Evaluation of the presence and effect of adenomyosis in patients with low-grade endometrial cancer

Birinci Z. Evaluation of the Presence and Effect of Adenomyosis in Patients with Low-Grade Endometrial Cancer. Eskişehir Osmangazi University Faculty of Medicine, Department of Obstetrics and Gynecology, Medical Specialty Thesis, Eskişehir, 2025. In this study, patients diagnosed with endometrioid-type endometrial carcinoma were evaluated. A total of 228 patients were included, with a mean age of 61.80 ± 10.12 years. The most common presenting symptom was postmenopausal bleeding (PMB) in 64% (n=146) of cases, followed by abnormal uterine bleeding (AUB) in 21.9% (n=50) and incidentally detected cases in 14% (n=32). Adenomyosis was detected in 37.3% (n=85) of patients. Significant differences were observed between patients with and without adenomyosis regarding BMI (p=0.027), infertility (p=0.027), and obesity (p=0.027). Myometrial invasion was present in 81.6% (n=186) of cases. The presence of myometrial invasion was significantly associated with age (p=0.001), symptom type (p=0.001), obesity (p=0.029), preoperative D&C results (p=0.001), postoperative grade 2 (p=0.001), lower uterine segment involvement (p=0.002), lymphovascular space invasion (LVSI) (p=0.001), cervical involvement (p=0.029), lymphadenectomy (p=0.001), and tumor size (p=0.001). In logistic regression analysis for predicting Stage 1B or higher disease, significant factors included age (p=0.009), lymphocyte count (p=0.038), preoperative Grade 2 (p=0.049), postoperative grade 2 (p=0.002), presence (p=0.002) and depth of myometrial invasion (p=0.001), tumor-free distance (TFD) (p=0.001), and cervical involvement (p=0.001). In conclusion, obesity and reproductive history were identified as significant risk factors for adenomyosis. In patients with low-grade endometrial cancer, univariate and multivariate analyses failed to demonstrate an association between the presence of adenomyosis and the prediction of stage IB or higher disease, or any significant impact on disease course. Key Words: Adenomyosis, Endometrial Cancer, Stage, Grade, Myometrial Invasion