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

References

  1. Баскаков В.П., Цвелев Ю.В., Кира Е.Ф. Эндометриоидная болезнь. СПб.: Издательство Н-Л; 2002. 452с. [Baskakov V.P., Tsvelev Yu.V., Kira E.F. Endometriosis disease. St. Petersburg: Publishing House N-L; 2002. 452p. (in Russian)]
  2. Адамян Л.В. Сочетанные доброкачественные опухоли и гиперпластические процессы матки (миома, аденомиоз, гиперплазия эндометрия). Клинические рекомендаций по ведению больных. М.; 2015. 26с. [Adamyan L.V. Combined benign tumors and hyperplastic processes of the uterus (myoma, adenomyosis, endometrial hyperplasia). Clinical recommendations for managing patients. Moscow; 2015. 26c. (in Russian)]
  3. Brosens J.J., Barker F.G., de Souza N.M. Myometrial zonal differentiation and uterine junctional zone hyperplasia in the non-pregnant uterus. Hum. Reprod. Update. 1998; 4(5): 496-502.
  4. Gargett C.E., Nguyen H.P., Ye L. Endometrial regeneration and endometrial stem/progenitor cells. Rev. Endocr. Metab. Disord. 2012; 13(4): 235-51. doi: 10.1007/s11154-012-9221-9.
  5. Шкляр А.А., Адамян Л.В., Коган Е.А., Парамонова Н.Б., Козаченко И.Ф., Гаврилова Т.Ю., Кононов С.Н. Трудности диагностики узловой и диффузной форм аденомиоза. Акушерство и гинекология. 2015; 3: 67-72. [Shklyar A.A., Adamyan L.V., Kogan E.A., Paramonova N.B., Kozachenko I.F., Gavrilova T.Yu., Kononov S.N. Difficulties in diagnosing nodular and diffuse adenomyosis. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2015; 3: 67-72. (in Russian)]
  6. Chen Y.Z., Wang J.H., Yan J., Liang Y., Zhang X.F., Zhou F. Increased expression of the adult stem cell marker Musashi-1 in the ectopic endo metrium of adenomyosis does not correlate with serum estradiol and progesterone levels. Eur. J. Obstet. Gynecol. Reprod. Biol. 2014; 173: 88-93.
  7. Gargett C.E., Schwab K.E., Deane J.A. Endometrial stem/ progenitor cells: the first 10 years. Hum. Reprod. Update. 2016; 22(2): 137-63.
  8. Rogers P.A., D’Hooghe T.M., Fazleabas A., Gargett C.E., Giudice L.C., Montgomery G.W. et al. Priorities for endometriosis research: recommendations from an international consensus workshop. Reprod. Sci. 2009; 16(4): 335-46.
  9. Koninckx P.R., Ussia A., Adamyan L., Wattiez A., Donnez J. Deep endometriosis: definition, diagnosis, and treatment. Fertil. Steril. 2012; 98(3): 564-71. doi: 10.1016/j.fertnstert.2012.07.1061.
  10. Shklyar A.A., Adamyan L.V., Kogan E.A., Gavrilova T.Y., Kozachenko I.F. Receptivity of endometrioid heterotopias with nodular and diffuse forms of adenomyosis. J. Minim. Invasive Gynecol. 2015; 22(6, Suppl.): S171. doi: 10.1016/j.jmig.2015.08.636.
  11. Brunn J., Block U., Ruf G., Bos I., Kunze W.P., Scriba P.C. Volumetrie der Schilddrusenlappen mittels Realtime-Sonogrpahie. Dtsch. Med. Wochenschr. 1981; 106(41): 1338-40.
  12. Давыдов А.И., Пашков В.М., Шахламова М.Н. Аденомиоз: новый взгляд на старую проблему. Вопросы гинекологии, акушерства и перинатологии. 2016; 15(2): 59-66. [Davydov A.I., Pashkov V.M., Shakhlamova M.N. Adenomyosis: A new look at the old problem. Voprosy ginekologii, akusherstva i perinatologii. 2016; 15 (2): 59-66 (in Russian)]
  13. Götte M., Greve B., Kelsch R., Müller-Uthoff H., Weiss K., Kharabi Masouleh B. et al. The adult stem cell marker Musashi-1 modulates endometrial carcinoma cell cycle progression and apoptosis via Notch-1 and p21WAF1/CIP1. Int. J. Cancer. 2011; 129(8): 2042-9.
  14. Gotte M., Wolf M., Staebler A., Buchweitz O., Kelsch R., Schuring A.N., Kiesel L. Increased expression of the adult stem cell marker Musashi-1 in endometriosis and endometrial carcinoma. J. Pathol. 2008; 215(3): 317-29.
  15. Nguyen M.S., Voci S. Adenomyomatosis. Ultrasound Q. 2013; 29(3): 215-7.
  16. Chang J.H., Au H.K., Lee W.C., Chi C.C., Ling T.Y., Wang L.M. et al. Expression of the pluripotent transcription factor OCT4 promotes cell migration in endometriosis. Fertil. Steril. 2013; 99(5): 1332-9.
  17. Proestling K., Birner P., Balendran S., Nirtl N., Marton E., Yerlikaya G. et al. Enhanced expression of the stemness-related factors OCT4, SOX15 and TWIST1 in ectopic endometrium of endometriosis patients. Reprod. Biol. Endocrinol. 2016; 14(1): 81.
  18. Pacchiarotti A., Caserta D., Sbracia M., Moscarini M. Expression of oct-4 and c-kit antigens in endometriosis. Fertil. Steril. 2011; 95(3): 1171-3.
  19. Au H.K., Chang J.H., Wu Y.C., Kuo Y.C., Chen Y.H., Lee W.C. et al. TGF-βI regulates cell migration through pluripotent transcription factor OCT4 in endometriosis. PLOS One. 2015; 10(12): e0145256.
  20. Wang Y., Qu Y., Song W. Genetic variation in COX-2 -1195 and the risk of endometriosis and adenomyosis. Clin. Exp. Obstet. Gynecol. 2015; 42(2): 168-72.
  21. Chen C. COX-2’s new role in inflammation. Nat. Chem. Biol. 2010; 6(6): 401-2.
  22. Chen Y.J., Li H.Y., Chang Y.L., Yuan C.C., Tai L.K., Lu K.H. et al. Suppression of migratory/invasive ability and induction of apoptosis in adenomyosis-derived mesenchymal stem cells by cyclooxygenase-2 inhibitors. Fertil. Steril. 2010; 94(6): 1972-9.

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