Objective. The aim of the study is to evaluate adenomyosis in patients undergoing surgery for different type of endometriosis. It is an observational study including women with preoperative ultrasound diagnosis of adenomyosis. Demographic data and symptoms were recorded (age, body mass index, parity, history of previous surgery, dysmenorrhea, dyspareunia, dyschezia, dysuria, and abnormal uterine bleeding). Moreover a particular endometrial shape “question mark sign” linked to the presence of adenomyosis was assessed. Results. From 217 patients with ultrasound diagnosis of adenomyosis, we found 73 with ovarian histological confirmation of endometriosis, 92 with deep infiltrating endometriosis, and 52 patients who underwent surgery for infertility. Women with adenomyosis alone represented the oldest group of patients ( years, ). Deep endometriosis patients were nulliparous more frequently ( ), had history of previous surgery ( ), and complained of more intense pain symptoms than other groups. Adenomyosis alone was significantly associated with abnormal uterine bleeding ( ). The question mark sign was found to be strongly related to posterior deep infiltrating endometriosis ( ). Conclusion. Our study confirmed the strong relationship between adenomyosis and endometriosis and evaluated demographic aspects and symptoms in patients affected by different type of endometriosis. 1. Introduction Adenomyosis is a benign condition of the uterus, defined by the presence of endometrial glands and stroma within the myometrium. It is known as a histological diagnosis but it has a clinical dignity showing symptoms (dysmenorrhea, dyspareunia, abnormal uterine bleeding, and infertility) and sharing some pathogenic mechanisms with endometriosis [1]. Most of the major authors of the first half of the past century dealing with the disease considered pelvic endometriosis and uterine adenomyosis as variants of the same disease process [2, 3]. Also, Sampson (1927), although focusing mainly on the aetiology of the pelvic dissemination of the disease, mentioned uterine adenomyosis and referred to it as “primary endometriosis” [4]. Bazot and colleagues reported that 27% of women with endometriosis had concomitant adenomyosis [5]. Moreover, a 42.76% prevalence of adenomyosis in patients with endometriosis has been recently identified in patients reporting severe or incapacitating dysmenorrhea and deep dyspareunia and in patients with endometriosis of the rectosigmoid [6]. A common pathogenesis for adenomyosis and endometriosis has been hypothesized [7–9] and it was argued that
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