The role of steroid receptors in the pathogenesis of adenomyosis in the presence of concomitant endometrial pathology in postmenopause
Determining the pathogenesis of adenomyosis in postmenopausal women is promising, as it will allow a more thorough study of the mechanisms of hormonal changes and resolve issues related to adenomyosis in women of reproductive age. The purpose of the study is to establish the role of steroid receptors in the pathogenesis of adenomyosis in the presence of concomitant endometrial pathology in postmenopausal women. Study material is removed uteri with parovaria from 117 patients of 49-76 years old. The cases were divided into 4 groups depending on the presence of adenomyosis (AM) and background pathology (endometrioid carcinoma of the endometrium (ECE) and endometrial hyperplasia (EHP)): 1) 27 women with adenomyosis and EHP; 2) 30 women with adenomyosis and ECE; 3) 30 women with adenomyosis and age-related changes in the endometrium; 4) 30 women with age-related changes without AM (comparison group). The immunohistochemical reaction was carried out using primary antibodies to estrogen (ER), progesterone (PR) and androgen (AR) receptors. Statistical processing was carried out using parametric methods of variation statistics (calculated the arithmetic mean, standard deviation, confidence interval, Student criterion). The predominance of the ER expression in the glandular and stromal components of the eutopic endometrium in the presence of AM and hyperplastic processes was compared with the comparison group (p<0.01). A high level of ER expression is characteristic of the epithelium of the endometrium with EHP (7.333±0.314) and ECE (6.200±0.712) rather than for the endometrium with atrophic changes in the presence of AM (4.433±0.773). In the stroma, a high ER activity was detected with EHP (7.148±0.276) rather than with atrophic changes (4.567±0.738) and ECE (4.167±0.602). It was established that in the epithelium of adenomyosis foci, ER expression indices were lower in atrophy (3.433±1.074) than with AM foci in ECE (4.667±0.526) and EHP (5.148±0.745). In the stroma of adenomyosis foci, ER expression is higher in EHP than in ECE and atrophy. The activity of PR in the eutopic endometrium decreases from simple non-typical to complex atypical EHP and in patients with adenomyosis and ECE, as the degree of differentiation of cells of ECA decreases (from G1 to G3 ECE). A minimal expression of PR was found in the comparison group. In the cells of internal endometriosis there were positive indices of immunohistochemical reaction with PR. There were obtained minimum scores for receptor expression of AR in eu- and ectopic endometria. Conclusion: adenomyosis foci have a regulatory effect on the uterine endometrium, stimulating the expression of ER and, to a lesser extent, PR, and do not affect the level of AR in the eutopic endometrium.
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