*112528*

Duryagin I.V., Ivanov I.I.

SI “Crimea State Medical University named after S. I. Georgievsky”

Impact of endometrial hyperplasia on the immunohystochemical index of steroid hormones receptors

As we know the endometrial hyperplasia (EH) is the non-invasive endometrium proliferation morphologically manifesting with impairment of stromal-vascular balance, epithelial-stromal balance, appearance of different shape and size glands clinically manifesting with dysfunctional bleedings.

According to various sources about 50% women of fertile and predecidual age suffer from EH with 3-14% frequency of endometrial cancer development. Also we should notice this pathology ‘cause of its «rejuvenation», juvenile uterine bleedings compose 20-40% of adolescent age gynecological pathologies.

The target of our investigation is the determination of histological changes in endometrium constitution and to determine receptor sensibility of endometrial cells to estrogen and progesterone in case of such pathology, also we determine the expression level and division of receptors in a tissue. For all of this we use immunohystochemical method as the combination of immunological and hystochemical methods.

The materials for our investigation are 42 fragments of endometrium received during the fractional diagnostic curettage in women aged of 22 to 48 years who applied with complaints connected with acyclic and/or profuse bleedings usually appearing after the menischesis. 9 patients were up to 30 years old, 15 patents were 30 to 40 and 18 patients were above 40 years old. During the investigation in 29 cases simple hyperplasia without atypia was verificated, in 8 cases was the complex hyperplasia without atypia, 3 cases were the simple atypical hyperplasia and in 2 cases complex atypical hyperplasia was verificated.

During the examination of 4 types of endometrial hyperplasia morphological features define changes of estrogen (Er) and progesterone (Pr) receptors expression activity was found. The impairment of impairment of stromal-vascular balance and increasing of mitotic activity were distinctive for all types of endometrial hyperplasia. Glands throughout had different sizes, branchy shapes with multiple excrescences and appendixes and such phenomenon as «gland in gland».

During the histological investigation 29 patients had such changes in endometrium: the number of glands is increased and most of them have irregular shape with multiple excrescences and appendixes, with singular (less frequently plural) cystic-enhanced glands lined with inline flattened prismatic epithelium with roundish normochromic nucleuses and homogeneous eosinophilic cytoplasm. Glands everywhere were divided against each other with thick layer of stroma. Such a picture corresponds the simple endometrial hyperplasia without atypia.

During the immunohystochemical investigation moderately expressed expression of Er in nucleuses of gland’s epithelium and stromal cells was found (it was 60 to 70%, 67.5±2,1% average).

8 cases of complex hyperplasia without atypia were accompanied with changes similar to previous type, however this changes were more expressed and glands were placed closely to each other divided with thin stromal septum. Nuclear-cytoplasmic balance impairment was pointed in the direction of nucleus’ square increase, among them hyperchromic nucleuses were found. During the immunohystochemical investigation strongly expressed expression of Er in nucleuses of gland’s epithelium and stromal cells (887,5±2,5%) and Pr were weakly expressed in nucleuses of epithelial cells (28,3±1,7%) and singular stromal cells (25±2,5%).

In 3 cases simple atypical endometrial hyperplasia was marked. In addition attributes of simple hyperplasia without atypia were marked, however at the same time they were accompanied with cytological changes such as nuclear atypia (different sizes and shapes, different susceptibility degree for stain with the appearance of hypo- and hyperchromic nucleuses), irregular cytoplasm eosinophilia. This patients had weakly expressed expression of Er in nucleuses of glandular cells (25±3,5%) and stromal cells (20±1,6%), Pr had low staining in glandular cells and no staining in stromal cells.

In the case close location of glands in typical cytological manifestations biopsies were verificated as the complex atypical hyperplasia (2 cases). The complex atypical hyperplasia is characterized with compact location of glands and micropapillar formations, in singular glands they form epithelial septum.

As the result of this investigation we can say that Er expression is the most expressed in the case of simple hyperplasia without atypia and the less expressed in the case of complex atypical hyperplasia. Pr expression was strongly decreased in all the cases but in the case of complex atypical hyperplasia it was mostly decreased.

The analyze of gained information in accordance with the age of patients says about absence of precise correlation between the age of patients and expression degree both of estrogen and progesterone. For example the highest level of estrogen expression was equal both in young women and women elder than 40 years in case of simple hyperplasia without atypia and the lowest level was in the patients of all ages with complex atypical hyperplasia.

Conclusions:

1. Estrogen and progesterone receptors are marked in almost all the types of typical or atypical endometrial hyperplasia.

2. At the non-atypical endometrium hyperplasia high and moderate level of Er was marked in combination with moderate and low level of Pr in stromal and glandular cells without depending of patients’ age.

3. Atypical hyperplasia is accompanied with sharp decreasing of Er and Pr expression in all structures of endometrium without depending of patients’ age.

4. Immunohystochemical method is the important diagnostic test which should be used as the prognosis method for the definition of atypical processes’ expression degree and correction of appropriate treatment.