Federal State Institute «Rostov-on-Don Scientific Research Institute of Obstetrics and Pediatrics», Rostov State Medical University

PROLIFERATIVE ACTIVITIES OF ECTOPICAL ENDOMETRIAL CELLS IN PATIENTS WITH PRIMARY AND RECURRENT ENDOMETRIOMAS

Svetlana Dubrovina

SEUD Congress 2016

Barcelona

First described via microscopic observation by Karl von Rokitansky in 1860, symptoms of endometriosis have been noted in medical texts for thousands of years 1, 2.

The average gap from the onset of symptoms to the

diagnosis of endometriosis is between 3 and 11 years 3.

_______________________________ 1. Nezhat C, Nezhat F, Nezhat C. Endometriosis: ancient disease, ancient treatments. Fertil Steril 2012;98(6,

Suppl):S1–S62. 2. Batt R. A History of Endometriosis. London: Springer Science & Business Media; 2011. 3. Sherwood S. Endometriosis Fact Sheet. ENDOmetriosis World-wide, March 13, 2014

The prevalence of endometriosis is approximately 10-20% among women of reproductive age, and it is 2-5 times higher in women with infertility.1

The need for subsequent surgery after the initial

conservative surgical treatment for endometriosis was 21.6%, 46.7%, and 55.4% at 2, 5, and 7 years after the previous surgery, respectively.1

________________________________ 1. Kim M-L , Kim J M, Seong SJ et al. Recurrence of ovarian endometrioma after second-line, conservative, laparoscopic cyst enucleation. Am J Obstet Gynecol 2014;210:216.e1-6.

A higher recurrence rate is reported in younger patients, in those with an advanced disease stage1,2,3, and in patients who underwent incomplete removal of endometriotic lesions 3, 4.

Even after complete resection, endometriosis typically recurs and medical treatment should be used to prevent future disease5.

____________________________________________________ 1. Kikuchi I, Takeuchi H, Kitade M, Shimanuki H, Kumakiri J, Kinoshita K. Recurrence rate of endometriomas

following a laparoscopic cys- tectomy. Acta Obstet Gynecol Scand 2006;85: 1120-4. 2. Liu X, Yuan L, Shen F, Zhu Z, Jiang H, Guo SW. Patterns of and risk factors for recur- rence in women with

ovarian endometriomas. Obstet Gynecol 2007;109:1411-20. 3.Vignali M, Bianchi S, Candiani M, Spadaccini G, Oggioni G, Busacca M. Surgical treatment of deep

endometriosis and risk of recurrence. J Minim Invasive Gynecol 2005;12: 508-13. 4.Carmona F, Martinez-Zamora A, Gonzalez X, Gines A, Bunesch L, Balasch J. Does the learning curve of

conservative laparoscopic surgery in women with rectovaginal endometri- osis impair the recurrence rate? Fertil Steril 2009;92:868-75.

5. Hufnagel D, Li F, Cosar E, Krikun G, Taylor H. The role of stem cells in the etiology and pathophysiology of endometriosis. Semin Reprod Med 2015;33:333–340.

However, prognosis and pathogenesis of recurrence of endometrioma are still not fully understood. So far as, we still have not known much about changes occurred in basalis cells of eutopic and ectopic epithelium of endometrial type in patients with endometriosis.

Samples were obtained from 46 women with primary endometriomas and 15 with recurrence cysts

Thickness of slices was 4 mm. The resulting sections were stained in the usual manner with hematoxylin-eosin and subjected to optical microscopy using immersion objective with a total optical power 10 x 100.

The aim of this study was to examine proliferative activities of ectopic endometrial cells in primary and recurrent endometriomas.

Data are presented as the mean ± standart deviation and were analyzed by the Pearson nonparametric correlation to indicate statistical differences between ectopical endometrial cells of primary and recurrence cysts.

Studied parameters:

•  The thickness of the gland •  The core area •  The thickness of the cytoplasmic membrane •  The thickness of the nuclear membrane •  The thickness of the secretory parts of the cell •  Radius of the nucleus •  Average brightness •  The average density of the nucleus

The thickness of the gland

р=0,004

The core area

р=0,0001

The thickness of the cytoplasmic

membrane

р=0,003

The thickness of the nuclear membrane

р=0,035

The thickness of the secretory parts of the cell

р=0,0001

Radius of the nucleus

р=0,14

Average brightness

р=0,0001

The average density of the nucleus

р=0,0001

Visualization of correlations

The average density of the

nucleus

The thickness of the cytoplasmic

membrane  

The thickness of the secretory parts of the cell

 

Average

brightness  

Radius of the nucleus

The thickness of the nuclear

membrane  

The core area

The thickness of the gland

 

nega&ve  

posi&ve  

Conclusion  __________________________________________________________________________  

         

 Almost all parameters increasing in the primary cysts may sign more active proliferation in primary cysts in comparison with recurrent cyst. The thickness of all membrane was larger in primary cysts compared with recurrent cysts, maybe because of quantity of specific and nonspecific receptors located in membranes.

Liu et al reported that recurrence rates are largely stable for up to 30 months after surgery and decrease thereafter1.

According opinion of Ouchi et al, there is a

consistent increase for 5 years, followed by a 0% recurrence rate after 5 years 2.

_______________________________________ 1. Liu X, Yuan L, Shen F, Zhu Z, Jiang H, Guo SW. Patterns of and risk factors

for recurrence in women with ovarian endometriosis. Obstet Gynecol 2007; 109: 1411–1420.

2. Ouchi N, Akira S, Mine K, Ichikawa M, Takeshita T. Recurrence of ovarian endometrioma after laparoscopic excision: Risk factors and prevention. J Obstet Gynaecol Res 2014; 40:1: 230–236.

 Aim of future investigation

To study specific and nonspecific receptors located

in nuclear and cytoplasmic membranes. To examine proliferative activities of eutopic

endometrial cells with study of morphometric characteristics and compare with ectopic endometrial cells in groups of the women with primary and recurrent endometriomas.

Acknowledgements

My co-authors: Krasilnikova Lilia,

Gimbut Vitaly, Areshuan Knarik,

Berlim Julia, Lemeshko Svetlana, Mazhugin Vladimir, Tikidzhieva Victoria

Thank you for attention