Abstract：
OBJECTIVE: To explore the imaging features and the molecular characterization of adenomyosis after menopause.
METHODS: 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.
METHODS: 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.
METHODS: 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.
METHODS: 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.
摘要：
目的：探讨绝经后子宫腺肌病的影像学特征及分子学特征。
方法：在一组接受经阴道超声（TVUS）的绝经后患者中进行了观察性横断面研究（n=468）。在那些提出美国子宫腺肌病标准的人中，磁共振成像(MRI)也证实了这一点，以前的月经症状，回顾了妇科和产科病史。在接受子宫切除术的亚组中，子宫标本通过组织学和表达与上皮-间质转化有关的基因进行分析，炎症和纤维化，包括鞘氨醇-1-磷酸（S1P）途径，进行了评估，并与匹配的非绝经子宫腺肌病标本进行了比较。
方法：根据TVUS子宫形态超声评估子宫腺肌病的直接和间接US特征。绝经后与绝经前子宫腺肌病样本的分子特征。
结果：根据TVUS和MRI，在49例患者中发现了子宫腺肌病（10.4％）。在美国，弥漫性子宫腺肌病是最常见的表型，而弥漫型和不对称型的内部子宫腺肌病在MRI上最常见。分子分析显示子宫腺肌病病灶表达上皮-间质转化标志物,炎症和纤维化也在绝经后妇女。通过将结果与绝经前样本的结果进行比较，α平滑肌肌动蛋白（αSMA）的表达，纤维化的标志，更年期后明显更大，观察到S1P分解代谢和信号传导的改变。
结论：绝经后妇女可以通过影像学检查发现子宫腺肌病，不管是TVUS还是MRI,纤维化是分子分析的关键特征之一。
方法：在一组接受经阴道超声（TVUS）的绝经后患者中进行了观察性横断面研究（n=468）。在那些提出美国子宫腺肌病标准的人中，磁共振成像(MRI)也证实了这一点，以前的月经症状，回顾了妇科和产科病史。在接受子宫切除术的亚组中，子宫标本通过组织学和表达与上皮-间质转化有关的基因进行分析，炎症和纤维化，包括鞘氨醇-1-磷酸（S1P）途径，进行了评估，并与匹配的非绝经子宫腺肌病标本进行了比较。
方法：根据TVUS子宫形态超声评估子宫腺肌病的直接和间接US特征。绝经后与绝经前子宫腺肌病样本的分子特征。
结果：根据TVUS和MRI，在49例患者中发现了子宫腺肌病（10.4％）。在美国，弥漫性子宫腺肌病是最常见的表型，而弥漫型和不对称型的内部子宫腺肌病在MRI上最常见。分子分析显示子宫腺肌病病灶表达上皮-间质转化标志物,炎症和纤维化也在绝经后妇女。通过将结果与绝经前样本的结果进行比较，α平滑肌肌动蛋白（αSMA）的表达，纤维化的标志，更年期后明显更大，观察到S1P分解代谢和信号传导的改变。
结论：绝经后妇女可以通过影像学检查发现子宫腺肌病，不管是TVUS还是MRI,纤维化是分子分析的关键特征之一。
