THE ROLE OF THE INFLAMMATORY FACTOR IN THE GENESIS OF HYPERPLASTIC CHANGES OF ENDOMETRIUM IN WOMEN OF REPRODUCTIVE AGE
DOI:
https://doi.org/10.11603/24116-4944.2019.1.10180Keywords:
hyperplasia, endometrium, receptor, endometritis, estrogen, progesteroneAbstract
The aim of the study – to identify the possible role of microbial and viral factors in the development of non-typical endometrial hyperplasia in women of reproductive age and assess the degree of expression of steroid hormone receptors (estrogen and progesterone) in pathologically altered tissue.
Materials and methods. We investigated 60 endometrial specimens in women with non-atypical endometrial hyperplasia. The control group was represented by 10 healthy women of reproductive age without gynecological pathology. Immunohistochemical studies of the material were performed: determination of the expressiveness of the nuclear receptor – estrogen using an indirect streptavidin-peroxidase method for detecting expression of antibodies to estrogen receptors (Clone SP1) (manufactured by Thermo scientific, monoclonal rabbit antibodies, working dilution 1: 100 – 1: 400, UltraVision detection system LP), progesterone (Clone YR85) (production of Thermo scientific, monoclonal rabbit antibodies, working dilution 1: 25-1: 50, UltraVision LP detection system), with their morphometric analysis and identification of plasmacytic cells CD-138 (Ab-2) (Syndecan-1) (manufactured Thermo scientific, murine, working dilution 1: 10-1: 20, UltraVision LP Detection System). The intensity of the immunohistochemical reaction was evaluated by a semi-quantitative method on a 3-point scale: “- / +” – no reaction, “++” – moderate reaction; “+++” is a pronounced reaction. For each case, the percentage of nuclei stained with varying degrees of intensity was calculated. The prevalence of the reaction in the cytoplasm was assessed by a semi-quantitative method as follows: 0 – no color; 1 – less than 25 % positively stained cells; 2 – more than 25 % and less than 75 % of positively stained cells; 3 – homogeneous staining of more than 75 % of cells.
Results and discussion. Before conducting an immunohistochemical study of a hyperplastic endometrial tissue, we carried out a bacteriological and virological analysis of material obtained from the uterus to analyze microbial dissemination in patients with non-atypical endometrial hyperplasia. Thus, the results of these studies indicate the registration of different types of microflora in all patients with non-atypical endometrial hyperplasia, however, the verified titers in most cases did not exceed 102–103 degrees.According to the obtained results, in crops from the uterus, most often on nutrient media, anaerobic microorganisms were sown – Bacteroides, found in 30.0 % of patients. Patients with non-atypical endometrial hyperplasia at the present stage should be subjected not only to bacteriological and virological examination, but also to the immunohistochemical determination of the marker CD-138, which is the “gold standard” of confirmation of chronic endometritis. Thus, chronic endometritis is one of the important pathogenetic links in the development of endometrial hyperplasia, which requires not only timely and accurate diagnosis, but also new tactics in approaches to the treatment of this pathology, namely, at the first stage of prescribing antibacterial and antiviral therapy in accordance with the results of bacterial – virus examination. Consequently, we can speak not only about the hormonal and metabolic pathway of the development of endometrial hyperplastic processes, but also the role of the inflammatory factor in the occurrence of this pathology.
Conclusions. The data on the role of microbial and viral factors in the development of nonatypical endometrial hyperplasia in women of reproductive age is presented. The structure of microbial seeding of the uterine cavity in such women was established. Cytomegalovirus antigens in the hyperplastic endometrium were detected in 38.3 % of cases. Overexpression of steroid hormone receptors was found in modified endometrial tissue in women with nonatypical endometrial hyperplasia during an inflammatory process (CD-138 positive), which is distinguished by heterogeneity and mosaicism of staining expression, which may be due to the degree of damage to cellular elements by the persistent effect of bacterial virus.
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