Immunohistochemical evaluation of the efficacy of therapy in female patients of reproductive age with abnormal uterine bleeding and endometrial hyperplasia

Abstract

Objective. Immunohistochemical analysis of the efficacy of progestin therapy for endometrial hyperplasia (EH) without atypia in female patients of reproductive age. Patients and methods. The study included 101 female patients of reproductive age with abnormal uterine bleeding who were diagnosed with EH without atypia after histological examination of the endometrium. These patients were treated with standard doses of progestins between days 5 and 25 of their menstrual cycle for 6 months. After the end of hormone therapy, aspiration biopsy of the endometrium was performed. Immunohistochemical examination of endometrial biopsy was performed in addition to histological examination in 54 patients before and after therapy: the expression of progesterone (PR-A, PR-B) and estrogen receptors (ERα) and the Ki-67 proliferative index were determined. The control group included 18 women without endometrial pathology. Results. Therapy was effective in 77 patients with EH (the menstrual cycle was normalized, the endometrium corresponded to the menstrual phase at pelvic ultrasound and histological examination of uterine aspirate); EH was still present in 24 patients. Immunohistochemical examination of the endometrium in patients without the effect of progestin therapy initially revealed lower expression of ERα in endometrial glands, PR-A and PR-B in endometrial stroma and glands, and a higher Ki-67 proliferative index in endometrial stroma; their expression did not change after therapy. In patients with a positive effect of hormone therapy, the expression of ERα in endometrial glands, PR-A and PR-B in endometrial stroma and glands increased and approached the values of healthy women in the control group. Conclusion. Patients with EH and positive effect of progestin therapy had higher values of the expression of ERα in endometrial glands, PR-A and PR-B in endometrial stroma and glands, and a lower Ki-67 proliferative index in endometrial stroma, which suggests that these parameters may serve as predictors of the efficacy of therapy for EH with gestagen-containing medications. Key words: abnormal uterine bleeding, progestagens, endometrial hyperplasia, immunohisto-chemical examination, Ki-67 proliferative index, endometrial pathomorphology, progesterone receptors, estrogen receptors

Prognostic significance of the immunohistochemical status of the endometrium as markers of therapy for endometrial hyperplasia

“…Широкая вариабельность ответа на гормональную терапию диктует необходимость разработки прогностических маркёров эффективности терапии и создания алгоритмов персонализированного подбора препаратов [10]. Имеются данные [11][12][13][14][15] о поисках предикторов среди различных маркёров: микроРНК, экспрессия генов рецепторов стероидных гормонов, полиморфизм гена группоспецифического компонента.…”

“…С целью оценки возможных предикторов эффективной терапии 100 пациенткам (54 -из группы 1 и 46из группы 2) дополнительно выполнено ИГХ-исследование эндометрия исходно и через 3 мес после окончания терапии по методике, представленной ранее [10]. Дифференцированно в железистом и стромальном компартментах оценили уровень экспрессии рецепторов к эстрогену (ERα), прогестерону (PR), а также Ki-67.…”