Morphological Features of Uterine Polyps in Females of Reproductive Age

Abstract

According to modern views based on evidence-based medicine, the concept of "poly-endometrium" is defined as a benign, exophytic nodophilic formation of the uterine mucus that consists of glands and stroma, predominantly fibrous, containing a "tangle" of thick-walled blood vessels.
 The aim of the study – to learn the morphological features of tissues of polyps of the body of the uterus and endometrium with the establishment of the role of inflammatory factor in the pathogenesis of hyperproliferative changes in women of reproductive age.
 Materials and Methods. The article presents the results of a survey of 62 patients of reproductive age with polyps in the body of the uterus. The presence of the glandular component in 79.03 % of cases, fibrotic polyps – 12.9 %, and micro-polyps – 8.06 % were determined, respectively. The combination of polyps with non-atypical endometrial hyperplasia was detected in 80 % of patients with micro-polyposis, in 63.6 % of women – with glandular-cystic polyps of the uterine body, in 44.4 % of the examined – with glandular-fibrous endometrial polyps and in 37.5 % of patients – with fibrous polyps. Immunohistochemically, CD138 expression was detected both in the tissues of the polyps of the uterus and adjacent endometrial tissues in 43.5 % of cases, which became a marker of the chronic endometritis in the part of the surveyed, which formed the basis of the pathogenetic approaches in the treatment of such a pathology. For processing data standard procedures using Microsoft Excel were used. The research was conducted in the Laboratory of Pathomorphology of the Department of O. Lukyanova Institute of Pediatrics, Obstetrics and Gynecology of the National Academy of Medical Sciences of Ukraine, head of the department – Corresponding Member of the National Academy of Medical Sciences of Ukraine, Professor T. Zadorozhna.
 Results and Discussion. In clinical analysis of complaints of polyps of the body of the uterus, clinical manifestations in the form of menstrual cord disturbance were 13 (20.97 %) patients, in 11 (17.74 %) patients there were no complaints about the desired pregnancy, at the same time as 38 (61.29 %) women were asked to carry out a preventive examination, which does not contradict the results of other researchers. During the morphological study, we established the following features of the polyps of the body of the uterus in women of reproductive age: the most frequently tested polyps of the body of the uterus, which had the glandular component – in 49 (79.03 %) cases, of which the glandular-cystic structure was found in 22 (35.48 %) of patients, the glandular-fibrous structure was in 27 (43.55 %) patients, approximately the same values ​​were found in fibrous polyps of the body of the uterus – 8 (12.90 %) of women and micropolymers of endometrium – in 5 (8.06 %) cases respectively. We found that in all groups of patients with polyps in the body of the uterus, there were signs of non-atypical hyperplasia of the endometrium. It should be noted that, according to literature, endometrial polyps larger than 15 mm were associated with hyperplasia. The above data is an important indication that the unidirectional determination of the positive expression of the CD138 inflammatory marker, both in the tissue of the polyp of the uterus and in the endometrial tissue, indicates the unity of the inflammatory factor in the pathogenesis of hyperproliferative processes and proves the significant role of the inflammatory process in the development of its pathological conditions and justifies the necessity take into account this fact in approaches to the tactics of patient management.
 Conclusions. The results of the conducted morphological and immunohistochemical research indicate that the basis of the formation of polyps of the body of the uterus is the inflammatory process, which is confirmed morphologically with the presence of chronic endometritis and a positive reaction to CD138. The study of pathogenetic mechanisms for the formation of endometrial pathology is a key factor in the development of methods for correction of these pathological processes, which thus allows to increase the efficiency of treatment and preserve reproductive health.

Аналіз Клініко-Анамнестичних Даних І Преморбідного Фону При Аденоміозі

“…Таким чином, отримані нами дані підтверджують думку, згідно з якою внутрішньоматкові втручання є факторами ризику розвитку аденоміозу. Ряд авторів вважає, що сприятливі умови для інвазії та росту ендометріальних клітин в міометрії створюють дистрофічні зміни в зоні гістобіологічного бар᾽єра, що виникають в результаті травматизації сполучної і м᾽язової тканин, а також у результаті запалення [6,9,10,21,30].…”

“…Підтвердженням цьому слугують дослідження, які доводять, що аборти й ускладнені пологи погіршують перебіг аденоміозу [8]. Крім того, високий інфекційний індекс [9] та супутні екстрагенітальні захворювання також є характерними рисами аденоміозу та фоном для формування дисфункції імунної системи [10].…”

Morphological Changes of the Endometrium in Hyperplastic Process in Women of Reproductive Age

“…A number of authors consider HPE as a clinical and morphological syndrome caused by damage to the endometrium by pathogen infections, with numerous secondary morphological and functional changes that disrupt cyclic biotransformation and susceptibility of the mucous membrane of the uterus [10][11][12][13][14]. Other scientists also note the role of the infectious factor in the occurrence of EH despite the lack of growth of the microflora in crops from the uterine cavity [15][16][17][18][19].…”

Histological and morphometrical features of endometrial polyposis complicated with uterus bleeding. Review and clinical data

“…The morphology of the glandular component is different. For example, the glands may be functioning or not, have normal histology, or be cystically altered, etc.. [2,[7][8][9]11] Although the risk of endometrial polyps low malignancy (except adenomatous polyps, which are predictors of malignant transformation), they are one of the causes of pathological conditions such as abnormal uterine bleeding and infertility. The prevalence of the pathology of EP in the population of women with infertility is put anywhere between 3% and 38% and this is in cases with primary infertility.…”