{"id":239,"title":"Adenomyosis in Congenital Müllerian Anomalies: Pathogenetic Insights From a Systematic Review","title_zh":"先天性苗勒管异常中的子宫腺肌症：系统综述的发病机制启示","url":"https://pubmed.ncbi.nlm.nih.gov/42982030","doi":"10.1111/1471-0528.70362","pmid":"42982030","journal":"BJOG","kind":"paper","lang":"en","published_at":"2026-11-04T00:00:00+00:00","fetched_at":"2026-11-08T03:44:00+00:00","authors":["Saponara S","Angioni S","Picci F","D'Alterio MN","Nicolì P","Cela V","Kalkan U","Grimbizis G","Daniilidis A"],"primary_topic":"endometrium","topics":[{"slug":"endometrium","score":8.0,"hits":["adenomyosis","endometriosis","endometrium","uterine","uterus"]}],"topic_score":8.0,"preference_score":0.0,"preference_labels":[],"llm_score":72.0,"final_score":76.0,"score_dims":{"novelty":70,"rigor":60,"impact":65,"relevance":85,"translation":55},"recommend_reason":"以苗勒管异常为天然模型探讨子宫腺肌症定位规律，为“流出受阻-机械压力”假说提供了病例级证据，对理解内膜相关疾病有启示；但证据等级低、样本异质性大，不宜过度解读。","keywords":["子宫腺肌症","苗勒管异常","子宫内膜异位症","梗阻性异常","系统综述"],"selected":1,"story_id":83,"llm_provider":"deepseek","llm_model":"deepseek-flash","llm_effort":"low","source_key":"pubmed-uterus-pregnancy","source_name":"PubMed · 内膜/植入/早孕","source_tier":1,"mention_count":1,"has_interpretation":false,"journal_key":"bjog","journal_tier":"field-top","journal_if":4.7,"is_mock":false,"summary_zh":"该系统综述检索PubMed、Embase和Scopus至2025年10月，纳入42项研究共135例先天性苗勒管异常合并子宫腺肌症患者。结果显示子宫腺肌症好发于结构异常或梗阻的子宫腔：非交通性功能残角子宫中10/12例累及残角，Robert子宫盲腔同侧3/3例，MRKH综合征无功能内膜残迹中10/15例。合并子宫内膜异位症占32.1%，梗阻性异常最高，且90%位于梗阻同侧。作者认为月经流出受阻可能是共同机械决定因素，但证据质量低，结论属假设生成性。","summary":"BACKGROUND: Adenomyosis is a prevalent gynaecological disorder whose pathogenesis remains incompletely understood. Congenital Müllerian anomalies provide an informative in vivo model, since obstructive and non-obstructive variants impose spatially defined alterations of intrauterine pressure, myometrial architecture, and contractility. OBJECTIVES: To characterise adenomyosis localisation across Müllerian anomaly subtypes, assess concomitant endometriosis prevalence, and examine their topographic concordance with sites of uterine obstruction. SEARCH STRATEGY: PubMed/MEDLINE, Embase and Scopus were searched from inception to October 2025 using MeSH/Emtree and free-text terms for adenomyosis and congenital Müllerian anomalies, without date restrictions. SELECTION CRITERIA: Original case reports, case series, and observational studies in English explicitly describing the diagnostic modalities used for both conditions. DATA COLLECTION AND ANALYSIS: Two reviewers independently screened and extracted data; methodological quality was assessed with the Joanna Briggs Institute tools. Data were synthesised descriptively by malformation subtype, with case-by-case laterality analysis where individual patient-level data were available. MAIN RESULTS: Forty-two studies (135 patients) were included. Unicornuate uterus predominated (102/135, 75.6%). Among patients with directly reported localisation and a non-communicating functional rudimentary horn, adenomyosis involved the rudimentary horn in 10/12 cases (83.3%). In Robert's uterus, adenomyosis was ipsilateral to the blind hemicavity in 3/3 evaluable cases (100%). In Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, adenomyosis occurred in remnants lacking functional endometrium in 10/15 patients (66.7%). Concomitant endometriosis (43/134 evaluable patients, 32.1%) was most frequent in obstructive anomalies (Herlyn-Werner-Wunderlich syndrome (HWW) 3/5, 60.0%; Robert's uterus 2/4, 50.0%) and least frequent in septate uterus (0/2, 0%) and MRKH (2/15, 13.3%), localising ipsilateral to the obstruction in 9/10 (90.0%) reported obstructive cases. CONCLUSIONS: Adenomyosis preferentially involved structurally abnormal or obstructed uterine compartments. The endometriosis gradient was compatible with impaired menstrual efflux as a shared mechanical determinant. These findings derive from a low-quality evidence base and should therefore be regarded as hypothesis-generating. Prospective confirmation is required, although these findings may support increased clinical awareness in women with Müllerian anomalies, particularly obstructive variants.","interpretation_basis":null,"fulltext_status":null,"interpretation":null,"fulltext":{"available":false,"status":null,"reason":"尚未抓取全文（未入选、分数未达阈值，或还没跑 fulltext 步骤）","pmcid":null,"license":null,"chars":0,"source":null,"fetched_at":null}}