Background: Both leiomyoma and adenomyosis are commonly encountered gynecological pathologies. It is a well-established fact that hyperestrogenic state is associated with growth of leiomyoma but the exact etiology of adenomyosis is unknown. Adenomyosis is also thought to be an estrogen dependent disease. Similarly, it has also been found that progesterone receptors are increased in leiomyomas whereasa decreased responsiveness of the ectopic endometrium to progesterone has been found in adenomyosis. Thus these two hormones are intricately related to leiomyoma and adenomyosis.

Aims: The aim of this study is to note the changes in endometrium that can be found in the respective cases of uterine leiomyoma and adenomyosis of uterus.

Materials and Methods: The study was conducted over a period of 12 months included 73 cases of leiomyoma and 73 cases of adenomyosis. Serum estradiol and progesterone levels of all the patients were measured by chemiluminescence immunoassay.

Results: In leiomyoma, inactive basal endometrium was the most common finding 36/73 (49.31%) and in adenomyosis simple hyperplasia of endometrium was found in majority 30/73 (41.09%). However, both estradiol and progesterone levels in leiomyoma and adenomyosis were mostly within the normal range.

Conclusion: Though both leiomyoma and adenomyosis are associated with a hyper estrogenic state, leiomyoma had inactive basal endometrium while adenomyosis had hyperplasia. Adenomyosis was also found to be associated with other pathologies like endometrial carcinoma, complex hyperplasia. Hence, in adenomyosis other associated pathologies should be looked for.  .

Keywords: Inactive basal endometrium, endometrial hyperplasia, estradiol, progesterone.

1. Deligdisch L. Hormonal pathology of endometrium. Modern Pathology, 2000; 13(3): 285-294.
2. Damle RP, Dravid NV. Clinicopathological spectrum of endometrial changes in Peri- menopausal &Post menopausal Abnormal uterine bleeding- A 2 years study. J Clinical Diagnostic Res, 2013 December; 7(12):2774-2776.
3. Kumar, Abbas, Aster. Robbins and Cotran Pathologic basis of disease. 9^th South Asia Edition: Elsevier, 2015. Volume 2. Chapter 22. The Female Genital Tract;p.1012-1021.
4. Montgomery Ben E, Daum GS, Dunton CJ. Endometrial hyperplasia- A Review. Obstetrical and Gynecological Survey, 2004 May; 59(5): 368-378.
5. Ciavattini A, Giuseppe JD, Stortoni P, Montik N, Giannubilo SR, Litta P, Islam Md S, Tranquilli AL, Reis FM, Ciarmela P. Uterine Fibroids: Pathogenesis and Interac-tions with Endometrium and Endomy-ometrial Junction. Obstetrics and Gynecology International, 2013.dx.doi.org/10.1155/2013/173184.
6. Grings AO, Lora V, Ferreira GD, Brum IS, Corleta HVE, Capp E. “ Protein expression of estrogen receptors α and β and aromatase in myometrium and uterine leiomyoma”. Gynecologic and Obstetrics Investigation, 2012; 73(2): 113- 117.
7. Kurachi O, Matsuo H, Samoto T, Maruo T. ― Tumor necrosis factor α-expression in human uterine leiomyoma and its down-regulation by progesterone‖. Journal of Clinical Endocrinology and Metabolism, 2001; 86(5):2275-2280.
8. Yin P, Lin Z, Cheng YH, Marsh EE, Utsun-omiya H, Ishikawa H, Xue Q, Reierstad S, Innes J, Thung S, Kim JJ, Xu E, Bulun SE. Progesterone receptor regulates Bcl-2 gene expression through direct binding to its promoter region in uterine leiomyoma cells. J Clin Endocrinology and Metabolism, 2007 Nov; 92(11): 4459-66.
9. Wong JY, Gold EB, Johnson WO, Lee JS- Circulating sex hormones and risk of uterine fibroids- Study of Women’s Health Across the Nation (SWAN); The Journal Of Endocrinology & Metabolism, 2016 January; 101 (1):123-30.
10. Hunter WC, Smith LL, Reiner Uterine adenomyosis- Incidence, symptoms and pathology in 1,856 hysterectomies. Ameri-can Journal of Obstetrics and Gynecology, 1947.dx.doi.org/10.1016/0002-9378(47)90286-X.
11. Chen YJ, Li HY, Huang CH, Twu NF, Yen MS, Wang PH, Chou TY, Liu YN, Chao KC and Yang MH- Oestrogen-induced epithelial-mesenchymal transition of endometrial epithelial cells contributes to the development of adenomyosis, The Journal Of Pathology, 2010 Nov; 222(3):261-270.
12. Chwalisz K, Perez MC, DeManno D, Winkel C, Schubert G, Elger W. Selective progesterone receptor modulator development and use in the treatment of leiomyomata and endometriosis. Endocrine Reviews, 2005 May; 26(3):423-438.
13. Kim JJ, Kurita T, Bulun SE. Progesterone action in endometrial cancer, endometriosis, uterine fibroids and breast cancer. Endocrine Reviews, 2013; Vol34: 130-162.
14. Lee WL, Lee FK, Su WH, Tsui KH, Kuo CD, Hsieh SL, Wang PH. Hormone therapy for younger patients with endometrial cancer. Taiwanese Journal of Obstetrics and Gynecology. 2012; 51(4):495-505.
15. Cheng MH, Chen JF, Fuh JL, Lee WL, Wang Osteoporosis treatment in post- menopausal women with pre- existing fracture. Taiwanese Journal of Obstetrics and Gynecology. 2012; 51(2):153-166.
16. Ferenczy A- Pathophysiology of Adenomyosis. Human Reproduction Update, 1998; (4): 312-322.
17. Deligdish L, Loewenthal M.-Endometrial changes associated with myomata of uterus J Clinical Pathology, 1970 ; 23(8);676-80.
18. Chethana M, Harendra Kumar ML¹, Munikrishna M², Department of Pathology, Kempegowda Institute of Medical Sciences, Bengaluru, Department of Pathology and Obstetrics and Gynaecology², Sri Devaraj Urs Medical College, Tamaka, Kolar- Endometrial changes in Uterine Leiomyomas J Clinical Biomedical Science, 2013 ; 3(2);72-79.
19. Chen YZ, Wang JH,  Yan J,  Liang Y, Zhang XF, Zhou F- Increased expression of adult stem cell marker Musashi-1in the ectopic endometrium of adenomyosis does not correlate with serum estradiol and progesterone levels; European Journal of Obstetrics & Gynecology &Reproductive Biology 173 (2014), pp 88-
20. Englund K, Blanck A, Gustavson I, Lundkvist U, Sjoblom P, Norgren A, Lindblom B- Sex steroid hormones in Human myometrium and Fibroids- changes during menstrual cycle and gonadotrophin releasing hormone treatment; The Journal of Clinical Endocrinology and Metabolism; 1998; Volume 83; pp4092-6.

Debosmita Bhattacharyya

Department of Pathology, R.G.Kar Medical College and Hospital

1, Khudiram Bose Road, Kolkata- 700004, West Bengal, India

Phone Number- 9804263032, Email- This email address is being protected from spambots. You need JavaScript enabled to view it.