ENDOMETRIAL MORPHOFUNCTIONAL STATE IN REPRODUCTIVE-AGED PATIENTS WITH UTERINE MYOMA

Objective. To study endometrial clinical, morphological, and immunohistochemical features in patients with uterine myoma. Subject and methods. The paper included the results of a prospective study in 101 women treated at the Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, from 2011 to 2012. The patients’ age ranged 18 to 39 years (34.4±3.4 years). Four clinical groups of patients with uterine myoma were formed: 1) 22 patients with endometrial polyps; 2) 11 with simple and complex endometrial hyperplasia; 3) 17 with chronic endometritis; 4) 51 without endometrial pathological changes. Immunohistochemical examination was made using paraffin-embedded sections. The expression of PR, ER, LIF, and Ki-67 was investigated. Results. Comorbidity occurs at different frequencies in different types of uterine leiomyoma (UL). Thus, the patients with simple UL were found to have endometrial polyps in 20%, simple hyperplasia in 10%, and chronic endometritis in 16.7%. At the same time, in the patients with cellular UL, there were endometrial polyps in 40%, simple hyperplasia in 10%, and chronic endometritis in 20%. The unchanged endometrium was more common in patients with simple UL (53.3%) than in those with cellular UL (30%). Conclusion. The immunohistochemical examination of different types of endometrial pathology in patients with UL showed an imbalance between steroid hormone receptors in the endometrium, by increasing progesterone receptors and by decreasing estrogen receptors and hence disturbing the progesterone/estrogen receptor ratio. The high levels of progesterone receptors in the endometrium and uterine myoma tissue give rise to both endometrial receptivity impairment and myoma nodular growth, which may indicate that there is a correlation between the proliferative processes in the endo- and myometrium and may suggest that there is a close relationship between the development of pathological processes in the endo- and myometrium.

uterine myoma, endometrial pathology, endometrial receptivity