Immunohistochemical evaluation of the efficacy of therapy in female patients of reproductive age with abnormal uterine bleeding and endometrial hyperplasia
Authors:   N.I.Pirogov Russian National Research Medical University, Moscow, Russian Federation, Kappusheva L.M. , Mikhaleva L.M. ,   A.P.Avtsyn Research Institute of Human Morphology, Moscow, Russian Federation, Golukhov G.N. ,   City Clinical Hospital No 31, Moscow, Russian Federation, Shcherbatyuk K.V. ,   N.I.Pirogov Russian National Research Medical University, Moscow, Russian Federation, Biryukov A.E. ,   City Clinical Hospital No 31, Moscow, Russian Federation, Gracheva N.A. ,   A.P.Avtsyn Research Institute of Human Morphology, Moscow, Russian Federation, Gutorova D.S. ,   N.I.Pirogov Russian National Research Medical University, Moscow, Russian Federation, Chigray L.V. ,   A.P.Avtsyn Research Institute of Human Morphology, Moscow, Russian Federation, Ochirova S.O. ,   A.P.Avtsyn Research Institute of Human Morphology, Moscow, Russian Federation, Breusenko V.G. ,   N.I.Pirogov Russian National Research Medical University, Moscow, Russian Federation
Published: June 2022

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