Morphological and immunogistochemical features of leiomyomatous proliferation associated with adenomyosis

Abstract

Histological and immunohistochemical analysis of morphofunctional features of leiomyomatous proliferation associated with adenomyosis (desmin, type IV collagen, basic fibroblast growth factor expression) was performed. Two types of leiomyomatous proliferation have been established: diffuse perifocal leiomiomatous hyperplasia without micromyoma development (97,8%) and perifocal leiomyomatous hyperplasia with development of microand macroscopically visible myomas (62,6%). Immunohistochemical study revealed differences in morphological and functional characteristics of perifocal leiomyomatous proliferation in deep and superficial endometrioid heterotopias. It was confirmed that the loss of desmin expression and positive expression of type IV collagen reflect a significant remodeling of the myometrium in this pathology. Topographical relationship between the smooth muscle proliferates in cytogenic adenomyosis stroma and microvessels as well as high frequency of microand macroscopically visible myomas formation in adenomyosis suggests potential for leiomyomas to appear in the setting of adenomyosis. The severity of the main clinical manifestations of adenomyosis – dysmenorrhea and menstrual disorder depends on the depth of endometrioid heterotopias in the myometrium and the degree of perifocal leiomyomatous hyperplasia. Significantly more patients with deep adenomyosis and moderate or severe perifocal leiomyomatous hiperplasia had complains of severe dysmenorrhea, and heavy menstrual bleeding. New conservative methods of treatment of this pathology need to be finding because of consistency of perifocal leyomiomatous hyperplasia associated with adenomyosis. These methods should be directed not only to suppress the progression of epithelial and stromal components in heterotopias, but also to prevent the proliferation of smooth muscle.

Keywords

adenomyosis / perifocal leiomyomatous hyperplasia / proliferation / endometrioid heterotopias / desmin / type IV collagen / basic fibroblast growth factor / leiomyoma

References

[1] Аничков, Н.М. Клинико-морфологические особенности эндометриоидной болезни: аденомиоза, эндометриоза яичников, экстрагенитального эндометриоза / Н.М. Аничков, В.А. Печеникова, Д.Ф. Костючек // Архив патологии. – 2011. – № 4. – С. 5–10.

[2] Баскаков, В.П. Эндометриоидная болезнь / В.П. Баскаков, Ю.В. Цвелев, Е.Ф. Кира. – СПб.: Н–Л, 2002. – 452 с.

[3] Дамиров, М.М. Аденомиоз: клиника, диагностика и лечение / М.М. Дамиров. – М.: Тверь: Триада, 2002. – 224 с.

[4] Железнов, Б.И. Генитальный эндометриоз / Б.И. Железнов, А.Н. Стрижаков. – М.: Медицина, 1985. – 160 с.

[5] Куценко, И.И. Генитальный эндометриоз. Проблемы диагностики и лечения / И.И. Куценко. – Краснодар: Адыгея, 1994. – 189 с.

[6] Клинико-морфологические параллели и молекулярные аспекты морфогенеза аденомиоза / Е.А. Коган [и др.] // Архив патологии. – 2008. – № 5. – С. 8–12.

[7] Лушникова, А.К. Клинико-морфологический анализ и иммуногистохимическая характеристика внутреннего и наружного генитального эндометриоза: дис. … канд. мед. наук / А.К. Лушникова. – Новосибирск, 2012. – 107 с.

[8] Сидорова, И.С. Новый взгляд на природу эндометриоза (аденомиоза) / И.С. Сидорова, Е.А. Коган, О.В. Зайратьянц // Акушерство и гинекология. – 2002. – № 3. – С. 32–38.

[9] Сидорова, И.С. Миома матки / И.С. Сидорова. – М.: Медицинское информационное агентство, 2003. – 256 с.

RIGHTS & PERMISSIONS

Eco-Vector