POLYP AND ENDOMETRIAL HYPERPLASIA – ETIOPATHOGENETIC ASPECTS OF A RATIONAL APPROACH TO THE PROBLEM
DOI:
https://doi.org/10.11603/2415-8798.2017.4.8246Keywords:
cytokine stress, hormonal imbalance, polyps of the endometrium, endometrial hyperplasia, hysteroscopy, pathology of the endometrium, cancer endometrium.Abstract
One of the main tasks of modern gynecology is the study of various aspects of the pathogenesis of proliferative processes of the endometrium. Currently, the hyperproliferative processes of the endometrium (HPE ) and the polyps of the endometrium (PE) are an actual problem, because, on the one hand, the obstetrician-gynecologist is on daily encounter with these pathological conditions, and on the other, the HPE can serve as a background for the development of cancer endometrium with prolonged course and absence of treatment [1].
The aim of the study – to learn the predictors of the risk of development of benign hyperproliferative pathology of the endometrium in women of reproductive age to improve approaches to tactics for conducting this contingent of patients.
Materials and Methods. To realize the task, we analyzed the medical history of 1.743 patients of reproductive age who were on surgical treatment (hysteroscopy with diagnostic scraping) in the family planning department of the Institute of Pediatrics, Obstetrics and Gynecology of the National Academy of Medical Sciences of Ukraine (supervised by Professor Vovk I. B.) in the period from 2010 to 2014. The criteria for inclusion in the study were: the reproductive age of the patient (18–49 years); histological verification of benign proliferative pathology of the endometrium (endometrial polyp, endometrial hyperplasia, combined endometrial proliferative pathology). To obtain samples of the material from the uterine cavity, a standard technique of hysteroscopy was used, followed by mechanical tissue evacuation and histological examination.
Results and Discussion. The incidence of benign proliferative endometrial pathology in women of reproductive age was 52.2 % of cases (910 cases out of 1.743 cases). When analyzing the age factor, it was found that the average age of the surveyed women is 35 years. Proceeding from the results of the histological conclusion about the type of proliferative pathology of the endometrium, all patients were divided into 3 groups: the group 1 consisted of patients with the presence of the endometrial polyp (n = 705); the group 2 – women with only endometrial hyperplasia (n = 89); the group 3 – patients with concomitant pathology of the endometrium – hyperplasia and endometrial polyps (n = 116). To analyze the factors associated with the risk of polyps and endometrial hyperplasia, a method of constructing and analyzing multivariate logistic regression models was used.
Conclusions. Polyps of the endometrium are a consequence of inflammation, cytokine stress, the realization of apoptosis disorder and the activation of growth factors. With the combined proliferative pathology of the endometrium, the same happens at the same time as the hormonal imbalance is initiated.
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