Objectives: evaluation of changes in the endometrial-myometrial junction (EMJ) in the combined pathology of the endometrium and myometrium.Materials and methods. 50 perimenopausal women with combined pathology of the endometrium and myometrium (main group) were examined. The control group consisted of 30 practically healthy women of the same age who were examined for the male factor of infertility. All patients underwent a comprehensive examination, which included clinical and paraclinical research methods.Patients were examined using transvaginal ultrasound. The DEERS (Diseases of Endometrium – Evaluation and Risk scoring System) index was used for the integral assessment of the endometrium and myometrium state.Results. The average age of women was 43.4 ± 1.2 years. The combination of endometrial hyperplasia (EH) and intramural uterine myoma was found in 58.0% of cases, EH and submucous uterine myoma – in 14.0%, EH and endometrial polyps – in 10.0%, EH and external peritoneal endometriosis – in 12.0%, EH and adenomyosis – in 4.0%, EH, adenomyosis and uterine fibroids – in 2.0%.The blood flow rate in the uterine arteries in the main group was 38.8 ± 0.6 cm/s, resistance index – 0.8 ± 0.04, pulsation index – 1.3 ± 0.1. In the control group the blood flow rate in the uterine arteries was 42.2 ± 0.8 cm/s without a clear difference of the sides, the resistance index – 0.9 ± 0.1, the pulsation index – 1.2 ± 0.1 (p > 0.05).The total DEERS score in the main group was 13.2 ± 0.4 points, in the control group it was 7.3 ± 0.7 points. In the vast majority of cases (88.0%) EMJ was not involved in the pathological process. The average thickness of the EMJ in women from the control group was 0.45 ± 0.05 cm, in the main group – 0.42 ± 0.03 cm. At the same time, 36 (72.0%) women with combined pathology of the endometrium and myometrium had signs of hypomobility EMJ.Conclusions. EMJ was not involved in the pathological process in the vast majority of patients with combined pathology of the endometrium and myometrium. At the same time, some women with combined pathology of the endometrium and myometrium showed signs of hypomobility of the EMJ.

Hyperproliferative diseases of the endometrium play an important role in the structure of gynecological pathology, which are a spectrum of irregular morphological changes. Particularly difficult is evaluation of the phenotypic characteristics of the endometrium hyperplastic processes (EHP) in premenopausal women in the presence of an unstable menstrual cycle. Diagnosis and EHP prognosis remains a difficult task given that it can occur as focal or diffuse lesions with various structural and cytological differences.Objective of the study: to evaluate the immunohistochemical features (phenotypic variants) of benign endometrial hyperplasia in premenopausal women.Material and methods. 33 premenopausal women with abnormal uterine bleeding and verified benign endometrial hyperplasia were examined. Expression of the α-receptors for estrogens type 1 (ER1), progesterone receptors and Ki-67 nuclear protein in the endometrium stroma and glands was analyzed. Micromorphometry was performed and the D-score was calculated.Results. Prevalence of comorbid lesions in patients was the combination of endometrial hyperplasia and fibroids (51.4%), cases of abnormal uterine bleedings against submucosal fibroids (13.5%), endometrial polyps (8.1%), combinations of EHP and peritoneal endometriosis (10.8%), adenomyosis and myoma (8.1%), or other combinations of endometrial and myometrial proliferative pathology. D-score for surgery averaged 1.78 ± 0.11 indicating a low risk of malignancy. There were changes after treatment in the quantitative presentation of the studied proteins in stroma and endometrial glands. Thus, before treatment in the glands was determined up to 100% of cells containing ER1 in large quantities, while after treatment their number decreased by an average of 20%. Similar dynamics was observed with progesterone receptors activity.Conclusions. The main prognostic significant phenotypes of endometrial proliferative pathology have been identified. After removing of pathologically chanced endometrium and subsequent treatment with dydrogesterone during 6 months there is prognostically positive decreasing in the ER1 density as well as the Ki-67 protein expression

Мета дослідження – оцінка впливу порушень ліпідного обміну на ризик виникнення аномальних маткових кровотеч у жінок репродуктивного віку. Матеріали та методи. Обстежено 30 жінок репродуктивного віку з аномальними матковими кровотечами. Проводили аналіз експресії α-рецепторів до естрогенів ER1, рецепторів до прогестерону PgR та ядерного білка Ki-67 у залозах та стромі ендометрія імуногістохімічним методом. Оцінювали показники ліпідограми, визначали індекс маси тіла, проводили антропометрію. Результати дослідження та їх обговорення. При оцінці аліментарного статусу встановлено переважання серед пацієнток осіб з ІМТ>25 кг/м2 – 96,7 %, при цьому ознаки аліментарно-конституційного ожиріння були у 33,3 %. Середні значення ІМТ склали (29,1±1,6) кг/м2. Експресія рецепторів до естрогену ER1 була більш високою у залозах (Ме (25 %;75 %) =  100 (80; 100), аніж у стромі (Ме (25 %;75 %) = 80 (60; 90). Натомість, кількість клітин із позитивною реакцією на рецептори до прогестерону PgR у стромі та залозах майже не відрізнялася – Ме (25 %;75 %) = 80 (50; 90). Експресія білка Кі-67 була вищою у залозах – (Ме (25 %;75 %) = 90 (70; 100), у стромі вона не перевищувала 50 % (Ме (25 %;75 %) = 40 (30; 50). Висновки. 1. У пацієнток з аномальними матковими кровотечами часто зустрічаються порушення ліпідного обміну у вигляді дисліпідемії 2b типу. 2. Вираження дисліпідемії корелює з інтенсивністю АМК та експресією маркерів проліферації.

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To determine clinical and morphological features of combined uterine hyperplastic diseases in premenopausal women at the background of adenomyosis, 62 patients operated on for chronic abnormal uterine bleeding were examined. The control group consisted of 30 premenopausal patients who applied for preventive examination. Anthropometric and ultrasound examinations, assessment of carbohydrate and lipid metabolism, histologic examination were done. It has been established that uterine hyperplasia patients often had lipid metabolism damages (dislipidemy) and damages of carbohydrate one (alimentaryconstitutional obesity, metabolic syndrome) which worsen the clinical course of the main disease. According to histological examination data, the activity of adenomyosis foci in patients with comorbid uterine pathology correlated with the severity of clinical manifestations (abnormal uterine bleeding, pain) and the presence of comorbid lesions (concomitant endometrial hyperplasia, chronic endometriosis, fibroids, endometriosis).