Сучасний погляд на проблему рецидивних гіперпластичних процесів ендометрія

Abstract

A review of current data on the problem of recurrent endometrial hyperplasia, presented in modern domestic and foreign literature, its place in the structure of gynecological morbidity, the impact on reducing fertility among women of childbearing age and the growth of cancer. The issues of existing classifications, their relevance and ease of use are considered. The main etiological factors and clinical and anamnestic factors of endometrial hyperplastic processes, prognostic influence of urogenital infections on endometrial pathology are highlighted. Possible mechanisms of pathogenesis are described, including disturbances of hormonal regulation, factors of local humoral and cellular immunity and molecular mechanisms of cellular regulation. The important role of biomolecular markers in the pathogenesis of hyperplastic processes and the correspondence of their degree of activity to morphological changes of the endometrium, because understanding the basics of induction of cell growth, especially in tumor tissue transformation, is an integral part of a competent approach to the management of patients with hyperplasia. The role of genetic research to assess the risk of malignancy and, accordingly, the choice of conservative or operative treatment tactics is considered. Modern morphometric diagnostic criteria are presented. Emphasis is placed on the need to collect endometrial biopsies under the control of a hysteroscope as the gold standard in the diagnosis of endometrial conditions. A separate role in the diagnosis at the present stage is given to immunohistochemical method; conducting not only histological examination of the removed endometrium, but also its receptor activity provides the ability to select the necessary pharmacological correction and predict the development of neoplastic changes. Variants of hormone therapy schemes of endometrial hyperplastic processes are described, and the order of their appointment, depending on the woman’s reproductive plans, concomitant diseases, age and constitutional features. Particular attention is paid to women with metabolic syndrome and the feasibility of including the correction of metabolic disorders in the treatment of such patients. The duration and frequency of observation of women during treatment are indicated. The presented data demonstrate the lack of a clear algorithm in the tactics of diagnosis and treatment of recurrent hyperplastic processes, which determines the relevance of in-depth scientific study in this area. Keywords: endometrial hyperplasia, recurrence, hysteroscopy, endometrial receptors