Abstract
Hyperproliferative diseases of the endometrium play an important role in the structure of gynecological pathology, which are a spectrum of irregular morphological changes. Particularly difficult is evaluation of the phenotypic characteristics of the endometrium hyperplastic processes (EHP) in premenopausal women in the presence of an unstable menstrual cycle. Diagnosis and EHP prognosis remains a difficult task given that it can occur as focal or diffuse lesions with various structural and cytological differences.Objective of the study: to evaluate the immunohistochemical features (phenotypic variants) of benign endometrial hyperplasia in premenopausal women.Material and methods. 33 premenopausal women with abnormal uterine bleeding and verified benign endometrial hyperplasia were examined. Expression of the α-receptors for estrogens type 1 (ER1), progesterone receptors and Ki-67 nuclear protein in the endometrium stroma and glands was analyzed. Micromorphometry was performed and the D-score was calculated.Results. Prevalence of comorbid lesions in patients was the combination of endometrial hyperplasia and fibroids (51.4%), cases of abnormal uterine bleedings against submucosal fibroids (13.5%), endometrial polyps (8.1%), combinations of EHP and peritoneal endometriosis (10.8%), adenomyosis and myoma (8.1%), or other combinations of endometrial and myometrial proliferative pathology. D-score for surgery averaged 1.78 ± 0.11 indicating a low risk of malignancy. There were changes after treatment in the quantitative presentation of the studied proteins in stroma and endometrial glands. Thus, before treatment in the glands was determined up to 100% of cells containing ER1 in large quantities, while after treatment their number decreased by an average of 20%. Similar dynamics was observed with progesterone receptors activity.Conclusions. The main prognostic significant phenotypes of endometrial proliferative pathology have been identified. After removing of pathologically chanced endometrium and subsequent treatment with dydrogesterone during 6 months there is prognostically positive decreasing in the ER1 density as well as the Ki-67 protein expression
Highlights
In the structure of gynecological pathology an important role is played by hyperproliferative diseases of the endometrium, which are a spectrum of irregular morphological changes, resulting in pathological proliferation of endometrial glands
It is suggested that most cases of endometrial hyperplastic processes (EHP) develop on the background of chronic endometrial stimulation by estrogens, when the effects of gestagens are not perceived, that is, they may occur secondary to a number of possible conditions
Further analysis revealed that after surgery there is a decrease in the density of estrogens type 1 (ER1) receptors as well as the expression of Ki-67 protein
Summary
In the structure of gynecological pathology an important role is played by hyperproliferative diseases of the endometrium, which are a spectrum of irregular morphological changes, resulting in pathological proliferation of endometrial glands. It leads to an increase in the ratio of gland to stroma compared with the endometrium in proliferative phase [1, 2]. Benign endometrial hyperplasia (simple, complex) is a normal endometrial tissue that responds to abnormal hormonal microenvironment (hyperestrogenia) by diffuse polyclonal estrogen-induced changes: size increase, gland density, thrombosis, ruptures. Endometrial intraepithelial neoplasia or atypical endometrial hyperplasia is a pathological, genetically compromised tissue that has clonal mutations (inactivation of PTEN – tumor suppressor protein, PAH-2 – transcription factor, etc.) [20, 22]
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