Акушерство и Гинекология Санкт-Петербурга. 2019; : 33-39
Прогнозирование развития рецидива эндометриоза яичников
Аннотация
Среди всех поражений наружного генитального эндометриоза ведущая роль принадлежит эндометриозу яичников, который характеризуется частым рецидивирующим течением и формированием бесплодия.
Цель исследования: снижение риска рецидива эндометриоза яичников путем выявления его клинических и молекулярнобиологических особенностей.
Материал и методы: 147 пациенток с эндометриозом яичников и 28 с аденокарциномами яичников проанализировано ретроспективно. Гистологическим и иммуногистохимическим методами изучено 78 и 35 наблюдений ЭЯ соответственно и 8 наблюдений аденокарцином. Использовались антитела к Ki-67, Bcl-2, p53, ядерному фактору гепатоцитов-1β (HNF-1β). Проспективно проанализировано 90 пациенток с подтвержденным диагнозом эндометриоза яичников по данным патоморфологического исследования по разработанному в исследовании алгоритму наблюдения и лечения пациенток с угрозой развития рецидива эндометриоза яичников.
Результаты: в эпителии стенокэндометриоидных кист обнаружены синцитиальные папиллярные регенераторные (гиперпластические) изменения (39,7%), метаплазия с появлением клеток типа «сапожного гвоздя с большой шляпкой» (15,4%), очаговая гиперплазия (3,9%). Атипия эпителия в очагах ЭЯ выявлена в 41% (6,4% – истинная атипия). Вне зависимости от наличия признаков атипии эпителия для очагов ЭЯ характерна гиперэкспресссия HNF-1β, что подтверждает гистогенетическую связь со светлоклеточными аденокарциномами. По результатам проспективного исследования разработан алгоритм наблюдения и лечения пациенток с угрозой развития рецидива ЭЯ.
Заключение: по результатам проведенного исследования можно сделать вывод о том, что правильная интерпретация лучевых методов диагностики, гистологического и иммуногистохимического обследования (с антителами к Ki-67, Всl-2, р53 и ядерному фактору гепатоцитов-1beta (HNF-1β)) наряду с обязательной оценкой анамнеза каждой пациентки позволяет заподозрить риск развития рецидива и неопластической трансформации эндометриоза яичников с последующей разработкой верной тактики ведения.
Список литературы
1. Brown J., Crawford T.J., Allen C., Hopewell S., Prentice A. Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database of Systematic Reviews. 2017; 1: CD004753. doi: 10.1002/14651858.
2. Fuldeore M.J., Soliman A.M. Prevalence and Symptomatic Burden of Diagnosed Endometriosis in the United States: National Estimates from a CrossSectional Survey of 59,411 Women. Gynecologic and obstetric investigation. 2017; 5 (82): 453–461. doi: 10.1159/000452660.
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4. Practice Committee of American Society for Reproductive Medicine Treatment of pelvic pain associated with endometriosis. Fertility and Sterility. 2008; 5 (90): S260–S269.
5. Kovachev P.S., Banerjee D., Rangel L.P. et al. Distinct modulatory role of RNA in the aggregation of the tumor suppressor protein p53 core domain. The Journal of biological chemistry. 2017; 22 (292): 9345–9357. doi: 10.1074/jbc. M116.762096.
6. Akbarzadeh-Jahromi M., Shekarkhar G., Sari Aslani F. et al. Prevalence of Endometriosis in Malignant Epithelial Ovarian Tumor. Archives of Iranian medicine. 2015; 12 (18): 844–8. doi: 0151812/AIM.009.
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13. Kajihara H., Yamada Y., Shigetomi H. et al. The dichotomy in the histogenesis of endometriosis-associated ovarian cancer: clear cell-type versus endometrioid-type adenocarcinoma. International journal of gynecological pathology. 2012; 4 (31): 304–12. doi: 10.1097/PGP.0b013e318243a97b.
14. Yalcin S.E., Ocal I., Yalcin Y. et al. Evaluation of the Ki-67 Proliferation Index and Urocortin Expression in Women with Ovarian Endometrioma. The Eurasian journal of medicine. 2017; 2 (49): 107–112. doi: 10.5152/eurasianjmed.2017.17070.
15. Guerriero S., Van Calster B., Somigliana E. et al. Age-related differences in the sonographic characteristics of endometriomas. Human reproduction. 2016; 8 (31): 1723–31. doi: 10.1093/humrep/dew113.
16. Kim S.H., Choi Y.M., Choung S.H. et al. Vascular endothelial growth factor gene +405 C/G polymorphism is associated with susceptibility to advanced stage endometriosis. Human reproduction. 2005; 10 (20): 2904–8.
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Obstetrics and Gynaecology of Saint-Petersburg. 2019; : 33-39
The possibility for predicting of recurrent ovarian endometriosis development
Abstract
Among all the lesions of external genital endometriosis, the leading role belongs to ovarian endometriosis, which is associated with frequent recurrences and may case infertility.
Objective: reducing the risk of recurrence of the ovarian endometriosis by identifying clinical, molecular and biological characteristics.
Material and methods: we retrospectively analyzed 147 patients with ovarianendometriosisand 28 withovarianadenocarcinomas. 78 histological and 35 immunohistochemical assays of ovarian endometriosis were conducted. 8 adenocarcinomacaseswerestudiedimmunohistochemically. Antibodies to Ki-67, Всl-2, р53 and hepatocyte nuclear factor-1beta (HNF- 1β) were used. 90 patients were prospectively analyzed with a confirmed diagnosis of ovarian endometriosis according to the pathomorphological assay. Prospective study conducted according to developed algorithm of observation and treatment of patients with risk of recurrent ovarian endometriosis.
Results: in the epithelium of endometrioid cyst walls we identified foci with syncytial papillary abnormalities (39,7%), metaplasia with clear cytoplasm cells (15,4%), focal hyperplasia (3,9%). In 41% of cases, epithelial atypia was observed (6,4% – true atypia). We identified overexpression HNF-1β in foci of ovarian endometriosis regardless of the presence of atypia. This fact confirms histogenetic association with clear cell adenocarcinomas. Algorithm for monitoring and treating patients with risk of recurrent ovarian endometriosis based on a prospective study was developed.
Conclusion: correctinterpretation of radiologicalmethods ofdiagnosis, histological and immunohistochemical methods (with antibodies to Ki-67, Всl-2, р53 and hepatocyte nuclear factor-1beta (HNF-1β)) and assessment of the history of each patient allows to suspect the risk of recurrence and neoplastic transformation of ovarian endometriosis and develop the right patient management tactics.
References
1. Brown J., Crawford T.J., Allen C., Hopewell S., Prentice A. Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database of Systematic Reviews. 2017; 1: CD004753. doi: 10.1002/14651858.
2. Fuldeore M.J., Soliman A.M. Prevalence and Symptomatic Burden of Diagnosed Endometriosis in the United States: National Estimates from a CrossSectional Survey of 59,411 Women. Gynecologic and obstetric investigation. 2017; 5 (82): 453–461. doi: 10.1159/000452660.
3. Pontoglio M. Hepatocyte nuclear factor 1, a transcription factor at the crossroads of glucose homeostasis. JASN. 2000; 11 (Suppl 16): S140–3.
4. Practice Committee of American Society for Reproductive Medicine Treatment of pelvic pain associated with endometriosis. Fertility and Sterility. 2008; 5 (90): S260–S269.
5. Kovachev P.S., Banerjee D., Rangel L.P. et al. Distinct modulatory role of RNA in the aggregation of the tumor suppressor protein p53 core domain. The Journal of biological chemistry. 2017; 22 (292): 9345–9357. doi: 10.1074/jbc. M116.762096.
6. Akbarzadeh-Jahromi M., Shekarkhar G., Sari Aslani F. et al. Prevalence of Endometriosis in Malignant Epithelial Ovarian Tumor. Archives of Iranian medicine. 2015; 12 (18): 844–8. doi: 0151812/AIM.009.
7. Kikuchi I., Takeuchi H., Kitade M. et al. Recurrence rate of endometriomas following a laparoscopic cystectomy. Acta obstetricia et gynecologica Scandinavica. 2006; 9 (85): 1120–4.
8. Ouchi N., Akira S., Mine K. etal. Recurrence of ovarian endometrioma after laparoscopic excision: risk factors and prevention. The journal of obstetrics and gynaecology research. 2014; 1 (40): 230–6. doi: 10.1111/jog.12164.
9. Menakaya U., Reid S., Lu C. et al. Performance of ultrasound-based endometriosis staging system (UBESS) for predicting level of complexity of laparoscopic surgery for endometriosis. Ultrasound in obstetrics & gynecology. 2016; 6 (48): 786–795. doi: 10.1002/uog.15858.
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12. Clement P. The pathology of endometriosis: a survey of the many faces of a common disease emphasizing diagnostic pitfalls and unusual and newly appreciated aspects. Advances in anatomic pathology. 2007; 4 (14): 241–60.
13. Kajihara H., Yamada Y., Shigetomi H. et al. The dichotomy in the histogenesis of endometriosis-associated ovarian cancer: clear cell-type versus endometrioid-type adenocarcinoma. International journal of gynecological pathology. 2012; 4 (31): 304–12. doi: 10.1097/PGP.0b013e318243a97b.
14. Yalcin S.E., Ocal I., Yalcin Y. et al. Evaluation of the Ki-67 Proliferation Index and Urocortin Expression in Women with Ovarian Endometrioma. The Eurasian journal of medicine. 2017; 2 (49): 107–112. doi: 10.5152/eurasianjmed.2017.17070.
15. Guerriero S., Van Calster B., Somigliana E. et al. Age-related differences in the sonographic characteristics of endometriomas. Human reproduction. 2016; 8 (31): 1723–31. doi: 10.1093/humrep/dew113.
16. Kim S.H., Choi Y.M., Choung S.H. et al. Vascular endothelial growth factor gene +405 C/G polymorphism is associated with susceptibility to advanced stage endometriosis. Human reproduction. 2005; 10 (20): 2904–8.
17. Igarashi P., Shao X., McNally B.T. et al. Roles of HNF-1beta in kidney development and congenital cystic diseases. Kidney international. 2005; 5 (68): 1944–7.
18. Zairat'yants O.V., Adamyan L.V., Andreeva E.N. i dr. Molekulyarnobiologicheskie osobennosti ektopicheskogo i eutopicheskogo endometriya pri genital'nom endometrioze. Arkhiv patologii. 2010; 5: 6–12.
19. Gromova T.A., Antoshechkina M.A., Kalinin D.V. i dr. Morfologicheskie i molekulyarno-biologicheskie priznaki neoplasticheskoi transformatsii epiteliya ochagov endometrioza yaichnikov. Klinicheskaya i eksperimental'naya morfologiya. 2017; 3 (23): 16–21.
20. Socolov R., Socolov D., Sindilar A. et al. An update on the biological markers of endometriosis. Minerva ginecologica. 2017; 5 (69): 462–467. doi: 10.23736/ S0026-4784.17.04046-1.
21. Luisi S., Pinzauti S., Regini C. et al. Serum markers for the noninvasive diagnosis of endometriosis. Women’s health. 2015; 5 (11): 603–10. doi: 10.2217/ whe.15.46.
22. Spitz I.M. Mifepristone: where do we come from and where are we going? Clinical development over a quarter of a century. Contraception. 2010; 5 (82): 442–52. doi: 10.1016/j.contraception.2009.12.012.
