fibrosis, including the sphingosine-1-phosphate (S1P) pathway, was evaluated and compared to matched non-menopausal adenomyosis specimens.

Main outcome measures: Direct and indirect US features of adenomyosis according to Morphological Uterus Sonographic Assessment at TVUS. Molecular characterization of postmenopausal versus pre-menopausal adenomyosis samples.

Results: According to TVUS and MRI, adenomyosis was identified in 49 patients (10.4 %). On US, diffuse adenomyosis was the most common phenotype, whereas internal adenomyosis with diffuse pattern and asymmetric type was the most prevalent on MRI. Molecular analysis showed that adenomyosis lesions express markers of epithelial-mesenchymal transition, inflammation and fibrosis also in postmenopausal women. By comparing the results with those from pre-menopausal samples, the expression of α smooth muscle actin (αSMA), a marker of fibrosis, was significantly greater after menopause, and altered S1P catabolism and signaling were observed.

Conclusions: Adenomyosis may be identified in postmenopausal women by imaging, either TVUS or MRI, and fibrosis is one of the key features on molecular analysis.

Keywords: Adenomyosis; Epithelial-mesenchymal transition; Fibrosis; Inflammation; MRI; Post-menopause; Transvaginal ultrasound.