Scientific journal
European Journal of Natural History
ISSN 2073-4972

COMPLEX DIAGNOSTICS OF MYOENDOMETRIUM PATHOLOGY

Dikariova L.V., Shvariov E.G.

In many countries of the world the recent decades  are characterizes by the incidence rate of hormonodependent tumors of reproductive organs  ( hysteromyoma among them), hyperplastic processes and endometrium cancer with the rejuvenescence of the sick women contingent. Numerous data allow to  consider hysteromyoma as a clinical risk marker of the development of genitals´ hormonodependent tumors (among them are primary-multiple formations) in women of not only  perimenopausal but also of reproductive age (J.B. Bosman, 1989; E.G Shvariov, 1993; L.M. Bershtein, 2001; N. Potischman, C.A. Swanson, L.A. Brinton et al., 1993).

In spite of the sufficient number of detection methods of myeondometrium pathology, the necessity of new ones is retained. It is stipulated by inadequate susceptibility of the existing methods, their complicacy and high cost at the screening and monitoring stages. For our research of biological material  the endometrial secretion was chosen. It is stipulated by the fact, that during the usage of  immunofluorescent and histochemical research methods of normal, hyperplastic and malignant endometrium tissue the ability of some enzymes and their isoforms to be accumulated in apical parts of glandular mucus was revealed (E.G. Shvariov, 1993). The biological peculiarity of endometrium is that this hormonosensitive tissue has the ability of cyclic renewal of cellular composition and is influenced by sexual hormones, peroxide lipid oxidation products and proteins.

No doubts that the development of various pathologic processes is associated with the so called "oxidant stress", which can be the direct cause of a disease or accompanies its development. The production of active oxygen forms increases, and the antioxidant system which regulates processes of peroxide lipid oxidation and peroxide protein destruction is involved into the  process. The oxidant stress development doesn´t affect the isolated disturbance of lipids, proteins or nucleic acids because of their close interaction; thus, they are to be considered as a whole complex.

The offered approach allows to carry out biochemical cytological and crystallographical research simultaneously. Diagnostically it turned out to be more effective than the detection of markers in serum, where the received indexes were rather diverse.

420 women were examined; they were divided into following groups:

1) control group, including 64 (15,2 %) women without reproductive organs pathology;

2) 208 (49,5%) women with hysteromyoma having normal structure of endometrium;

3) 84 (20,1%) women with hysteromyoma having hyperplastic processes;

4) 13 (2,86%) women with hysteromyoma in combination with atypical hyperplasia of endometrium:

5) 52 (12,4 %) women with hysteromyoma in combination with cancer of endometrium.

In these groups the content of catalase was detected. Catalase is one of the enzymes of antioxidant protection, that is malon dialdehyde, which is the secondary product of peroxide lipid oxidation and carbonil groups of protein - markers of peroxide destruction.

The meanings of catalase index and catalase number in the control group were 3,09 ± 0,18 untis and 0,8 ± 0,08 units. In women with hysteromyoma having normal endomtrium structure, the investigated parameters were 2,53 ± 0,16 units and 0.71 ± 0,05 units; in women with hystromyoma in combination with hyperplastic processes the parameters were 1,8 ± 0,33 units and 0,44 ± 0,09 units. The lowest meanings of there enzymes were registered in the group of women with hysteromyoma in combination with atypical hyperplasia of endometrium and endometrium cancer - 0,68 ± 0,2 and 0,2 ± 0,09 units (p < 0,05). The meanings of malon dialdehyde in the investigated groups, on the contrary, had the  tendency to the increasing and were 0,37 ± 0,1 units; 0,49 ± 0,06 units; 1,68 ± 0,23 units and 3,01 ± 0,85 units. When evaluating the coefficient of correlation it was determined that there is a strong inverse connection between the investigated data (p < 0,05).

The determination of peroxide protein destruction was carried out according to the technique of R.L. Levine et al. (1990) in modification of E.E. Dubinina et al. (1995). The showings were evaluated in peripheral blood as well as in endometrial secretion; the most convincing data were received in  endometrial secretion. The results showed the evaluation of showings of peroxide protein destruction on the level of carbonil derivatives in endometrial secretion to be one of the most sensitive showings of the oxidant stress.

The previous years in clinical medicine a new diagnostic technique was developed; it is based on the information  of overmolecular level during the  transition of biological liquids into the solid states (V.N. Shabalin, S.N. Shtokhina, 1999; 2001).

This information is contained in the structure of the so called facii, the microscopic investigation of which allows to receive the morphological decoding (V.N. Shabalin, S.N. Shatokhina, 2000).

The described phenomena allows the usage of the results of structural analysis of biological liquids in screening and monitoring of patients with hyperplastic processes of myoendometrium and endometrium cancer.

For the investigation of endometrial secretion, its transition into solid phase with the method of cuneate dehydration was made. The analysis of structural elements of a dehydrated drop was made with the  stereomicroscope Mz-12 (Leica) and digital camera "Pixera" (USA). We investigated the samples of dried drops, i.e. facii, as well as their enlarged photographs (from x10 to x160). The coefficients appropriate the endometrium pathology of different levels were calculated. Morphometrical showings of facii of endometrium secretion were evaluated with the help of the programme Image Tool.

During  the examination of endometrial secret of hormonodependent tumors we determined 3 types of facii: radial (it is found in 48,4% of patients having hysteromyoma with the normal endometrium structure); mixed, which is found in patients with hysteromyoma in combination with hyperplastic endometrium; three-radial, which is found in patients with atypical endometrium hyperplasia and endometrium cancer.

In patients having hysteromyoma with  normal endometrium structure in the samples of facii large fissures prevailed, forming special separate parts, where only isolated three-radial fissures were met. With the increasing of severity of endometrium pathology (glandular endometrium hyperplasia) the spread of three-radial fissures increased. In patients with atypical endometrium hyperplasia and endometrium cancer the structure of facii differed from that described above: in the investigated samples all over the area of facii the net of three-radial fissures was found.

To determine the power on interaction between the showings Srad and Str the tetrachorioidal coefficient of Pirson was calculated, which was  increased with the severity of pathology of myemoendometrium from 0,3 to 0,8.

The main structural elements of facii are given in the table №1.

Table 1. The main Characteristics of Endometrial Facii in Myemoendometrium Pathology.

The investigated groups

The main structural elements of facii of uterus biological liquids

Srad (mm²)

(area of radiality)

Str (mm²)

(area of 3-radial fissures)

Patients without tumor pathology of reproductive system (N=64)

 

Hysteromyoma with normal endometrium (N=208)

 

 

Hysteromyoma with  endometrium hyperplasia (N=84)

 

 

 

Hysteromyoma with atypical endometrium hyperplasia (N=13)

 

 

Hysteromyoma with endometrium cancer (N=52)

 siteness, radial fissures, separate parts are expressed, in 10% isolated three-radial fissures can be found.

 

 

 siteness, radiality of fissures, separate parts, in 48,4%  isolated three-radial fissures at any age are found.

 

 

 siteness, radiality of fissures, increasing number of separate parts, three-radial fissures.

 

 

 

 clear siteness is being lost, in peripheral zone isolated radial fissures are kept, on the other part of surface there is a net of three-radial fissures.

 

 

 siteness is lost, in 88% of patients radial fissures are absent, three-radial fissures are the main structural elements.

6,8 ± 0,12

 

 

 

 

5,1 ± 0,42

 

 

 

 

6,1 ± 0,46

 

 

 

 

 

2,23 ± 0,58

 

 

 

 

 

0

 

 

 

0,3-0,5±

± 0,06

 

 

 

1,1 ± 0,08

 

 

 

 

2,1 ± 0,11

 

 

 

 

 

3,2 ± 0,58

 

 

 

 

 

6,7 ± 0,6

Thus, the evaluation of structural peculiarities of endometrial secretion, some enzymes of antioxidant protection, secondary products of peroxide lipid oxidation and markers of peroxide protein destruction allows to reveal patients of high risk group with endometrium pathology at the preclinical period; it also allows to reveal forming pathologic processes of myenoendometrium, preventing the development of precancer and cancer of this localization. Nontraumatic sampling of the material, the simplicity of its processing give us large possibilities of effective dispancerization of women with the investigated pathology.

The article is admitted to the International Scientific Conference «Basic and applied research in medicine», China (Beijing), November 26-December 4, 2007, came to the editorial office on 22.11.07