ELECTRON MICROSCOPIC STUDY OF THE EPITHELIAL-STROMAL INTERACTION IN GLANDULAR HYPERPLASIA OF THE ENDOMETRIUM
DOI:
https://doi.org/10.11603/24116-4944.2024.2.15080Keywords:
electron microscopic study, simple non-atypical endometrial hyperplasia, complex non-atypical endometrial hyperplasia, simple atypical endometrial hyperplasia, complex atypical endometrial hyperplasia, stroma, endometrial glandsAbstract
The aim of the study – to investigate and identify the structural characteristics and interactions between the glandular and stromal components of the endometrium in the context of hyperplastic processes.
Materials and Methods. An electron microscopic study was conducted on 21 women: 5 patients with simple non-atypical endometrial hyperplasia (SNEH), 5 with simple atypical endometrial hyperplasia (SAEH), 6 with complex non-atypical endometrial hyperplasia (CNEH), 5 with complex atypical endometrial hyperplasia (CAEH), and 5 women in the control group.
Results and Discussion. Electron microscopic examination of endometrial hypertrophy showed that it is manifested through glandular cell hyperplasia without hyperplasia or hypertrophy of intracellular structures. The submicroscopic organization of the endometrium in SNEH differs little from the glandular epithelium during the proliferative phase, and stromal component consists of fibroblast-like cells. Common features of SAEH and CAEH include an increase in the number of glands, structural polymorphism, stratification, increased mitotic activity, and architectural atypia, which is more pronounced in CAEH. However, in case of SAEH and CAEH, simple and complex desmosomal contacts between epithelial cells remain intact, as does the well-defined basal membrane. A key feature of the stromal component in atypical endometrial hyperplasia of both types is a reduction in its area, high protein-synthesizing activity of fibroblast-like cells, and their apoptosis: sparse in SAEH and significant in CAEH. Electron microscopic studies revealed the presence of tight adhesive connections between the glandular epithelium and endometrial stroma.
Conclusions. The electron microscopic structure of the endometrium in SNEH (simple non-atypical endometrial hyperplasia) shows little difference from the glandular epithelium in the proliferative phase, while the stromal component consists of fibroblast-like cells with a well-developed protein synthesis apparatus, which produce collagen fibers. Common features of SAEH (simple atypical endometrial hyperplasia) and CAEH (complex atypical endometrial hyperplasia) include an increase in the number of glands, structural polymorphism, stratification, increased mitotic activity, and more pronounced architectural atypia in CAEH. In SAEH and CAEH, simple and complex desmosomal contacts between epithelial cells and a well-defined basal membrane are preserved. In atypical hyperplasia of both types, there is a reduction in the area of the stromal component, high protein-synthesizing activity of fibroblasts, and their apoptosis: sparse in SAEH and significant in CAEH. There are tight adhesive connections between the basal poles of the glandular epithelial cells, projections of fibroblast-like cells, and lymphocytes.
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