Feasibility of laparoscopic high-intensity focused ultrasound treatment for patients with uterine localized adenomyosis Zhu Yang, M.D., Ph.D., You-De.

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Feasibility of laparoscopic high-intensity focused ultrasound treatment for patients with uterine localized adenomyosis Zhu Yang, M.D., Ph.D., You-De Cao, Ph.D., Li-Na Hu, M.D., Zhi-Biao Wang, M.D., Ph.D. Fertility and Sterility Volume 91, Issue 6, Pages 2338-2343 (June 2009) DOI: 10.1016/j.fertnstert.2008.03.017 Copyright © 2009 American Society for Reproductive Medicine Terms and Conditions

Figure 1 Macroscopic section of ablated localized adenomyosis taken immediately after high-intensity focused ultrasound treatment. This specimen was incubated for 20 minutes with 2% 2,3,5-triphenyltetrazolium chloride solution, a marker for mitochondrial enzymatic activity. Coagulation necrosis represents beige region (T), whereas viable tissue expresses with red (U). A margin is very clear between dead and viable tissues (arrows). Fertility and Sterility 2009 91, 2338-2343DOI: (10.1016/j.fertnstert.2008.03.017) Copyright © 2009 American Society for Reproductive Medicine Terms and Conditions

Figure 2 Histopathologic changes in localized adenomyosis immediately after high-intensity focused ultrasound (HIFU) treatment (H & E, ×400). (A) Untreated viable localized adenomyosis: focus of adenomyosis is made of endometrial gland (arrow) and stroma, surrounded by bundles of hypertrophic smooth muscle cells. The structure of adenomyotic gland and glandular cells are normal, with formation of epithelial cilium. (B) HIFU-treated localized adenomyosis: necrosed cells represented by pyknotic nuclei in endometrial gland (arrow) and stroma, as well as smooth muscle cells. The structure adenomyotic gland and epithelial cells are clearly damaged, with disappearance of cilium. Fertility and Sterility 2009 91, 2338-2343DOI: (10.1016/j.fertnstert.2008.03.017) Copyright © 2009 American Society for Reproductive Medicine Terms and Conditions

Figure 3 Changes in subcellular structure of high-intensity focused ultrasound-treated endometrial gland cell. The continuity of nuclear membrane is interrupted, and chromatin is concentrated at the peripheral region of the nuclei. Plasma membrane is disintegrated, and some vacuoles are observed in cytoplasm. It is difficult to identify intracytoplasmic organelles, with formation of abnormal sheath-shaped structures (×30,000). Fertility and Sterility 2009 91, 2338-2343DOI: (10.1016/j.fertnstert.2008.03.017) Copyright © 2009 American Society for Reproductive Medicine Terms and Conditions

Figure 4 Histochemical changes in nicotinamide adenine dinucleotide (NADH) activity at the marginal region of ablated localized adenomyosis after high-intensity focused ultrasound treatment. The treated tissue (T) presents negative staining, and the untreated tissue (U) shows positive staining (blue color). A clear margin (arrow) is observed between the treated and untreated regions (NADH-diaphorase histochemical stain, ×400). Fertility and Sterility 2009 91, 2338-2343DOI: (10.1016/j.fertnstert.2008.03.017) Copyright © 2009 American Society for Reproductive Medicine Terms and Conditions