Coexistence of Chronic Endometritis in Adenomyosis: A Histopathological Study

Abstract

Background: Adenomyosis with chronic endometritis are common yet underdiagnosed gynecological conditions with overlapping clinical features and their potential coexistence and pathophysiological relationship remain inadequately explored.

Objective: To determine the prevalence of chronic endometritis among patients with adenomyosis and to examine its underlying etiology and histopathological characteristics.

Methods: This retrospective study was conducted in the Department of Pathology at Sri Ramachandra Institute of Higher Education and Research over a six-year period, from January 2018 to April 2024.

Results: Of the 52 cases of chronic endometritis identified using CD138 immunostaining, 12 cases (23.1%) showed coexisting adenomyosis. The mean age of affected patients was 47.75 years, with most cases occurring between 44 and 50 years. All patients presented with abnormal uterine bleeding and many had reported dysmenorrhea with pelvic pain. Histopathology showed proliferative endometrium with chronic inflammatory changes and plasma cell infiltration confirmed by immunohistochemistry CD138. Adenomyosis was identified by the presence of endometrial glands and stroma within the myometrium and coexisting leiomyomas were noted in some cases, indicating overlapping uterine pathology in this symptomatic patient group.

Conclusion: Chronic endometritis was identified in a significant proportion of adenomyosis cases, indicating a potential pathological association. Recognizing this coexistence may aid in better clinical management and understanding of disease mechanisms.