Clinical and morphological features of nodular and diffuse adenomyosis


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Abstract

Objective. To enhance the efficiency of diagnosis and surgical treatment in patients with nodular and diffuse adenomyosis, by investiating the expression of stem cell markers in the eutopic and ectopic endometrium. Subjects and methods. A total of150 women aged 18 to 55 years with diffuse and nodular forms of adenomyosis were examined and surgically treated. Their intraoperative material underwent histological and immunohistochemical examinations. The expression of the stem cell markers Musashi-1, COX-2, and Oct4 markers was investigated. Results. Organ-sparing surgery was performed in 91 out of the 150 examinees; the others underwent radical surgery. The mean nodular size in adenomyosis was 3.85±2.20 cm. In the nodular form, the nodules were mainly located along the posterior (55.1%) and anterior (38.6%) uterine walls and in the area of its fundus (13.5%). Immunohistochemical analysis of the tussues of the endometrium and adenomyosis revealed that a positive reaction for Musashi-1 was observed in both the nuclei and cytoplasm of glandular and stromal cells. There was a cytoplasmic reaction for COX-2. A positive immunohistochemical reaction for OCT4 was seen in the nuclei of epithelial and stromal cells. Conclusion. Our findings may suggest that the major components in the development of adenomyosis are a weakened or damaged connective tissue area and the activation of different properties of stem cells in the eutopic endometrium, which manifested, in particular, as overexpression of stem cell markers. The results of our investigation and the data available in the literature can partially explain the lack of effects from hormone treatment and the cause of recurrent disease, indicating the necessity of searching for targeted impacts just on these components of pathogenesis.

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About the authors

Kistaman Magomedzapirovna Dzhamalutdinova

Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: DK0590@mail.ru
post-graduate student of the Department of Operative Gynecology

Irena Feliksovna Kozachenko

Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Ph.D., Senior Researcher, Department of Operative Gynecology

Aleksandr Ivanovich Shchegolev

Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Doctor of Medical Sciences, Professor, Head of Pathology and Anatomy Department

Nafisa Munavarovna Faizullina

Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: nafisa05@inbox.ru
Ph.D., senior researcher of the pathoanatomical department

Leila Vladimirovna Adamyan

Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: Adamyanleila@gmail.com
MD, Professor, Academician of the Russian Academy of Sciences, Deputy Director for Research and Head of the Department of Operative Gynecology

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