Изучение клинико-морфологических особенностей различных форм эндометриоидной болезни Текст научной статьи по специальности «Клиническая медицина»

Science

through time and space

Жамият ва инновациялар -

Общество и инновации -

Society and innovations

Journal home page:

https: //inscience.uz/index.php/socinov/index

Study of clinical and morphological features of different forms of

endometrioid disease

Gulbakhor JURAEVA !

Bukhara Medical Institute

ARTICLE INFO

Article history:

Received February 2021

Received in revised form

20 February 2021

Accepted 15 March 2021

Available online

5 April 2021

Keywords:

the occurrence of

endometriosis,

ovarian endometriosis,

adenomyosis,

clinical and morphological

variants,

reproductive age.

ABSTRACT

The frequency of occurrence and morphological forms of the

endometrioid disease in 148 women of reproductive age were

studied at the Bukhara pathoanatomical bureau sent from the

republican emergency center to the department gynecology of

the Bukhara branch. The material for the study was operating

materials. Histological preparations were examined under a light

microscope, and the critical areas were photographed.

Morphometric studies of adenomyosis and endometriosis

tissue were studied under a Leyka microscope using Avtandilov's

grid, the ratio of parenchyma and glandular components.

According to the study results, the following changes were

identified: histologically, both in the myometrium and in the

ovaries, endometrioid foci were determined, which penetrated

to different depths. The lesions had two components: stromal

and glandular structures. The ratio of these components varied

depending on the type of these nodes.

An endometrioid ovarian cyst was found in 49 patients,

retrocervical endometriosis in 24 women, uterine adenomyosis

in 15, and a combination of various localization of endometrioid

lesions in 60 patients.

Thus, analysis of the results of morphological studies of micro

preparations of different histological variants of endometrioid

disease demonstrates a significant degree of uneven distribution

of tissue components and structures in different observation

cases. Various forms of adenomyosis and endometriosis must be

considered when choosing rational tactics for managing patients

in the postoperative period to prevent relapse. Endometriosis of

the uterus and ovary is characterized by a long asymptomatic or

oligosymptomatic course followed by the rapid development of

the clinical picture and the appearance of indications for surgical

treatment. In this case, the main indications are pain syndrome

1 Associate Professor, Candidate of Medical Sciences, Head of the Department of Pathological Anatomy Bukhara

Medical Institute, Bukhara, Uzbekistan.

e-mail: [email protected]

through time and space

о

: Science }KaMuaT Ba HHHOBalMANap - O6mecTBO H HHHOBarIMH — Society and innovations

Issue - 2 N° 2 (2021) / ISSN 2181-1415

(100%) combined with hypermenstrual syndrome (55.7%),

accompanied by rapid growth in every second patient, and

anemia in every third patient.

2181-1415/© 2021 in Science LLC.

This is an open access article under the Attribution 4.0 International

(CC BY 4.0) license (https://creativecommons.org/licenses/by/4.0/deed.ru)

Эндометриоид касаллигининг турли хил шаклларининг

клиник ва морфологик хусусиятларини урганиш

АННОТАЦИЯ

Калит сузлар:

эндометриоз пайдо булиш

частотаси,

бачадон эндометриози,

аденомиоз,

клиник ва морфологик

вариантлар,

репродуктив ёш.

Республика шошилинч гинекология булимининг Бухоро

филиалидан патологик анатомия бюросига эндометриоид

касаллиги билан касалланган 148 та репродуктив ёшдаги

аёлларнинг юборилган операцион материаллари

Урганилди. Тадкикот учун биопсия материаллари олинган.

Гистологик препаратлар ёруглик микроскопида

текширилиб керакли жойлар расмга олинди.

Аденомиоз ва эндометриозда тукиманинг морфометрик

хусусиятлари ГеуКа микроскопида Автандилов сеткасидан

фойдаланилган холда, паренхима ва строма

элементларининг нисбати урганилди. Тадкикот

натижаларига кура куйидаги Узгаришлар аникланди:

гистологик жихатдан хам миометрийга, хам эндометрийга

турли чукурликда кириб борган эндометриоид Учоклар

аникланди. Учоклар иккита таркибий кисмга: яьни стромал

ва безли тузилишга эга. Эндометриознинг турига караб

ушбу компонентнинг таркибий кисми уУзгариб турарди.

Касалларнинг 49 тасида эндометриоид тухумдон кистаси,

24 аёлда ретроцервикал эндометриоз, 15 Тасида бачадон

аденомиози ва 60 беморда эса эндометриоид тугунларнинг

турли комбинацияси аникланди.

Шундай килиб, эндометриоид касаллигининг турли хил

гистологик вариантларини морфологик тахлил килиш

натижалари турли кузатув холатларида тукима таркибий

кисмлари ва тузилмаларнинг нотекис таксимланганлигини

курсатди. Операциядан кейинги даврда асоратларни

олдини олишда аденомиоз ва эндометриозни турли

шаклларини мавжудлигини беморларни бошкаришда

окилона тактикани танлашни такозо этади. Бачадон ва

тухумдоннинг эндометриози узок вакт симптомсиз ва кам

симптомлар билан кечиб, сунгра тез ривожланадиган ва

жаррохлик амалиёти учун курсатма пайдо киладиган

патология эканлиги аникланди. Бунда беморларда асосий

курсаткичлар (100%) холатларда огрик синдроми, (55,7%)

холатларда гиперменструал, Xap иккита беморда

тугунларнинг тез усиши ва хар учинчи беморда камконлик

белгилари билан намоён булди.

265

Я | о

Ш] 5‹епсе Жамият ва инновациялар - Общество и инновации - $ос1еёу and innovations

PRES ai geen Issue - 2 Ne 2 (2021) / ISSN 2181-1415

Изучение клинико-морфологических особенностей

различных форм эндометриоидной болезни

АННОТАЦИЯ

Ключевые слова: Изучены частота встречаемости и морфологические

частота возникновения формы эндометриоидной болезни у 148 женщин

эндометриоза, Б арском

ндометриоз яичников, репродуктивного возраста B ухар

аденомиоз, патологоанатомическом бюро направленное из

клинико- республиканского экстренного неотложного центра

морфологические отделении гинекологии Бухарского филиала. Материалом

варианты, для исследования служили взятые биопсии.

репродуктивный возраст.

Гистологические препараты изучали под световым

микроскопом и фотографировали необходимые участки.

Морфометрические исследования ткани аденомиоза и

эндометриоза изучали под микроскопом [еуКа с помощью

сетки Автандилова соотношение паренхимы и железистых

компонентов. По результатам исследования были

выделены следующие изменения: гистологически, как в

миометрии так и в яичниках, определили эндометриоидные

очаги, которые проникли на различную глубину. Очаги

имели в себе два компонента: стромальные и железистые

структуры. Соотношение этих компонентов варьировали в

зависимости от вида этих узлов.

У 49 больных обнаружено эндометриоидная киста

яичника, у 24 женщин ретроцервикальный эндометриоз, у

15 аденомиоз матки, ау 60 больных сочетание различных

локализации эндометриоидных поражений.

Таким образом, анализ результатов морфологических

исследований микропрепаратов разных гистологических

вариантов эндометриоидной болезни демонстрирует

значительную степень неравномерностям распределения

тканевых компонентов и структур в разных случаях

наблюдения. Существование различных форм аденомиоза и

эндометриоза необходимо учитывать при выборе

рациональной тактики ведения пациенток B

послеоперационном периоде для профилактики рецидивов.

Для эндометриоза матки и яичника, характерно длительное

бессимптомное или малосимптомное течение с

последующим быстрым развитием клинической картины и

появлением показаний для хирургического лечения. При

этом основными показаниями являются: болевой синдром

(100%) в сочетании с гиперменструальным синдромом

(55.7%), сопровождающиеся у каждой второй пациентки

быстрым ростом, у каждой третьей - анемией.

THE AIM OF THE RESEARCH

Conduct a clinical and morphological analysis of ovarian endometriosis and

adenomyosis, taking into account its various variants and morphofunctional forms.

266

©

iu Science Жамият ва инновациялар - Общество и инновации - 50 1еу ап4 шпоуаНоп$

PRES ai geen Issue - 2 Ne 2 (2021) / ISSN 2181-1415

MATERIALS AND METHODS

The morphological forms of adenomyosis and endometriosis of the ovaries were

studied in 148 women of reproductive age in the Bukhara Patho-anatomical bureau sent

from the Republican Emergency Center to the Department of Gynecology of the Bukhara

branch. The material for the study was operating materials. For general morphology, 3

pieces were excised from each endometrioid node that was, 1.5 x 1.5 cm from the center,

middle and peripheral parts, and solidified in 10% neutral formalin. After washing for 2-

4 h in running water, it was dehydrated in concentrated alcohol and chloroform, then

embedded in paraffin and prepared blocks. On paraffin blocks, sections of 5-8 um were cut,

stained with hematoxylin and eosin. Semi-thin 1 um sections were obtained from Epon

bricks on a LeyKa ultramicrotomy. Histological preparations were examined under 10, 20,

40 lenses of a light microscope and the necessary areas were photographed.

RESULTS AND DISCUSSION

Surgery materials of 148 female patients of reproductive age without other

gynecological diseases with various localizations of genital endometriosis, removed during

surgical operations, were examined. The average age of patients was 36.8 + 0.74 years,

40% of patients were under the age of 35; 41% - from 36 to 45 years old; 22.2% - over 46

years old. Women were hospitalized on an emergency basis. Upon admission to the clinic,

the examined women indicated complaints related to various manifestations of pain

syndrome and menstrual irregularities. Periodic pain was indicated by 52.6% of patients,

severe pain during the menstrual cycle was in 21.4% of patients, and pain before the

menstrual cycle was noted by 5.7% of women. Indications for surgical treatment were:

ovarian cystoma, uterine adenomyosis, a combination of adenomyosis with uterine

myoma and menstrual irregularities by the type of hyperpolymenorrhea. Scope of surgical

interventions - supravaginal amputation of the uterus without or with appendages,

extirpation of the uterus without or with appendages and removal of endometriotic

ovarian cysts. The removed preparations were carefully examined; the sizes of the uterus,

the thickness of the endometrium and ovaries, and the thickness of the endometrium and

ovaries were measured. The presence of macroscopically visible pathological areas was

determined. In macroscopic examination, the uterus was enlarged in all cases. This is

associated with both the growth of uterine fibroids and the shape and activity of foci of

adenomyosis. In focal adenomyosis, thickening of one or several walls of the uterus was

observed, in diffuse, the myometrium was thickened throughout. The nodular variant did

not have a capsule, with indistinct boundaries of intramural nodules of various sizes. The

incidence of different forms of endometriosis was also studied.

Table 1. The incidence of different forms of endometriosis

Forms Number of women

Endometrioid ovarian cyst 49(68 %)

Retrocervical endometriosis 24(24%)

Adenomyosis of the uterus 15(26%)

Combination of different localization of | 60(74%)

endometriotic lesions

267

fMScience

}KaMuaT Ba HHHOBalMANap - O6mecTBO H HHHOBarIMH — Society and innovations

Нин Issue - 2 No 2 (2021) / ISSN 2181-1415

a №

Fig. N¢ 1. Glandular structures of various __ Fig, Ne 2. Penetration of the basal layer of

shapes, sizes from small with a narrow the endometrium into the myometrium.

lumen to larger ones, endometrial Staining with hematoxylin and eosin.

hyperplasia and dilated venules. Staining 10x10.

with hematoxylin and eosin. 10x10.

Fig Ne 3. Adenomyosis of the uterus, Fig. N@ 4, Adenomyosis of the uterus, cystic

endometrial glands with the surrounding altered glands of the endometrial type

cytogenetic stroma is located in the with the surrounding cytogenetic stroma

myometrium. Staining with hematoxylin located in the myometrium. Stained with

and eosin. 10x10. hematoxylin and eosin. 10x10.

Histologically, both in the myometrium and in the ovaries, endometrioid foci were

determined, which penetrated to different depths. The lesions had two components, both

stromal and glandular structures: the ratio of these components varied depending on the

types of these nodes. In active adenomyosis, the glandular component was 33.4 + 17.4%,

the share of the stromal was -66.5 + 16.4 %, not significantly differing from inactive foci -

the proportion of the glandular component and the stromal, respectively (36.5 + 11.4%

and 63.4 + 11.4% at p = 0.14 and 0.32).

Thus, the results of morphological studies had shown that endometriosis in women

was one of the most common pathologies. The existence of various forms of ovarian

268

©

iu Science Жамият ва инновациялар - Общество и инновации - 50 1еу ап4 шпоуаНоп$

PRES ai geen Issue - 2 Ne 2 (2021) / ISSN 2181-1415

endometriosis and adenomyosis should be taken into account when choosing a rational

tactics for managing patients in the postoperative period to prevent relapse.

CONCLUSION

In patients with endometriosis against the background of inflammatory processes,

the syndrome of chronic pelvic pain, various mono and multiple organ pathologies was

most often observed. Endometriosis of the uterus and ovary was characterized by a long-

term asymptomatic or low-symptom course, followed by a rapid development of the

clinical picture and the appearance of indications for surgical treatment. In this case, the

main indications were: pain syndrome (100%) in combination with hyper menstrual

syndrome (55.7%), accompanied by every second patient grows rapidly, every third had

anemia.

REFERENCES:

1. Adamyan L.V., Kulakov V.L, Andreeva E.N., Endometriosis (Moscow: Medicine),

2nd ed. 2006; p. 416.

2. Adamyan L.V Clinic, diagnosis and treatment of genital endometriosis //

Obstetrics and gynecology, 1992. No. 7. - p. 5-10.

3. Use of Nemestran in the treatment of patients after laparoscopic removal of

endometrioid cysts / Adamyan L. V. et al. // Endoscopy in the diagnosis and treatment of

uterine pathology (with a course of endoscopy): Mater, Intern. Congress. M., 1997.-4.2. -

pp. 15-37.

4. Adamyan L.V. Laparoscopy and laparotomy in the diagnosis and treatment of

ovarian formations / Adamyan L. V., Beloglazova S. E. // Endoscopy in gynecology: Mater,

scientific. editions. M., 1999 .-- pp. 375-388.

5. Adamyan L.V. Genital endometriosis: etiopathogenesis, clinical picture, diagnosis,

treatment: Methodological guide for doctors / Adamyan LV, Andreeva E.M, 2001. - p. 35.

6. Genital endometriosis: the role of endoscopic methods and hormone therapy in

diagnostics, treatment, monitoring / Adamyan L.V et al. // Laparoscopy and hysteroscopy

in gynecology and obstetrics: Mater, scientific. editions. M.: Pantori, 2002.- pp. 75-87.

7. Adamyan L.V Genital endometriosis. Modern view of the problem / Adamyan L.V.,

Gasparyan S.A. Stavropol: SGMA, 2004.- p. 228.

8. Andreeva E.N Common forms of genital endometriosis: medico-genetic aspects,

diagnosis, clinic, treatment and monitoring of patients: Dis. for a job. learned, Doct. Med.

Sciences. M., 1997 .- p. 333.

9. Balakshina N.G Laparoscopic surgery in patients with small forms of

endometriosis with infertility / Balakshina N.G, Soklakova I.V, Koh L.I // Endoscopy in

gynecology: Mater, scientific. editions. M., 1999 .-- pp. 361-363.

10. Baskakov V.P Clinic and treatment of endometriosis. L .: Medicine, 1990. p. 240.

11. Baskakov V.P Diagnostics and treatment of endometriosis at the present stage:

A manual for doctors / Baskakov V.P, Tsvylev Yu. V., Kira E.F SPb, 1998. - p. 33.

12. Bobkova M.V Clinical and morphological features of external genital

endometriosis: Dis. for a job. Learned, Cand. Med. Sciences. -M., 1995.- p. 174.

13. Comparative effectiveness of various methods of treating infertility in patients

with external genital endometriosis / Volkov N.I et al. // Journal of Obstetrics and

Women's Diseases, 2001. T. 50. - No. 3. - pp. 25-27.

269

©

Ш] 5‹епсе Жамият ва инновациялар - Общество и инновации - 50 1еу ап4 шпоуаНоп$

ee inna spor Issue - 2 N° 2 (2021) / ISSN 2181-1415

14. Gadaeva I.V Possibility of endoscopic methods of treatment of patients with

common forms of endometriosis / Gadaeva I.V, Ishchenko A.I, Kudrina E.A // Endoscopy

in gynecology: Mater, scientific. editions. M., 1999 .- pp. 358-359.

15. Gynecology according to Emil Novik / ed. J. Bereke, I. Arkashi and P. Hillard /

Transl. from English M .: Practice, 2002 .- p. 896.

16. Gorbushin S.M Peritoneal endometriosis and infertility: clinical and

morphological parallels: author. Dis. for a Job. Learned, Cand. Med. Sciences. -S.Pb.,

1996.18 р.

17. Gorokhov A.P Endometrioid ovarian cysts, frequency, features of surgical

treatment / Gorokhov A.P, Lazarev I.P // Scientific Bulletin of Tyumen. Medic. Acad.

Tyumen, 2001. - No. 1. -pp. 108-109.

18. Grishchenko V. I. Magnetic resonance imaging and dopplerometry in obstetrics

and gynecology / Grishchenko V. I. etal. // Intern. Medic. Magazine, 1998. T. 4. - Мо. 3.- рр.

23-26 to. 87.

19. Adamson G. D. Laparoscopic CO-2 laser vaporization of endometriosis /

Adamson G.D., Lu J., Subak L. L. // Fertil. Steril., 1988. Vol. 50. - № 5. - рр. 704-710.

20. Ahmed M. S. Reoperation rates for recurrent ovarian endometriomas after

surgical excision / Ahmed M. S., Barbieri R. L. // Gynec. and Obstet. Investigation, 1997.

Vol. 43. - P. 53-54.

21. The role of transvaginal ultrasonography combined with velocity imaging and

pulsed Doppler in the diagnosis of endometrioma / Alcazar J. L. et al. // Fertil. Steril., 1997.

-Уо1. 67. -№3.-рр. 487-491.

270