Pathogenetic aspects of recurrent endometrial hyperplasia without atypia in women of childbearing age

Abstract

Aim: to determine the most informative immunohistochemical markers of recurrent endometrial hyperplasia without atypia in women of childbearing age. Methods. Prospective analysis of 89 patients of childbearing age was performed at the Department of Obstetrics and Gynecology with Perinatology, Medical Institute of the Peoples' Friendship University of Russia. During the study the patients were divided into two cohorts based on the EH course: the index group (n=45) was represented by patients with the morphologically verified recurrent endometrial hyperplasia without atypia (one or more episodes within a year), the control group (n=44) was represented by patients with the newly diagnosed endometrial hyperplasia without atypia. The average age of patients in the studied cohort was 44±3.0 years (comparison group – 42±2.0 years). Results. Immunohistochemical markers of recurrence were identified during the study: high Ki-67 expression (p<0.05), low Bcl-2 expression (p<0.05) that enhanced proliferative and reduce antiproliferative processes in the endometrium. Immunohistochemical signs of chronic endometritis (СD138+) were found in 40% of patients suffering from recurrent endometrial hyperplasia (in 18.2% of controls). It should be also noted that there was local hyperestrogenism associated with high expression of estrogen in the glandular epithelium and stroma. Conclusion. Thus, the Ki-67 marker expression and low Bcl-2 expression contribute to recurrence of endometrial hyperplasia without atypia. Furthermore, the combination of endometrial hyperplasia and morphologically verified chronic endometritis provides a further predictor of the endometrial proliferative process recurrence. Immunohistochemistry makes it possible to predict not only the risk of recurrent endometrial hyperplasia, but also the disease course. However, there is currently no universal marker allowing one to predict the chance of hyperplasia diagnosis and recurrence. Design: a comparative prospective study.

Keywords

• hysteroscopy
• endometrial proliferative disease
• endometrial cancer
• endometrial hyperplasia
• immunohistochemical markers