Role of the endometrium immunehistochemical profile in treatment of reproductive and pre-menopausal patients with endometrium ordinary hyperplasia

В. О. Бенюк, В. М. Гончаренко, О. В. Каленська, О. П. Мельничук, Т. В. Ковалюк

Abstract


Aim of the study – improvement of the treatment effectiveness of patients with the endomentrium ordinary hyperplasia by development and implementation of the treatment algorithm with consideration endometrium immune histochemical profile specific features.

Methods and material. 203 women of reproductive and pre-menopause age with the endometrium ordinary hyperplasia were examined and treated. Receptor phenotype, apoptosis processes state and the levels of the diffuse endocrine system (APUD) activation in hyperplastic endometrium were investigated with immune histochemical method. On the basis of obtained results the method of hormonal therapy with consideration the state of the receptors systems and apoptosis level activation and the level of the APUD-system of hyperplastic endometrium activation’s was developed and offered; it was used in the treatment of 107 women with the endometrium ordinary hyperplasia. The experimental group composed of 96 women with the endometrium ordinary hyperplasia who were treated by the hormonal therapy (receptors state was not taken into account).

Study results. Analysis of the obtained data gave the grounds to state that the progestine resistant form of the pathological process was observed in 13.1% reproductive age women with non-atypical endometrium ordinary hyperplasia and in 18.5% pre-menopause age patients. It was stated that the hormonal therapy with taken into account the receptor phenotype allows to improve its effectiveness (up to 24.0% for reproductive age women and 20.6% for pre-menopause age).

Conclusions. Detection of immunohistochemical endometrial profiles reduce expression of progesterone receptors below 100 points scale HISTOScore, increasing antiapoptosis protein Bcl-2 above 2.4 points and increase the number of EC-cells of endometrium APUD-system above 4.8 in view indicates progestin-insensitive form of hyperplastic process and need individualized treatment strategy using gonadotropin-releasing hormone.

Individual approach in treatment of patients with the endomentrium hyperplastic processes taken into consideration the immunehistochemical profile indexes allows to improve the treatment, avoid regression, improve the therapy results, set category of patients with contraindications to hormone therapy and to prove the feasibility of surgical treatment.


Keywords


endometrium hyperplastic processes; immunohistochemistry; endometrium receptor systems; EC-cells

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DOI: http://dx.doi.org/10.18370/2309-4117.2016.31.49-53

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ISSN 2411-1295 (Online), ISSN 2309-4117 (Print)