Hysteroscopic, morphofunctional and immunohistochemical endometriun features in women with uterine leiomyoma after different types of organ-preserving treatment

Abstract

Uterus leiomyoma is the most common benign tumor that takes one of the leading places in the structure of gynecological pathology. According to different authors proportion of this disease in the infertility structure is 48–55.3%, in the structure of pregnancy miscarriage – 14–18%, in pregnancy and childbirth complications – 10–30%. Uterus leiomyoma reduces in vitro fertilization results from 29% to 9% in cases of submucous nodus localization, lowers pregnancy rate to 28.2% against 63.4% after hysteroscopic node resection. The authors performed a study to improve the efficiency of uterine fibroids treatment through the development of methods to improve the functional state of the endometrium after use of different types of organ-preserving surgery. Following data were received after various types of organ saving surgical procedures: patients with normal endometrium structure (73.33%) dominated at first group. Endometrial hypoplasia was found in 20% cases of the identified pathology. Endometrial fibro-glandular type polyps were found in 6.67% of cases. The main features of this group were uneven focal estrogen receptor down regulation, disturbance of natural killer cells CD16 and CD56 and CD45 expression, compared to the control group. Immunohistochemical study showed positive expression of CD138 (plasma) in 25% of cases in endometrium of women after uterine artery embolization, indicating the presence of chronic endometritis in this group. Immunohistochemical studies of endometrium in the third group showed high level expression of inflammatory markers (CD45, CD16 and CD56). It was detected a significant increase in expression of the proliferation marker Ki-67 in endometrial stroma in the IIIb group, indicating a potential risk of hyper proliferation against a background of inflammatory process of the endometrium. Thus, endometrium changes after organ saving surgical treatment of uterine leiomyoma, such as uterine artery embolization, conservative myomectomy, hysteroscopic resection of node determines the need for the prevention of endometrial dysfunction after surgery.