THE STRUCTURE OF THE WALL OF THE OVARY ENDOMETRIOID CYST UNDER THE INFLUENCE OF 76 % ETHANOL

Abstract

SUMMARY. Treatment of endometriosis-associated infertility remains a controversial issue in the practice of obstetrician-gynecologists. The study shows that ultrasound-guided aspiration and sclerotherapy are valid alternatives to surgery in the treatment of "chocolate" ovarian cysts, especially in young women.

The aim – to conduct a histological examination of the endometrioid cyst wall under the influence of 76 % ethanol after 1, 3, 5 minutes and establish its structural changes.

Material and Methods. The obtained material after surgical interventions (laparotomy cystectomies) and sclerotherapy with the help of 76 % ethanol with controlled exposure to alcohol in relation to time (1 min, 3 min, 5 min) was fixed in 10 % neutral buffered formalin according to the generally accepted technique. Tissue processing was carried out in a closed vacuum histoprocessor Logos ONE. The finished material was poured into paraffin blocks. Histological sections were prepared on an Amos AMR-400 rotary microtome with a thickness of 4-5 μm (at least two sections for each histological slide), stained with hematoxylin and eosin. Research and photo-registration of the preparations was carried out using an Eclipse Ci-E microscope (Japan) with a Sigeta M3CMOS 14000 digital camera at various magnifications ´100, ´200, ´400.

Results. It was found that after 1 min of exposure to 76 % ethanol in the surface epithelial layer, pronounced dystrophic-necrotic changes of epitheliocytes were visualized in combination with hemorrhaging of small-caliber vessels and the formation of erythrodiapedesis, after 3 min, epitheliocytes were significantly damaged with the formation of areas of necrosis and damage to the basement membranes, acute disorders of blood circulation. After 5 minutes, the structural changes of the epithelium remained pronounced and were accompanied by dystrophy and necrosis. In the collagen stroma around the glands, moderate blood circulation disorders were visualized, slight lymphohistiocytic infiltration, the course of the fibers changed.

Conclusions. Ethanol in a concentration of 76 % has a damaging effect on the epithelium of the endometrioid cyst and leads to its dystrophic-necrotic changes. The depth of damage to the epithelial layer depends on the period of exposure. After 5 minutes of use, this concentration has a pronounced effect on the epithelial lining of the cyst and minimal manifestations of inflammation on the surrounding tissue.

The data from the 76 % ethanol study, when taken into account in the literature, are promising and suggest a minimally invasive alternative to ovarian cystectomy for patients with endometrioma who wish to preserve fertility, and especially in those patients who have undergone cystectomy in the past and are at high risk further decrease in the ovarian reserve.