Clinical and morphological characteristics of the endometrium in intrauterine synechiae: evaluation of the expression of estrogen and progesterone receptors

Objective. To evaluate the expression of estrogen receptors (ER) and progesterone receptors (PR) in the nuclei of the glandular epithelium and endometrial stroma, and intrauterine synechiae in reproductive-aged women. Subjects and methods. Endometrial samples from 30 patients with intrauterine synechiae and from 10 control group patients, who had been operated on at the Department of Gynecology, V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, were examined during a prospective study. Endometrial tissue samples were taken using pipelle biopsy and then morphologically studied by the standard procedure. Histological findings could reveal 3 grades of intrauterine synechiae. Immunohistochemical examination was made using monoclonal antibodies against PR (clone 636, Dako, Denmark) and ER (clone 1D5, Dako, Denmark); the Dako REAL EnVision system (Dako, Denmark) served as secondary antibodies. After immunohistochemical reactions, the sections were contrasted with hematoxylin and eosin and placed into the Shandon mount TM medium (USA). The degree of nuclear staining intensity was determined by a semiquantitative assay. Results. The immunohistochemical examination showed that the ER expression in the glandular epithelium and endometrial stroma was significantly higher in the women with moderate and medium intrauterine synechiae than that in the apparently healthy women; that the PR expression in the glandular epithelium and endometrial stroma was lower in the women with all grades of the adhesive process than that in the endometrium of the apparently healthy women. Conclusion. The found increased ER expression in the epithelium and stroma of intrauterine synechiae and surrounding endometrium in the proliferative phase of the menstrual cycle in reproductive-aged women with grades I and II intrauterine synechiae, as well as the decreased ER expression in all grades of the process are a prerequisite for a differentiated approach to prescribing hormone therapy after surgical adhesiolysis.

intrauterine synechiae, Asherman’s syndrome, immunohistochemistry, estrogen receptors (ER), progesterone receptors (PR), endometrial receptivity