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Uterine junctional zone: function and disease

J J Brosens1, N M de Souza, F G Barker

  • 1Institute of Obstetrics and Gynaecology, Royal Postgraduate Medical School, London, UK.

Lancet (London, England)
|August 26, 1995
PubMed
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Adenomyosis may be a dichotomous disease, primarily involving disruption of the inner uterine myometrium. This disruption, rather than mucosal invasion, could explain adenomyosis diagnoses and its link to dysfunctional uterine bleeding.

Area of Science:

  • Reproductive Medicine
  • Uterine Physiology
  • Medical Imaging

Background:

  • The myometrium, the uterine smooth muscle layer, was traditionally viewed as uniform.
  • Magnetic resonance (MR) imaging reveals distinct inner (junctional zone) and outer myometrial layers.
  • The junctional zone exhibits unique structural and functional properties compared to the outer myometrium.

Purpose of the Study:

  • To investigate the distinct roles of the inner and outer myometrium.
  • To re-evaluate the pathophysiology of adenomyosis based on myometrial zonation.
  • To propose a new hypothesis for adenomyosis, focusing on inner myometrial disruption.

Main Methods:

  • Review of magnetic resonance (MR) imaging findings in uterine studies.
  • Analysis of myometrial functional differences between the junctional zone and outer myometrium.

Related Experiment Videos

  • Postulation of a new pathophysiological model for adenomyosis.

    • Main Results:

    • Myometrial contractions in non-pregnant women originate exclusively from the junctional zone.
    • Junctional zone thickening on MR imaging is associated with adenomyosis but may reflect architectural disruption.
    • The current MR criterion for adenomyosis relies on smooth muscle hyperplasia, not mucosal invasion.

    Conclusions:

    • Adenomyosis is hypothesized as a dichotomous condition primarily characterized by inner myometrial architectural and functional disruption.
    • Secondary infiltration of endometrial elements into the myometrium may occur under specific circumstances.
    • This hypothesis may explain the high incidence of superficial adenomyosis in cases of dysfunctional uterine bleeding.