Clinical and morphological features of nodular and diffuse adenomyosis
Objective. To enhance the efficiency of diagnosis and surgical treatment in patients with nodular and diffuse adenomyosis, by investiating the expression of stem cell markers in the eutopic and ectopic endometrium.Dzhamalutdinova K.M., Kozachenko I.F., Shchegolev A.I., Faizullina N.M., Adamyan L.V.
Subjects and methods. A total of 150 women aged 18 to 55 years with diffuse and nodular forms of adenomyosis were examined and surgically treated. Their intraoperative material underwent histological and immunohistochemical examinations. The expression of the stem cell markers Musashi-1, COX-2, and Oct4 markers was investigated.
Results. Organ-sparing surgery was performed in 91 out of the 150 examinees; the others underwent radical surgery. The mean nodular size in adenomyosis was 3.85±2.20 cm. In the nodular form, the nodules were mainly located along the posterior (55.1%) and anterior (38.6%) uterine walls and in the area of its fundus (13.5%). Immunohistochemical analysis of the tussues of the endometrium and adenomyosis revealed that a positive reaction for Musashi-1 was observed in both the nuclei and cytoplasm of glandular and stromal cells. There was a cytoplasmic reaction for COX-2. A positive immunohistochemical reaction for OCT4 was seen in the nuclei of epithelial and stromal cells.
Conclusion. Our findings may suggest that the major components in the development of adenomyosis are a weakened or damaged connective tissue area and the activation of different properties of stem cells in the eutopic endometrium, which manifested, in particular, as overexpression of stem cell markers. The results of our investigation and the data available in the literature can partially explain the lack of effects from hormone treatment and the cause of recurrent disease, indicating the necessity of searching for targeted impacts just on these components of pathogenesis.
Keywords
adenomyosis
stem cells
Musashi-1
COX-2
Oct4
Supplementary Materials
- Fig. 1. Expression of Msh1 in the samples of nodular adenomyosis (a) in the phase of secretion of the menstrual cycle and in the endometrium cells in the phase of secretion (b). Immunopeoxidase method, original magnification. a, b - 200.
- Fig. 2. Levels of COX-2 expression in epithelial and stromal cells of eutopic endometrium and in sites of nodular and diffuse adenomyosis.
- Fig. 3. COX-2 expression in samples of nodular adenomyosis (a) during the proliferation phase of the menstrual cycle and in the endometrial cells during the proliferation phase (b). Immunoperoxidase method, original magnification- a, b - 200.
- Fig. 4. Expression of OCT4 in samples of diffuse adenomyosis (a) during the proliferation of the menstrual cycle and in the endometrial cells during the proliferation phase (b). Immunoperoxidase method, original magnification. a, b - 200.
- Fig. 5. Number (%) of OCT4 immunopositive cells in the eutopic endometrium and sites of nodular and diffuse adenomyosis.
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Received 16.06.2017
Accepted 23.06.2017
About the Authors
Dzhamalutdinova Kistaman Magomedzapirovna, post-graduate student of the Department of Operative Gynecology, Research Center of Obstetrics,Gynecology, and Perinatology, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +79168881210. E-mail: DK0590@mail.ru
Kozachenko Irena Feliksovna, Ph.D., Senior Researcher, Department of Operative Gynecology, Research Center of Obstetrics, Gynecology, and Perinatology,
Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4
Shegolev Aleksandr Ivanovich, Doctor of Medical Sciences, Professor, Head of Pathology and Anatomy Department, Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4
Faizullina Nafisa Munavarovna, Ph.D., senior researcher of the pathoanatomical department, Research Center of Obstetrics, Gynecology, and Perinatology,
Ministry of Health of Russia. 117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +79164534087. E-mail: nafisa05@inbox.ru
Adamyan Leila Vladimirovna, MD, Professor, Academician of the Russian Academy of Sciences, Deputy Director for Research and Head
of the Department of Operative Gynecology, Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia.
117997, Russia, Moscow, Ac. Oparina str. 4. Tel.: +74952223737. E-mail: Adamyanleila@gmail.com
For citations: Dzhamalutdinova K.M., Kozachenko I.F., Shchegolev A.I., Faizullina N.M., Adamyan L.V. Clinical and morphological features of nodular and diffuse adenomyosis. Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2017; (9): 86-94. (in Russian)
http://dx.doi.org/10.18565/aig.2017.9.86-94
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