V.F.Snegirev Archives of Obstetrics and Gynecology

In the clinical lecture there are considered modern aspects of pathogenesis, risk factors, diagnosis and treatment of uterine myoma - one of the most common diseases in females of reproductive and menopausal age. Among the major pathogenetic mechanisms of the development of uterine myoma the special attention has been paid to gene and chromosomal aberrations, disturbances of carbohydrate and fat metabolism, chronic inflammatory responses. There was emphasized the attention to modern organ-saving methods of the management of uterine myoma with taking in account the clinical course of the disease, probable complications. There are considered possibilities of various modalities of hormonal therapy as preoperative preparation and prevention of recurrences of uterine myoma after the execution of the organ-saving surgery.

The purpose of the study was to investigate clinical, morphological and immunohistochemical features and pathogenetic interrelationship between focal, nodular and diffuse forms of adenomyosis. There was investigated surgical samples of removed uterines and their fragments; patients were divided into 3 groups, the 1st group was consisted of 16 cases with focal adenomyosis, the 2nd - 24 females with nodular form of adenomyosis, the 3rd - 21 female with diffuse form of adenomyosis. All patients were underwent general clinical examination, instrumental and laboratory observation with the aim of the verification of the diagnosis. There were executed macro- and microscopic immunohistochemical investigations of fragments of the tissue from the zone of endometrioid heterotopias, surrounding myometrium and eutopic endometrium. There were used antibodies: Ki-67, PTEN, ER, PR (“DAKO”), p16 (“Roshe”). There was established the significant increase in the expression of proliferation marker Ki-67, in parallel with a decrease in the expression level of PTEN, ER, PR from the focal to the nodular and diffuse forms of adenonomyosis. Thus it seems to be possible to consider focal, nodular and diffuse forms of adenomyosis as forms-phases of adenomyosis, that according both to histological characteristics of adenomyosis and immunohistochemical markers offocal and nodular forms may antedate the diffuse form of adenomyosis, that is also confirmed by the detection of a combination of all of these forms. Diffuse form of adenomyosis can be assumed to have the highest potential for the growth and dissemination of the pathological process in the uterine.

In the article there are presented main approaches to the diagnosis, treatment and follow-up of patients with classical and nonclassical forms of 21-hydroxylase deficiency. The techniques of diagnostic tests and parameters of hormonal indices for the assessment of the adequacy of replacement therapy with glucocorticoids and mineralocorticoids are considered.