IMPORTANCE OF THE DETERMINATION OF BIOMOLECULAR MARKERS IN THE PATHOGENESIS OF DEVELOPMENT OF THE HYPERPLASTIC PROCESSES OF ENDOMETRYUM IN THE PERIMINOPAUSAL PERIOD
DOI:
https://doi.org/10.11603/24116-4944.2017.1.7562Keywords:
endometrial hyperplasia, proliferation, biomolecular markers, apoptosis, immunohistochemical criteria.Abstract
The aim of the study – to investigate biomolecular markers in endometrial hyperplasia (EG) in women in the perimenopausal period and the degree of their activity to the morphological changes in the uterine mucosa.
Material and Methods: 70 women with EG who made up the basic group were examined, 38 (54.5 %) patients had morphological signs of a simple form of typical endometrial hyperplasia (TEG), 32 (45.5 %) had complicated hyperplasia (CEG). 20 women made up a control group. In 50 patients with different types of EG, immunohistochemical studies were performed to determine the marker of apoptosis – p53 protein, markers of proliferative activity – Ki-67 protein, p27 protein and steroid hormone receptors – estrogens and progesterone.
Results and Discussion. The expression of the pro-oncogenic protein Ki 67 indicates a high proliferative activity of endometrial cells in women of the 2 group with CEG (p <0.05), while in the case of TEG was significantly less and did not differ from the control group. The expression of the antioncogeniс protein of the p53 in glands and stromal cells with СEG was significantly lower than in endometrial biopsy specimens in patients with TGE. Analysis of the content of proteins that regulate the cell cycle indicates a decrease in the content of the p27 cycle inhibitor. A positive increase in the proliferation marker of Ki67 occurred with GE: at TGE from 4.3 % to 9.2 % (epithelial cells), CGE in endometrial biopsies from 11.1 % to 23.4 %, and a decrease in the apoptosis marker of p53 from 10.7 % to 4.3 % and from 13.4 % to 5.8 %, respectively (p <0.05). There was also a different immunohistochemical reaction of estrogen and progesterone receptors depending on the type of EG. An algorithm for examining patients with EG in perimenopause was proposed, based on the verification of a morphological diagnosis using immunohistochemical criteria.
Conclusions. A differentiated approach to the diagnosis of EG based on immunohistochemical determination of biomolecular markers (Ki67, p27, p53) allows not only to predict the course of the hyperplastic process, but also to evaluate the effectiveness of the treatment.
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