FEATURES OF THE REMODELING OF ENDOMETRIUM TORTUOUS ARTERIES DURING THE FORMATION OF THE VASCULAR COMPONENT OF FIBROVASCULAR NUCLEI ENDOMETRIAL POLYPS IN WOMEN OF REPRODUCTIVE AGE
DOI:
https://doi.org/10.11603/1811-2471.2019.v0.i1.10070Keywords:
endometrial remodeling, angiogenesis, endometrial polyp, fibrovascular polyp core, tortuous arteries, reproductive ageAbstract
The issues of remodeling of the endometrium and its components in recent years have received increasing attention. The functional layer of the uterus has a unique property – physiological angiogenesis, depending on the hormonal cyclicity of the female body. Changes in the endometrium in general and its vascular component in particular are not well understood. The issue of remodeling the tortuous arteries of the functional layer of the uterus when exposed to additional external factors requires attention.
The aim of the study – based on the pathological analysis of archival preparations of the endometrium of women of reproductive age using additional histochemical techniques, determine the structural features of the vascular component and the fibrovascular core of endometrial polyps.
Material and Methods. The study included 55 cases of biopsy archival preparations of the endometrium of women of reproductive age: 43 were endometrial polyps, 12 – physiological endometrium. Conducted standard staining with hematoxylin and eosin and additional histochemical methods: resorcin-fuscin by Hart, picrofuscin by Van Gieson and three chrome Masson.
Results and Discussion. Among 43 cases of endometrial polyps, 15 cases of glandular polyps were revealed, 26 cases of glandular-stromal ones. Clinically, 33 patients were diagnosed with infertility, 10 fertile women. For control, 12 samples of normal functional endometrium were selected: in the proliferation phase – six cases and secretion – six.
Histochemical staining methods made it possible to determine the structural features of the fibrovascular nucleus of endometrial polyps – cells of large thick-walled vessels, often arranged in chains in the form of a “track”. It is established that the composition of the endometrium of the gland normally includes epithelial cells and fibrous elements of the connective tissue located circularly around them, which are visualized by using additional histochemical staining. Our studies have shown that in the normal spiral arteries there are nofibrous elements, and in the conditions of endometrial remodeling in the form of polypous transformation, fibrous elements are an essential element of the arteries. Additional external factors (such as chronic inflammation, etc.) contribute to the progressive vascularization of polyps. The latter is manifested not only by the fibrovascular nucleus of the polyp, but also by the phenomenon of capillary polyps.
Conclusions. The presence of fibrovascular nuclei in endometrial polyps is a manifestation of vascular remodeling, which consists in the appearance of arteries with an elastically collagen skeleton. Vascular accumulation is characteristic of the fibrovascular nuclei of a polyp and, along with the more pronounced fibrous character of the stroma, can serve as a valuable differential diagnostic sign that distinguishes the polyp from the background tissue of the endometrium with its small size. The described vascularization is crucial for the progressive growth of the polyp and its possible malignancy. The use of additional histochemical methods allows to facilitate the differential diagnosis of a polyp from both different types of hyperplasia and normal endometrium.
References
Indraccolo, U., Di Iorio, R., & Matteo, M. (2013). The pathogenesis of endometrial polyps: а systematic semi-quantitative revive. European Journal of Gynaecological Oncology, XXXIV (1), 5-22.
Klynyshkova, T.V., Frolova, N.B., & Mozgovoy, S.I. (2011). Klinicheskoe znachenye kompleksnoy otsenki retseptornogo statusa endometriya pri endometrialnykh polipakh [The clinical significance of a comprehensive assessment of the endometrial receptor status in endometrial polyps]. Akusherstvo i ginekologiya – Obstetrics and Gynecology, 3, 37-41 [in Russian].
Kozyreva, E.V., & Davydyan, L.Yu. (2015). Rol faktorov rosta v patogeneze besplodiya i nevynashyvaniya beremennosti [The role of growth factors in the pathogenesis of infertility and miscarriage]. Sovremennye problemy nauki i obrazovaniya – Modern Problems of Science and Education, 4 [in Russian].
Kuzyk, Yu.I., & Chornenka, H.M. (2018). Hiperplastychni protsesy endometriia u zhinok iz bezplidnistiu: zistavlennia rezultativ ultrasonohrafichnykh ta patomorfolohichnykh doslidzhen endometriia [Hyperplastic processes of endometrium in women with infertility: reproduction of ultrasonographies and pathologic dosimetology]. Zdorovye zhenshchiny – Woman's Health, 7 (133), 129-133 [in Ukrainian].
Zakharova, N.B., Durnov, D.A., & Mykhailov, V.Yu. (2011). Diagnosticheskoye znachenye issledovaniya faktora rosta endoteliya sosudov v syvorotke krovi [The diagnostic value of the study of vascular endothelial growth factor in blood serum]. Fundamentalnye issledovaniya – Fundamental Researches, 11, 215-220 [in Russian].
Hannan, N.J., Paiva, P., Hannan, N.J., & Meehan, K.L. (2011). Analysis of fertility-related soluble mediators in human uterine fluid identifies VEGF as a key regulator of embryo implantation. Endocrinology, 152, 4948-4956.
Carmeliet, P. (2003). Angiogenesis in health and disease. Nat. Med., 9, 653-660. doi: 10.1038/nm0603–653.
Burlev, V.A., Yliasova, N.A., & Shyshkanova, O.A. (2006). Tsyklicheskiy angiogenez eutopicheskogo endometriya [Cyclic angiogenesis of eutopic endometrium]. Problemy reproduktsyy – Problems of Reproduction, 6, 22-30 [in Russian].
Lutsenko, S.V., Kyselev, S.M., & Feldman, N.B. (2004). Molekulyarnye mekhanizmy angiogeneza v fiziologicheskikh i patologicheskykh protsessakh [Molecular mechanisms of angiogenesis in physiological and pathological processes]. Paltsev, M.A. (Ed.). Vvedenye v molekulyarnuyu meditsynu – Introduction in Molecular Medicine. Moscow: OAO “Meditsyna” [in Russian].
Dubyna, M.V. (1999). Vliyanye deksametazona na funktsyonalnye svoystva mikrososudov u krys s limfosarkomoy Plyssa [Effect of dexamethasone on the functional properties of microvessels in rats with Pliss lymphosarcoma]. Vopr. Onkologii – Issues of Oncology, 45, 655-669 [in Russian].
Tsaltas, J., Rogers, P. A., Gargett, V.C., & Healy, D.L. (1998). Excessive angiogenesis: a new theory for endometriosis. Current Obst. Gynaecol., 8, 186-188.
Binder, N.K., Evans, J., & Gardner, D.K. (2014). Endometrial signals improve embryo outcome: functional role of vascular endothelial growth factor isoforms on embryo development and implantation in mice. Hum. Reprod., 29 (10), 2278-2286.
Chornenka, H.M., & Kuzyk, Yu.I. (2018). Polipozna transformatsiia endometriia: osoblyvosti diahnostyky v zhinok iz nepliddiam [Polypositive transformation of endometrium: features of diagnosis in women with infertility]. Aktualni pytannia pediatrii akusherstva ta hinekolohii – Actual Issues of Pediatrics of Obstetrics and Gynecology, 3, 94-99 [in Ukrainian].
Kuznetsova, I.V., Zemlina, N.S., Rashydov, T.N., & Kovalenko, M.A. (2015). Problema tonkogo endometriya i vozmozhnye puti ee resheniya [The problem of thin endometrium and possible ways of its solution]. Effektivnaya farmakoterapiya – Effective Pharmacotherapy, 1, 15-25 [in Russian].
Spryndzhuk, M.V. (2010). Angyogenez [Angiogenesis]. Morfologiya – Morphology, IV (2), 4-13 [in Russian].
