Clinical and morphometric characteristics of endometrial polyps and underlying mechanisms of abnormal uterine bleeding


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Abstract

The incidence of various types of abnormal uterine bleeding (AUB) in patients with endometrial polyps (EP) and their underlying mechanisms remain unclear, which causes diff iculties in the diagnosis and the choice of optimal management strategy. Aim To investigate the histological and morphometric characteristics of EPs and their association with AUB. Materials and methods. Medical records (n = 130) were reviewed to retrospectively analyze the course of the disease, histological, and morphometric characteristics of EPs. Results. In the study cohort, 60.8% of patients with EPs had AUB, every second woman had AUB characterized by prolonged and excessive menstrual bleeding, every third had intermenstrual bleeding, and the remaining patients had their combination. Morphometric analysis showed that EPs associated AUB had dilated thin-walled capillaries. Co-occurrence of EPs with chronic endometritis (CE) aggravates the vascular changes and increases the likelihood of AUB. Conclusions. AUB that was observed in every second patient with EP may be caused by the vascular wall pathological abnormalities, which were most significantly expressed in patients with CE.

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About the authors

Alexandra V. Asaturova

V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology of Minzdrav of Russia

Email: a_asaturova@oparina4.ru
Ph.D., Senior Researcher at the Department of Anatomic Pathology

Galina E. Chernukha

V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology of Minzdrav of Russia

Email: g_chernukha@oparina4.ru
Professor, Dr.Med.Sci., Head of the Department of Gynecologic Endocrinology

Ilya A. Ivanov

V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology of Minzdrav of Russia

Email: doctor.i.ivanov@yandex.ru
Ph.D. Student at the Department of Gynecologic Endocrinology

Andrey A. Kuzemin

V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology of Minzdrav of Russia

Email: andkuzemin@mail.ru
Ph.D., Head the One Day Clinic.

References

  1. Clark T.J., Stevenson H. Endometrial polyps and abnormal uterine bleeding (AUB-P) - what is the relationship; how are they diagnosed and how are they treated? Best Pract. Res. Clin. Obstet. Gynaecol. 2017; 40: 89-104
  2. Tanos V., Berry K.E., Seikkula J., Abi Raad E., Stavroulis A., Sleiman Z. et al. The management of polyps in female reproductive organs. Int. J. Surg. 2017; 43: 7-16.
  3. Capmas P., Pourcelot A.G., Giral E., Fedida D., Fernandez H. Office hysteroscopy: a report of 2402 cases. J. Gynecol. Obstet. Biol. Reprod. (Paris). 2016; 45(5): 445-50.
  4. Чернуха Г.Е., Асатурова А.В., Иванов И.А., Думановская М.Р. Структура патологии эндометрия в различные возрастные периоды. Акушерство и гинекология. 2018; 8: 129-34.
  5. Саттаров Ш.Н., Коган Е.А., Саркисов С.Э., Мамиконян И.О., Бойко М.А., Гюрджян С.А. Молекулярные механизмы патогенеза полипов эндометрия в постменопаузе. Акушерство и гинекология. 2013; 6: 17-22.
  6. Elfayomy A.K., Soliman B.S. Risk factors associated with the malignant changes of symptomatic and asymptomatic endometrial polyps in premenopausal women. J. Obstet. Gynaecol. India. 2015; 65(3): 186-92.
  7. Kanthi J.M., Remadevi C., Sumathy S., Sharma D., Sreedhar S., Jose A. Clinical study of endometrial polyp and role of diagnostic hysteroscopy and blind avulsion of polyp. J. Clin. Diagn. Res. 2016; 10(6): QC01-4.
  8. Wolfman W., Leyland N., Heywood M., Singh S.S., Rittenberg D.A., Soucy R. et al. Asymptomatic endometrial thickening. J. Obstet. Gynaecol. Can. 2010; 32(10): 990-9.
  9. Sarvi F., Alleyassin A., Aghahosseini M., Ghasemi M., Gity S. Hysteroscopy: A necessary method for detecting uterine pathologies in post-menopausal women with abnormal uterine bleeding or increased endometrial thickness. Iran. Turk. J. Obstet. Gynecol. 2016; 13(4): 183-8.
  10. Xuebing P., TinChiu L., Enlan X., Jing L., Xiaowu H. Is endometrial polyp formation associated with increased expression of vascular endothelial growth factor and transforming growth factor-beta1? Eur. J. Obstet. Gynecol. Reprod. Biol. 2011; 159(1): 198-203.
  11. Arici B., Cengiz H., Yas arL., Ozdemir I.A., Keven M.C. The effects of the number, location, dimension and histopathological diagnosis of endometrial polyps on laboratory and clinical findings. Gaziantep. Med. J. 2012; 18(2): 90-4.
  12. American Association of Gynecologic Laparoscopists. AAGL practice report: practice guidelines for the diagnosis and management of endometrial polyps. J. Minim. Invasive Gynecol. 2012; 19(1): 3-10.
  13. Кондриков Н.И., Баранова И.В. Патология матки. Руководство для врачей. М.: Практическая медицина; 2019: 229-33.
  14. Kurman R.J., Ellenson L.H., Ronnett B.M., eds. Blaustein’s pathology of the female genital tract. 6th ed. Springer; 2011: 342-5.
  15. Fritz M.A., Speroff L., eds. Clinical gynecologic endocrinology and infertility. 8th ed. Wolters Kluwer; 2010: 591-612.
  16. Donoghue J.F., McGavigan C.J., Lederman F.L., Cann L.M., Fu L., Dimitriadis E. et al. Dilated thin-walled blood and lymphatic vessels in human endometrium: a potential role for VEGF-D in progestin-induced break-through bleeding. PLoS One. 2012; 7(2): e30916.
  17. Kayisli U.A., Basar M., Guzeloglu-Kayisli O., Semerci N., Atkinson H.C., Shapiro J. et al. Long-acting progestin-only contraceptives impair endometrial vasculature by inhibiting uterine vascular smooth muscle cell survival. Proc. Natl. Acad. Sci. USA. 2015; 112(16): 5153-8.
  18. Schatz F., Guzeloglu-Kayisli O., Arlier S., Kayisli U.A., Lockwood C.J. The role of decidual cells in uterine hemostasis, menstruation, inflammation, adverse pregnancy outcomes and abnormal uterine bleeding. Hum. Reprod. Update. 2016; 22(4): 497-515.
  19. Cheng W., Wang Y.J., Zhang X., Gao X.M. The effect on angiogenesis of endometrium after transcervical resection of polyp. Sichuan Da Xue Xue Bao Yi Xue Ban. 2010; 41(5): 854-7.
  20. Indraccolo U., Di Iorio R., Matteo M., Corona G., Greco P., Indraccolo S.R. The pathogenesis of endometrial polyps: a systematic semi-quantitative review. Eur. J. Gynaecol. Oncol. 2013; 34(1): 5-22.
  21. Cobellis L., Caprio F., Trabucco E., Mastrogiacomo A., Coppola G., Manente L. et al. The pattern of expression of Notch protein members in normal and pathological endometrium. J. Anat. 2008; 213(4): 464-72.
  22. Boras E., Slevin M., Alexander M.Y., Aljohi A., Gilmore W., Ashworth J. et al. Monomeric C-reactive protein and Notch-3 co-operatively increase angiogenesis through PI3K signalling pathway. Cytokine. 2014; 69(2): 165-79.
  23. Carvalho F.M., Aguiar F.N., Tomioka R., de Oliveira R.M., Frantz N., Ueno J. Functional endometrial polyps in infertile asymptomatic patients: a possible evolution of vascular changes secondary to endometritis. Eur. J. Obstet. Gynecol. Reprod. Biol. 2013; 170(1): 152-6.
  24. Гомболевская Н.А., Бурменская О.В., Демура Т.А., Марченко Л.А., Коган Е.А., Трофимов Д.Ю., Сухих Г.Т. Оценка экспрессии мРНК генов цитокинов в эндометрии при хроническом эндометрите. Акушерство и гинекология. 2013; 11: 35-41.

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