Exploring the challenges for a new classification of adenomyosis

Area of Science:

• Gynecology
• Reproductive Medicine
• Pathology

Background:

• Non-invasive diagnostic tests have increased interest in adenomyosis.
• Accurate mapping of adenomyosis in the uterus is now possible without hysterectomy.
• A standardized classification system is crucial for understanding adenomyosis and comparing research.

Purpose of the Study:

• To review previous and recent attempts at creating an adenomyosis taxonomy.
• To assess the proposed subdivision of adenomyosis into internal and external variants.
• To explore uncertainties in classifying specific adenomyosis involvements and their pathogenesis.

Main Methods:

• Literature review of existing and proposed adenomyosis classification systems.
• Analysis of hypotheses regarding the pathogenesis of adenomyosis variants.
• Examination of evidence supporting different etiological theories.

Main Results:

• Previous and recent classification attempts were assessed.
• The proposed subdivision into internal and external adenomyosis variants was considered.
• Uncertainties regarding the classification of uterovesical pouch, pouch of Douglas, and outer myometrial lesions were explored.

Conclusions:

• Fragmentary evidence underlies debates on adenomyosis pathogenesis.
• Two opposing hypotheses exist for the origin of adenomyosis variants.
• Lack of conclusive evidence hinders broad agreement on a classification hypothesis.