Hyperplastic Processes Research Articles

PERIPHERAL ODONTOGENIC FIBROMA IN THE GINGIVA

A 22-year-old Caucasian male was referred to evaluate an isolated lesion in the region of tooth 23. During anamnesis, a slow, progressive, and painless growth was perceived, not bleeding upon palpation and with no color change, with a one-year evolution. On clinical examination, a well-defined exophytic enlargement was noticed, with no color change in the distal papilla of tooth 23. Some gingival hyperplastic process was suspected. Imaging exams were requested, in which a possible fibro-osseous lesion was detected in the apical region of the same tooth. A biopsy was performed, targeting the intrasulcular region between teeth 22 and 25, from which a bone fragment and the entire soft tissue lesion were collected. The material was sent for histopathological analysis, and the report was conclusive for peripheral odontogenic fibroma over vital bone tissue. The patient is currently under follow-up, with no clinical signs of recurrence. A 22-year-old Caucasian male was referred to evaluate an isolated lesion in the region of tooth 23. During anamnesis, a slow, progressive, and painless growth was perceived, not bleeding upon palpation and with no color change, with a one-year evolution. On clinical examination, a well-defined exophytic enlargement was noticed, with no color change in the distal papilla of tooth 23. Some gingival hyperplastic process was suspected. Imaging exams were requested, in which a possible fibro-osseous lesion was detected in the apical region of the same tooth. A biopsy was performed, targeting the intrasulcular region between teeth 22 and 25, from which a bone fragment and the entire soft tissue lesion were collected. The material was sent for histopathological analysis, and the report was conclusive for peripheral odontogenic fibroma over vital bone tissue. The patient is currently under follow-up, with no clinical signs of recurrence.

СОВРЕМЕННЫЙ СОЦИО-СОМАТИЧЕСКИЙ ПОРТРЕТ ЖЕНЩИНЫ С ПАТОЛОГИЧЕСКИМ КЛИМАКСОМ

Introduction. Nowadays, the number of menopausal women in the world population has strong tendency to increase. According to statistics the majority have a moderate and severe course of it. This is the reason preventive gerontology develops today, especially climatology. That is why using new machine learning technologies is relevant today. Such method as gradient boosting helped us to identify the characteristic features and factors that cause the pathological course of menopause in women which made it possible to draw up a medical «portrait» of such patients. Using the knowledge of these factors influence it is easily to recognize women needs to be observed even before the manifestations of menopause. Aim. The aim of the study is to conduct a socio-somatic «portrait» of a modern patient with a pathological menopause. Material and methods. A detailed survey of 1275 women aged 45–60 years was carried out with an assessment of the socio-cultural status, general somatic and gynecological health. The received data were sorted and categorized using modern statistical processing methods and machine learning method - gradient boosting. Results and discussion. Firstly, there are factors with high influence on menopausal syndrome developing: level of education, oncological anamnesis, diseases of the gastrointestinal tract, vegetative and insomnia disorders, the use of intrauterine contraceptives, the number of children 2 or more, the presence of abortions in anamnesis. The rest of the questionnaires were characterized as having only a small impact. This is a pathology of the thyroid gland, the cardiovascular system; hyperplastic processes in history; occupation, namely social and medical workers, as well as a negative attitude towards menopause. The greater number of these features one woman has, the higher the likelihood of developing a pathological menopause she gets. Conclusion. The collective image we have received of a modern patient with pathological menopausal syndrome is based on aspects of the life and health of women which it is worth paying attention on. This can serve as a kind of guideline for clinicians in order to achieve correction of hypoestrogenism with the development of a pathological menopause.

A differentiated approach to the management of patients with hyperplastic diseases of the uterus complicated by abnormal uterine bleeding

The purpose: to justify a differentiated approach to the management of patients with hyperplastic uterine diseases complicated by abnormal uterine bleeding (AUB) based on the study of the morpho-functional features of the endo- and myometrium. It has been shown that PgR expression is low in patients with combined lesions of the endometrium and myometrium complicated by AMC. The degree of PgR expression has a strong negative correlation with pathological changes of the endometrial-myometrial junction (r=-0.71), which made it possible to consider these criteria in the creation of a differentiated algorithm for the management of patients taking into account clinical and morphological pathogenetic variants of the disease. The use of differentiated approaches to the treatment of patients with combined hyperplastic processes of the uterus, taking into account the clinical and morphological features of the disease, made it possible to reduce the number of recurrences of AMC and achieve a long-term clinical effect in comparison with traditional treatment.

Clinical factors of the risk of hyperplastic endometry processes on tamoxifen therapy with breast cancer: Retrospective population study

Background. One of the main stages of the treatment of breast cancer (BC) is endocrine therapy with tamoxifen or aromatase inhibitors. Five years of adjuvant tamoxifen therapy reduces the risk of disease recurrence by 39%. Tamoxifen was approved by the U.S. Food and Drug Administration in 1977 as a treatment for ER-positive BC. However, sometime after the start of tamoxifen's wide use, reports have been published on its long-term adverse effects. Most common were hot flashes, gynecological symptoms (vaginal dryness, vaginal discharge), depression, forgetfulness, sleep changes, weight gain, and decreased libido. However, more serious adverse events such as venous thromboembolic disease and endometrial hyperplasia or cancer are the most clinically significant. The article presents the results of a retrospective population-based study on assessing hyperplastic processes of the endometrium (HPE) in patients with breast cancer during TAM therapy, conducted in 2017, approved by the Ethics Committee of the Scientific Research of the Russian Medical Academy of Continuing Professional Education. Aim. To identify clinical factors that may increase the risk of HPE during tamoxifen therapy in patients with a history of breast cancer living in the Moscow region. Materials and methods. We retrospectively reviewed 230 case histories of patients with breast cancer. Of these, 120 patients who received TAM therapy had the following HPE risk factors: average age, menopausal status, body mass index, and duration of TAM therapy. Results. It was found that patients with HPE taking TAM were older (p=0.017), more likely to be postmenopausal (p=0.035), overweight (p=0.023), and received TAM for a longer period (p=0.028) than patients without HPE. Conclusion. The data obtained indicate the need for continuous monitoring by gynecologists of patients with breast cancer taking tamoxifen, paying particular attention to women from high-risk groups, namely older postmenopausal women with high body mass index receiving TAM for more than 1.52 years.

Modern options for the treatment of iron defciency anemia in patients with abnormal uterine bleeding

The article presents a modern, comprehensive approach to the treatment of anemia in abnormal uterine bleeding in patients with endometrial hyperplastic processes. The effectiveness of therapy with the iron-containing drug Sorbifer Durules was evaluated.

Endometrial hyperplasia and progesterone resistance: a complex relationship

The endometrium is one of the most dynamic tissues that constantly undergoes changes during the menstrual cycle in women of the reproductive period. All these processes take place mainly under the influence of steroid hormones that are produced in the woman’s body. However, it is important to remember that throughout life the endometrial tissue undergoes changes under the influence of various factors that lead to imbalances in hormonal regulation. All these changes can lead to the development of endometrial hyperplasia, which has a high risk of both recurrence and malignization. Over the past few decades, the incidence of endometrial cancer has increased in many countries. This trend is thought to be related to the increasing prevalence of obesity, as well as to changing female reproductive patterns. Although there are currently no well-established screening programmers for endometrial cancer, endometrial hyperplasia is a recognized precursor, and its detection provides an opportunity for prevention. Studying the pathogenesis and risk factors will give a great advantage in the future to prevent possible complications. At this point, the activity and inhibition of the different hormone isoforms can lead to different hyperplastic processes. The management of patients depends on many factors: age, species, reproductive potential and other factors. Therefore, a comprehensive approach to treatment is always necessary. In recent years, interest in the study of endometrial hyperplasia has increased dramatically due to the increase in endometrial cancer. Therefore, the issue of early diagnosis and prevention is most urgent in modern gynecology and requires further study. This review reflects the current understanding of the disruption of progesterone signaling mechanisms in endometrial hyperplasia according to domestic and foreign literature.

Phenomenon of hormone-dependent polyneoplasia of the female reproductive system

BACKGROUND: Primary multiplicity of malignant tumors of the female reproductive system is the least studied area of clinical oncology. In addition, the steady rise in the number of patients and various localizations of polyneoplasia with lesions of the female reproductive organs necessitate a detailed study of this problem.
 AIM: This study aimed to determine the incidence and risk factors and describe the clinical aspects of polyneoplasia of the female reproductive system for 20102021 in women seen at the Medical and Rehabilitation Center of the Ministry of Health of Russia, Moscow, and the University Clinical Hospital No. 4 of the I.M. Sechenov First Moscow State Medical University.
 MATERIALS AND METHODS: We conducted a retrospective analysis of the case records of 147 patients with a confirmed diagnosis of polyneoplasia of the female reproductive system for 20102021, which accounted for 3.6% of all newly diagnosed neoplasms of the female reproductive system in the above medical institutions. Moreover, a continuous sampling method was used.
 RESULTS: Breast cancer was the most frequent first tumor, combined with cancer of the contralateral breast in 27 (42.1%) patients, cancer of the uterine body in 4 (6.25%) patients, ovarian cancer in 4 (6.25%) patients, colon cancer in 4 (6.25%) patients, and thyroid cancer in 1 (1.5%) patient. Cancer of the uterine body was combined with breast cancer in 10 (35.7%) patients, ovarian cancer in 2 (7.1%) patients, thyroid cancer in 2 (7.1%) patients, and colon cancer in 3 (11.1%) patients. Endometrioid adenocarcinoma, pathogenic variant I was determined in 20 (71.4%) cases according to the histological structure. Thyroid cancer was detected in 7 (5.6%) cases; in all cases, it developed metachronously, and it was combined as the initial tumor with breast cancer in 1 (14.3%) case, uterine body cancer in 2 (28.5%) cases, and ovarian cancer in 1 (14.3%) case. As the second tumor, it was also combined with uterine body cancer in 2 (28.5%) cases and ovarian cancer in 1 (14.3%) case. The risk factors assessment led to the identification of several factors that are common in patients with hormone-dependent forms of primary multiple cancer, including obesity, diabetes mellitus, irregular menstrual cycle, history of proliferative diseases of the mammary glands, intake of thyroid drugs, uterine hyperplastic processes, and hypothyroidism.
 CONCLUSIONS: Understanding the different aspects of the development and course of hormone-dependent polyneoplasia of the female reproductive system will help in developing approaches for follow-up monitoring of women who have been treated for a primary tumor and are at risk of developing a subsequent tumor of hormone-dependent organs, to prevent the recurrence of the disease and predict the subsequent tumor and ensure its timely detection.

Determining the level of stromal and epithelial cells activity in normal and hyperplastic endometrium of late reproductive and perimenopausal women.

Hyperplastic processes of the endometrium (HPE) are a group of benign endometrial and stromal cells that have undergone altered growth. This study aimed to investigate the potential role of hypoxia (as indicated by Hif-1α) and apoptosis markers (p53 and BCL-2) in the development of hyperplastic processes of the endometrium (HPE). Results showed that endometrial cells with atypical hyperplasia had increased levels of Hif-1ɑ, which indicates the presence of endometrial hypoxia and may trigger pathological manifestations. Though this result was not statistically significant, it could be the cause of atypia hyperplasia in the late reproductive period (Hif-1ɑ=1.89±0.09 units) and the perimenopausal period (Hif-1ɑ=2.09±0.07 units). Additionally, the study found that p53 markers were elevated in epithelial cells in the late reproductive period, and similar patterns were observed in the perimenopausal period, with the biggest expression in atypical hyperplasia. The study also found that the high expression of BCL-2 indicator (+++) was less common in late reproductive period women with atypia than those without it (χ2=7.2 p=0.01). A similar situation was observed in women in the perimenopausal period (χ2=4.2 p=0.04). These findings suggest that hypoxia may play a role in the development of HPE, as well as changes in apoptotic markers present in the endometrial tissue.

ASSESSMENT OF THE MICROBIOTA STATE OF THE REPRODUCTIVE TRACT IN PATIENTS WITH HYPERPLASTIC PROCESSES OF THE ENDOMETRIUM

Hyperplastic processes of the endometrium, in the structure of gynecological pathology, occupy from 15.0% to 50.0% in women of reproductive age, disrupting the reproductive function, manifested by infertility, miscarriage, long, irregular, painful menstruation, high frequency of chronic adnexitis (73.9 %), uterine leiomyomas (45.8%), genital endometriosis (17.7%), cervical erosion (26.0-34%). The development of the disease is associated both with inadequate treatment of the acute altering process and with the primary chronicity of inflammation with a violation of local mechanisms of anti-infective protection. We cannot ignore the important role of inflammatory diseases of the pelvic organs, which causes the increase in the fate of chronic endometritis to 70.0%, and the chronicity of the process, inadequate therapeutic options and resistance to medical measures cause a change in women's field, which, undoubtedly affects the implantation processes.
 The question of the role of an infectious factor in endometrial hyperplasia remains incompletely elucidated and understudied, which preserves the expediency of detailing the pathogenetic mechanisms of endometrial hyperplastic processes.
 The aim of the study: to evaluate the microbiocenosis of the vaginal mucosa in patients with hyperplastic processes of endometrium.
 Materials and methods. A comprehensive clinical and laboratory examination of 80 patients of reproductive age with endometrial hyperplastic processes was performed: 40 patients with endometrial hyperplasia without atypia (group 1), 40 patients with endometrial polyps (group 2). The control group consisted of 30 healthy women without gynecological pathology.
 All patients underwent diagnostic and therapeutic hysteroscopy followed by morphological and immunohistochemical examination. Bacterioscopic and investigation of biomaterial of the reproductive tract was carried out using the "Femoflor" test system in real time. The TORСH-group pathogens were verified by the DNA-PCR method.
 Research results. A significant proportion of menstrual cycle disorders (AUB - 55.0 %, algodismenorrhea - 41.3 %), generative function (infertility - 36.9 %, spontaneous abortions - 18.8 %, missed abortion- 8.8%) and also transferred inflammatory processes of the genitals (dysbiosis, PID, exo-endocervicitis - 75.0%).
 Based on the results of DNA-PCR data evaluation, the following were found: Chlamydia trachomatis — in 24 (30.0%) cases, Mycoplasma genitalium — in 21 (26.3%), Ureaplasma urealyticum — in 17 (21.3%), Candida albicans — in 18 (22.5%), in 37 (46.3%) cases – genital herpes (HSV) types 1 and 2, cytomegalovirus (CMV) and human papillomavirus type 16.18 (HPV) in 23 (28.8%) ), as well as viral (32.5%) and viral-bacterial associations (51.3%). According to the results of the evaluation of the microbiocenosis of the vagina in the examined women with impaired reproductive function against the background of endometrial hyperplasia and endometrial polyps, pronounced dysbiosis prevailed (47.5% and 62.5%, respectively).
 Conclusions. The obtained results confirm the scientific position regarding the important role of an infectious factor in the development of hyperplastic processes of endometrium, and the normalization of the microbiocenosis of the genital tract contributes to the effectiveness of treatment and the prevention of possible relapses.

A prospective observational study on the effectiveness of pterygium excision with limbal conjunctival autograft transplantation and recurrence in patients of primary pterygium

Background: Pterygium is a degenerative and hyperplastic process with abnormal fibrovascular proliferation. Surgery is the treatment of choice in progressive or symptomatic cases but recurrence is a concern. Aims and Objective: We aim to evaluate the effectiveness of pterygium excision and conjunctival autograft (done by post-graduate trainees in the 2nd and 3rd year of residency under supervision) and recurrence of this process in a tertiary care setup. Materials and Methods: It is a single-centric prospective observational study. 50 patients who underwent pterygium excision with conjunctival autografting surgery in a tertiary care hospital were followed up for 1 year. Patients were evaluated on day 1, day 7, 1 month, 6 months, and 1 year. Efficacy and graft stability were assessed on day 7 and 1 month; 6 months and 1 year for recurrence and the factors associated with it. Results: Total number of patients was 50; 31 were female, and 19 were male. All cases were effectively managed with excision and autograft. Post-operatively, 13 (26%) patients had shown suture loosening, 17 (34%) patients had graft edema, and 13 (26%) patients had post-operative recurrence. Out of 13 patients, 8 patients had mild recurrence, 4 patients had moderate recurrence, and 1 patient had severe recurrence. Graft stability is significantly associated with suture loosening (P < 0.05). There is no association between the extent and grade of pterygium (P > 0.05). Recurrence was statistically highly associated with (P < 0.0001) suture loosening. Conclusion: We conclude that autografting is an effective technique. Intraoperative proper suturing technique and minimal tissue manipulation can minimize recurrence.

Hyperplastic processes in the endometrium: controversial and unresolved problems of the disease

Hyperplastic processes in the endometrium: controversial and unresolved problems of the disease

Вторичная профилактика опухолей репродуктивной системы у женщин, проживающих в городских и сельских условиях

Aim: to analyze specific aspects of diagnosing reproductive system disorders in women depending on the place of residence, medical activity and awareness of the female population, staffing resources and the availability of equipment in medical institutions. Patients and Methods: the analysis covered medical records of 9,785 women who, at their own volition, visited the medical center for medical check-up. Gynecological examination, colposcopy, liquid-based cytology, pelvic and breast ultrasound examination, and mammography were performed in all patients. The patients were asked to fill out a questionnaire including the following data: conditions of life and work, lifestyle, and risk factors of malignant tumors of the female reproductive system. Results and Discussion: women over 40 years of age were more concerned about their health status. Thus, it is necessary to find mechanisms for the additional motivation of women of early and middle reproductive age for expanding the screening coverage. It was found out that the differences in the organization of secondary prevention of reproductive system tumors in women living in the urban and rural environments are underpinned by the impact of demographic and social factors, characteristics of medical activity of the population, and staffing shortages in healthcare institutions. These aspects should be taken into consideration for developing methods aimed at overcoming the current failures in the diagnostic process. Conclusion: the establishing of regional "Women's Health Centers" based on multi-disciplinary comprehensive approach will help to improve the detection of tumors of the female reproductive system at the pre-cancer stage, facilitate the timely identification and mitigation of the risk factors of tumor development, and to ensure the prevention of recurrences and progression of hyperplastic processes of the reproductive system in women. KEYWORDS: tumors of reproductive system, prevention, diagnosis, organizational measures. FOR CITATION: Aminodova I.P., Vasiliev M.D., Makarova E.V., Makarova V.I. Secondary prevention of reproductive system tumors in women living in the urban and rural environments. Russian Journal of Woman and Child Health. 2023;6(2):112–118 (in Russ.). DOI: 10.32364/2618- 8430-2023-6-2-112-118.

Non-drug technologies in restoring endometrial receptivity as a cause of impaired fertility in women of reproductive age. (Literature review)

Globally, 13% of the population has difficulty conceiving. In Russia, the proportion of infertile marriages ranges from 8 to 17.5%, with half of all forms of female infertility being the uterine form. The main etiological factors for impaired endometrial receptivity are infectious diseases leading to the development of chronic endometritis (most often found in tuboperitoneal infertility), dishormonal background associated with the development of hyperplastic processes in endocrine infertility, uterine fibroids, chronic endometritis and endometriosis. The frequency of detection of uterine cavity diseases in patients with repeated unsuccessful IVF programs ranges from 18 to 50%. The review examines the etiological factors and other causes of endometrial pathology leading to the development of chronic endometritis, possible mechanisms for the development of impaired growth and receptivity of the endometrium, and, as a consequence, the impossibility of pregnancy. Therapeutic strategies for restoring endometrial thickness and receptivity using pharmacological and non-pharmacological methods are described. Based on the analysis of literature data, it is shown that the use of physiotherapeutic factors in treatment programs that have pronounced anti-inflammatory, immuno- and hormone-modulating, reparative-regenerative, metabolic, vasocorrective and defibrosing effects allows for a relatively short period of time to improve endometrial receptivity, normalize hormonal levels and restore fertility in women of reproductive age, which ensures the possibility of successful embryo implantation, fetal development and childbirth.

EFFECTIVENESS OF HORMONAL TREATMENT IN PATIENTS WITH COMBINED ENDOMETRIAL PATHOLOGY AND BENIGN FORMATIONS OF MAMMARY GLANDS

Issues related to the treatment of HPE are still very relevant, which is due to the high frequency of relapses of this disease. Today, in the arsenal of modern medicine, there are various approaches to the treatment of HPE. However, the development of benign neoplasms of the mammary glands against the background of HPE limits the possibilities of conservative treatment. Hormonal therapy remains one of the most common methods of treating HPE.
 The purpose of the study: to optimize the treatment of patients with various types of hyperplastic processes of the endometrium in combination with benign diseases of the mammary glands.
 Materials and methods. A prospective study of 90 women aged 18 to 47 was conducted. The main group consisted of patients who were diagnosed with HPE and benign diseases of the mammary glands. The comparison group included patients who were diagnosed with HPE without accompanying pathology of the mammary glands. For the treatment of endometrial hyperplasia without atypia, medroxyprogesterone was used, for the treatment of atypical endometrial hyperplasia, medroxyprogesterone was used in combination with a gonadotropin-releasing hormone analog. For the treatment of patients with combined pathology, the commercial drug Danazol or medroxyprogesterone in combination with Koberlin was used.
 The results. The implementation of various treatment regimens for patients with HPE and benign breast neoplasms showed that the more effective treatment regimen was the one involving the use of Danazol. In this group of patients, the levels of estradiol and progesterone in the blood plasma normalized already after six months of using the drug.
 Conclusion. The study of the levels of estrogens, progestins and gonadotropic hormones showed that in the patients of the comparison group, the best treatment scheme is the combined use of medroxyprogesterone and gonadotropin-releasing hormone analogues compared to the monouse of only medroxyprogesterone. In patients with the combined pathology of HPE and mastopathy, the best treatment scheme is the use of Danazol.

Impact of changes in the vaginal microbiome and chronic endometritis on the initiation of hyperplastic processes of the endometrium in women

the article presents a review of the literature, which examines the impact of changes in the vaginal microbiome and chronic endometritis on the development of hyperplastic processes of the endometrium in women. Many studies have proven the undoubted role of these factors in the development of endometrial hyperplastic processes, such as atypical hyperplasia and endometrial polyposis. Chronic endometritis, on the background of which there was a course of endometrial hyperplasia, in 95.1% of women studied was caused by an infection of viral, bacterial or fungal origin. Numerous studies indicate the important role of chronic persistent infection in the development of hyperproliferative processes of the endometrium. The largest role in the pathological process is probably played by bacteria of the genus Gardnerella viridans as well as gram-positive cocci (Streptococcus). Herpes simplex virus, cytomegalovirus, human papilloma virus and pathogenic fungi represented by the genus Candida also influence the occurrence of this process. Further studies of the pathological action of these microorganisms will achieve greater accuracy in the diagnosis of hyperplastic processes of the endometrium.

Analysis of risk factors for the development of hyperproliferative endometrial processes in women of reproductive age

Based on clinical and statistical analysis, a study of the leading etiopathogenetic factors in the development of hyperplastic processes of the endometrium in patients of reproductive age was carried out.The aim of the study: to study the risk factors for hyperplasia and endometrial polyps in women of early reproductive age.Materials and methods. Clinical and statistical analysis of 120 patients of active reproductive age with verified atypical hyperproliferative pathology of the endometrium (hyperplasia and endometrial polyps) was included in the main group. The main group was divided into subgroups: Subgroup I - 45 women with endometrial hyperplasia, Subgroup II - 45 patients with endometrial polyps and Subgroup III - 30 patients with combined endometrial pathology (hyperplasia and endometrial polyps).Results of reseаrсh. The leading risk factors for the development of hyperplastic endometrial processes in women of the examined groups have been identified: aggravated heredity, high frequency of medical abortions, miscarriages and a history of abnormal births. There is a high incidence of gynecological and extragenital diseases, surgical interventions on the uterus and appendages in the examined contingent of women, which contributes to the development of endometrial pathology. It is established that the most common clinical manifestations of endometrial hyperproliferative processes are pain and hemorrhagic syndromes.Conclusions. Risk factors for hyperproliferative pathology of the endometrium in women of reproductive age are the following: burdened heredity (60.8%), concomitant extragenital pathology (57.4%), menstrual disorders (86.7%), impaired reproductive function; burdened gynecological anamnesis: chronic inflammatory processes of the uterus and appendages (45.8%), artificial (74.2%) and spontaneous (22.5%) abortions; intrauterine surgical interventions (26.7%).

Malignant transformation of endometrial hyperplastic processes: immunohistochemical features

Background. Endometrial hyperplasia is one of the most common pathologies of the female reproductive system. There is a high risk of transformation of an atypical form of endometrial hyperplasia into endometrial cancer, which takes a leading position in oncogynecological morbidity. Immunohistochemical markers can become predictors of endometrial malignancy, their role is currently being actively studied.Aim. Search for molecular predictors of malignant transformation of endometrial hyperplasia.Materials and methods. Histological and immunohistochemical studies were performed in 107 patients with diagnoses of endometrial hyperplasia without atypia (EH), endometrial atypical hyperplasia (EIN), endometrioid adenocarcinoma (EC). The tumor receptor status, MSI, expression of ARID1A, PTEN, β-catenin, PAX2, proliferation index (Ki-67) were determined by the immunohistochemical method according to the standard protocol.Results. Loss of PAX2 expression was most common in precancerous and malignant endometrial cells. Loss of PAX2 expression was found in 89 % of cases in the EIN samples, in 86 % of cases in the EC samples and only in 2 cases of EH. Loss of PTEN expression was less common: with an equal proportion in 67 % of the samples of EIN and EC, while practically not occurring in women with benign GE. MSI was detected in 36 % of endometrial cancer samples. There was a deficiency in the DNA repair system in 1 case of EIN. Loss of ARID1A expression was detected in endometrial cancer with a frequency of 33 %. This gene functioned normally in all cases of EIN and EH. The expression of β-catenin was more pronounced in EC than in cases of EH. The Ki-67 proliferation index was statistically higher in the EC group than in EH and EIN.Conclusion. Evaluation of morphological data and expression of the panel of markers PAX2, PTEN, ARID1A, β-catenin, Ki-67 index, PMS2 and MLH1 will improve diagnostic search in case of suspected malignancy of endometrial hyperplasia.

The Role of Minimally Invasive Intrauterine Surgery in Improving the Results of IVF Programs

<h3>Study Objective</h3> to determine the intrauterine pathology in women preparing for IVF and to evaluate the impact of minimally invasive intrauterine interventions on the success of subsequent IVF programs. <h3>Design</h3> prospective observational study, Level II, Canadian Task Force. <h3>Setting</h3> Department of Operative Gynecology, National Medical Research Center of Obstetrics, Gynecology and Perinatology named after V.I. Kulakov, Moscow, Russia. <h3>Patients or Participants</h3> 600 patients preparing for IVF program underwent diagnostic hysteroscopy. <h3>Interventions</h3> All patients underwent diagnostic or operative hysteroscopy on the 5th-8th day of the menstrual cycle. The patients included in the study received infertility treatment following the IVF protocol with controlled ovarian stimulation. <h3>Measurements and Main Results</h3> 36% of the examined patients had normal endometrial morphology, 42.7% had benign endometrial pathology (23.3% had chronic endometritis, 18.3% had endometrial hyperplastic processes), 5.5% of women had atypical hyperplasia and endometrial cancer. 15.9% had other intrauterine pathology. The average duration of infertility was 5.8±0.6 years, 42% of women could not achieve reproduction for more than 5 years, 59.8% had a history of ineffective IVF programs. Based on analysis of data 1 year after embryo transfer, pregnancy occurred in 62% of women. 51% of pregnancies ended in successful childbirth. <h3>Conclusion</h3> Intrauterine pathology that required hysteroscopic evaluation and treatment was observed in 58.5% of women with infertility. Surgical and subsequent conservative treatment of intrauterine pathology contributed to a reduction of the frequency of pregnancy losses (OR 1.4, 95%CI 1,0-2,0), as well as an increase in the frequency of pregnancies that ended in childbirth <b>(</b>OR 1.7, 95% CI 1,2-2,6), on average 1.5 times.

Results of treatment of endometrial hyperplasia with the use of non-steroidal anti-inflammatory agents against the background of chronic endometritis and without accompanying inflammatory process

The paper examines the treatment results of women with non-atypical hyperplastic endometrial processes with the use of anti-inflammatory drugs for a long time. The purpose of our study was to evaluate the effectiveness of the proposed treatment regimen depending on the type of hyperplastic processes and their connection with chronic inflammatory processes in the endometrium. Material and methods. We examined 101 women, of which 29 women with hyperplastic processes without accompanying chronic endometritis were included in experimental group №1, 49 women with a combination of hyperplastic processes and chronic endometritis were included in experimental group №2, the control group included 23 women with hyperplastic processes without chronic endometritis. The control group received only hormonal therapy, the experimental group №1 received long-term anti-inflammatory nonsteroidal drugs in addition to hormonal correction, the experimental group №2 received a course of broad-spectrum antibiotics in addition to anti-inflammatory drugs. Treatment effectiveness was evaluated 6, 12 and 24 months after hysteroscopy.Results of the study. 24 months after hysteroscopy in the control group, we observed 43.5% recurrence of hyperplastic endometrial processes, while at the same time when using anti-inflammatory therapy with non-steroidal drugs (experimental group No. 1), after 24 months we observed 20.7% recurrence ( p&lt;0.05) and in women with a combination of GE and HE (experimental group No. 2) with the use of anti-inflammatory nonsteroidal drugs and antibiotics, the relapse rate was 22.4% (p&lt;0.05). The results of additional studies and the use of statistical methods have proven that the effectiveness of treatment is related to the applied methods and is not accidental.Conclusions. The use of non-steroidal anti-inflammatory drugs increases the effectiveness of anti-recurrence conservative treatment of women with hyperplastic processes after hysteroscopy.

Features of the sonographic picture in female veterans of reproductive age who suffered injuries during combat actions

The objective: to study the features of the sonographic picture of the pelvic organs in women of reproductive age who took part in combat operations and suffered a concussion. Materials and methods. Ultrasound examination of the pelvic organs with Doppler study on the 5th and 21st days of the menstrual cycle was performed in 457 women of reproductive age who took part in combat operations and suffered a concussion. 246 patients of theses persons with a history of trauma without post-concussion syndrome were included in the comparison group, 211 women with consequences of concussion in the form of post-concussion syndrome – in the main group. The control group included 30 healthy civilian women of reproductive age. The concentration of progesterone in blood serum was studied in all subjects on the 5th and 21st days of the menstrual cycle. The average age of women was 37.08±4.23 years. The period of stay in the combat zone was 60.26±42.21 months, the time since the traumatic brain injury (concussion) was 18.8±9.2 months. Results. In patients of the main group without hyperplastic processes of the endometrium the M-echo thickness on the 21st day of the menstrual cycle was 1.12 times less (p&lt;0.001) than in the control group, and 1.15 times less in patients in the comparison group (p&lt;0.001). In 20.71 % of women with a contusion during combat operations, there is an inferior secretory transformation of the endometrium with increased echogenicity only in the peripheral parts of the M-echo with a hypoechoic zone in the center, in 13.81 % of patients there are no secretory changes in the endometrium on echograms, which manifested by the preservation on the 21st day of its three-layer construction, typical for the preovulatory period, with a hypoechoic functional layer. Intrauterine synechiae are formed in 10.95 % of women who suffered contusions during combat operationss, hyperplastic endometrial processes – 30.24 % of women, 12.3 8% of which had hyperplasia, 17.86 % –endometrial polyps.In patients who suffered a contusion during combat operations a decrease in the vascularization of the corpus luteum with a significant increase in the resistance index of blood flow in the corpus luteum by 1.27 times and a decrease in the maximum systolic velocity by 1.19 times was, in the subjects of the main group compared to women of the comparison group – 1.07 (p&lt;0.01) and 1.05 (p&lt;0.01) times, respectively. On the 21st day of the menstrual cycle in women who took part in combat operations and had concussion, a correlation between the level of serum progesterone and the index of blood flow resistance in the corpus luteum – r=-0.76, p&lt;0.05, as well as maximum systolic blood flow velocity - r=0.70, p&lt;0.05 was established. Conclusions. According to the ultrasound examination of the pelvic organs for women of reproductive age who took part in combat operations and suffered a concussion, ultrasound changes in the structure of the tissues of the pelvic organs and their vascularization are typical, in particular, the thickening of the M-echo on the 21st day of the menstrual cycle, and in a third of cases – the presence of hyperplastic changes of the endometrium.