Endometriosis Locations and Coexistence with other Uterine Conditions in a Bulgarian Sample of Patients

  • D. Serteva Medical Faculty, Department of general and clinical pathology, Medical University – Plovdiv, Bulgaria
  • E. Poryazova Medical Faculty, Department of general and clinical pathology, Medical University – Plovdiv, Bulgaria
  • Ts. Velikova Medical Faculty, Department of Clinical Immunology, University Hospital Lozenetz–Sofia, Bulgaria
Keywords: Endometriosis, Localization, Adenomyosis, Combination with other Uterine Pathology


Endometriosis is a non-tumor, estrogen-dependent, chronic gynecological disease, which is characterized by the presence of endometrial glands and stroma outside the endometrium of the uterus. Endometriosis affects between 10% and 15% of women in reproductive age. It is often associated with chronic pelvic pain and reproductive difficulties. Endometriosis can be classified as ovarian, extra-ovarian or mixed. Adenomyosis is considered, by some authors, as a separate variant of endometriosis. It is diagnosed as the presence of ectopic benign endometrial glands and stroma in the myometrium, where the minimal distance from the endometrio-myometrial junction is 2-4 mm. Our study includes 224 cases of women with endometriosis with different locations - in the myometrium (adenomyosis), in the ovaries, fallopian tubes, soft tissues and appendix as well as in combination with other conditions of the uterine body, such as endometrial carcinoma, leiomyomas, endometrial hyperplasia, polyps and atrophy and cervical cancer. There are cases of coexistence of several conditions in the same patient, and we are trying to find the reason behind this.


Baird, D.D., Dunson, D.B., Hill, M.C., Cousins, D.S., & Schectman, J.M. (2003). High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. American journal of obstetrics and gynecology, 188 1, 100-7 .
Buttram VC, Jr, Reiter RC. Uterine leiomyomata: etiology, symptomatology, and management. Fertil Steril. 1981;36:433–445.
Cardozo ER, Clark AD, Banks NK, Henne MB, Stegmann BJ, Segars JH. The estimated annual cost of uterine leiomyomata in the United States. Am J Obstet Gynecol. 2012;206:e211–e219.
Cumiskey J, Whyte P, Kelehan P, Gibbons D. A detailed morphologic and immunohistochemical comparison of pre- and postmenopausal endometriosis. J Clin Pathol. 2008;61:455–9
Eskenazi B,Warner M,Bonsignore L et al.Validation study of nonsurgical diagnosis of endometriosis.Fertil Steril 2001;76:929–35
Giudice LC, Kao LC. Endometriosis. Lancet. 2004; 364:1789–99
Hua Yang LZ, Shu Wang, Jinghe Lang, Tao Xu. Noninvasive diagnosis of moderate to severe endometriosis: the platelet-lymphocyte ratio cannot be a neoadjuvant biomarker for serum cancer antigen 125. J Minim Invasive Gynecol. 2013;22:373–377.
Huang J.Q., Lathi R.B., Lemyre M., Rodriguez H.E., Nezhat C.H., Nezhat C., Coexistence of endometriosis in women with symptomatic leiomyomas (2010) Fertility and Sterility, 94 (2) , pp. 720-723.
Ismiil N, Rasty G, Ghorab Z, Nofech-Mozes S, Bernardini M, Ackerman I, Thomas G, Covens A, Khalifa MA. Adenomyosis involved by endometrial adenocarcinoma is a significant risk factor for deep myometrial invasion. Ann Diagn Pathol. 2007;11:252–257.
Lee HJ, Park YM, Jee BC, Kim YB, Suh CS. Various anatomic locations of surgically proven endometriosis: A single-center experience. Obstet Gynecol Sci. 2015;58(1):53–58. doi:10.5468/ogs.2015.58.1.53
Matalliotaki C, Matalliotakis M, Ieromonachou P, et al. Co-existence of benign gynecological tumors with endometriosis in a group of 1,000 women. Oncol Lett. 2017;15(2):1529–1532. doi:10.3892/ol.2017.7449
McKenney JK, Kong CS, Longacre TA. Endometrial adenocarcinoma associated with subtle lymph-vascular space invasion and lymph node metastasis: a histologic pattern mimicking intravascular and sinusoidal histiocytes. Int J Gynecol Pathol2005;24:73–7
Nezhat C, Li A, Abed S, et al. Strong Association Between Endometriosis and Symptomatic Leiomyomas. JSLS. 2016;20(3):e2016.00053.
Overton C., C. Davis MD, L. McMillan,R. W. Shaw, Atlas of endometriosis, third edition, 2007, ISBN-10: 0 415 39573 9, ISBN-13: 978 0 415 39573 1
Parazzini F, Vercellini P, Panazza S, Chatenoud L, Oldani S, Crosignani PG: Risk factors for adenomyosis. Hum Reprod 1997; 12:1275-1279.
Karagiozov I, Iliev, Atanasov A., Doganov N., Pranchev N., Dimitrov A., Shterev A, Nalbanski B, Obstetrics and gynecology, 2005, ISBN 954-420-040-1
Robboy St., Hubbard Chr., Madden J., Dash R., ‘Robboy’s pathology of the female genital tract’, 2008 , ISBN 9780702033551
Shah D. Postmenopausal endometriosis: An enigma revisited. J Midlife Health. 2014;5(4):163–164. doi:10.4103/0976-7800.145189
Stewart EA. Uterine fibroids. Lancet. 2001;357:293–298.
Tetikkurt S, Çelik E, Taş H, Cay T, Işik S, Usta AT. Coexistence of adenomyosis, adenocarcinoma, endometrial and myometrial lesions in resected uterine specimens. Mol Clin Oncol. 2018;9(2):231–237.
Vollenhoven BJ, Lawrence AS, Healy DL. Uterine fibroids: a clinical review. Br J Obstet Gynaecol. 1990;97:285–298.
Wechter ME, Stewart EA, Myers ER, Kho RM, Wu JM. Leiomyoma-related hospitalization and surgery: prevalence and predicted growth based on population trends. Am J Obstet Gynecol. 2011;205:e491–e495.
How to Cite
Serteva, D., Poryazova, E., & Velikova, T. (2019). Endometriosis Locations and Coexistence with other Uterine Conditions in a Bulgarian Sample of Patients. American International Journal of Multidisciplinary Scientific Research, 5(2), 5-9. https://doi.org/10.46281/aijmsr.v5i2.255
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