Clinicopathological characteristics of adenomyosis with and without coexisting leiomyomas and/or endometriosis: a retrospective hysterectomy cohort study

To compare the clinical and pathological characteristics of histologically confirmed adenomyosis with and without coexisting leiomyoma and/or endometriosis in a hysterectomy cohort. We conducted a retrospective, pathology-based cohort study of hysterectomy specimens obtained at a tertiary center between 2012 and 2017. Among the 2028 hysterectomies performed, 297 patients were diagnosed with histologically confirmed adenomyosis, resulting in a prevalence rate of 14.6%. Patients were classified as having adenomyosis without coexisting leiomyoma or endometriosis, or as having adenomyosis with coexisting leiomyoma and/or endometriosis. Demographics, presenting symptoms, and concurrent gynecologic malignancies were compared between groups. Multivariable logistic regression and additional sensitivity analyses were used to assess factors independently associated with concurrent gynecologic malignancy. Adenomyosis without coexisting leiomyoma or endometriosis was identified in 119 patients (40.1%), whereas adenomyosis coexisting with leiomyoma and/or endometriosis was identified in 178 patients (59.9%). Patients without coexisting leiomyoma or endometriosis were older than those with coexisting leiomyoma and/or endometriosis (mean 54.2 vs. 50.0 years; p = 0.001). Menorrhagia was less frequent (50 vs. 115 patients; p < 0.001), whereas postmenopausal bleeding (24 vs. 19 patients; p = 0.024) and uterine prolapse (17 vs. 12 patients; p = 0.033) were more frequent in this group. Concurrent gynecologic malignancy was also more frequent in patients without coexisting leiomyoma/endometriosis ( n = 42, 35.3% vs. n = 17, 9.6%; p < 0.001). This association remained significant after multivariable adjustment (aOR 5.22, 95% CI 2.66–10.6; p < 0.001) and in age-focused sensitivity analyses. In subtype-specific analyses, the association was primarily observed in endometrial cancer. In this retrospective hysterectomy cohort, adenomyosis without coexisting leiomyoma/endometriosis and adenomyosis coexisting with leiomyoma and/or endometriosis showed different clinicopathological features. Adenomyosis without coexisting leiomyoma/endometriosis was associated with a higher frequency of concurrent gynecologic malignancy, mainly endometrial cancer. These findings should be interpreted within the limitations of this retrospective, hysterectomy-based design.