Hormonal therapy in patients of reproductive age with endometrial hyperplasia without atypia. Immunohistochemical predictors of efficacy

Objective. Evaluation of endometrial immunohistochemical parameters in patients with endometrial hyperplasia without atypia and abnormal uterine bleeding (AMB) as predictors of hormonal therapy efficacy. Material and methods. A total of 78 AMI patients of the reproductive period were examined. Hysteroscopy and separate diagnostic scraping of the uterine mucosa were performed. Histological examination of the endometrium revealed endometrial hyper-plasia without atypia. Norethisterone acetate at a dose of 10 mg/day was administered cyclically for 6 months. Endometrial aspi-ration biopsy was performed 3 months after the completion of treatment. Histological study was retrospectively divided into 2 groups: those with treatment success (Group 1) — 62 (79.49%) patients and those without (Group 2) — 16 (20.51%), in whom endometrial hyperplasia was diagnosed again. An immunohistochemical study (IGCI) of endometrial biopsy specimens containing ERα, PR-A, PR-B, Ki-67 expression was carried out before and after treatment. The control group comprised 18 healthy women. Results. According to IGCI data, the treatment effect patients showed a significantly lower initial ERα expression in the stromal and glandular structural components of the endometrium compared to healthy women. After treatment, all indices reached normal values. Patients with newly diagnosed endometrial hyperplasia showed initially low levels of ERα, PR-A, PR-B expression in the glandular and stromal endometrial structural components as compared to those in healthy women and Group 1 patients (except for ERα in the stroma) and these changes remained after treatment. The Ki-67 expression was initially higher in Group 2 patients compared to Group 1. Conclusion. It is reasonable to determine immunohistochemical markers in the endometrial tissue before treatment as they may be promising predictors of the efficacy of hormonal therapy in women of reproductive age with endometrial hyperplasia without atypia and abnormal uterine bleeding. © 2022, Media Sphera Publishing Group. All rights reserved.

Authors
Kappusheva L.M. , Mikhaleva L.M. , Breusenko V.G. , Golukhov G.N. , Midiber K.Y.U. , Biryukov A.E. , Ovchinnikova A.V. , Gutorova D.S. , Scherbatyuk K.V.
Publisher
Общество с ограниченной ответственностью Издательство Медиа Сфера
Number of issue
5
Language
Russian
Pages
22-29
Status
Published
Volume
22
Year
2022
Organizations
  • 1 N.I. Pirogov Russian Medical Research University, Moscow, Russian Federation
  • 2 A.P. Avtsyn Research Institute of Human Morphology, B.V. Petrovsky Russian Scientific Centre for Surgery, Moscow, Russian Federation
  • 3 City Clinical Hospital No31 of Moscow, Moscow, Russian Federation
  • 4 Peoples’ Friendship University of Russia, Moscow, Russian Federation
Keywords
abnormal uterine bleeding; endometrial hyperplasia without atypia; ERα; estrogen receptors; Ki-67; norethiosterone acetate; PR-A; PR-B; progesterone receptors
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