«Implantation window» disturbance in patients with hyperplastic processes of endometrium

Authors

  • O. I. Parnytska ДУ «Інститут педiатрії, акушерства та гінекології НАМН України», Ukraine

DOI:

https://doi.org/10.14739/2310-1237.2013.3.22349

Keywords:

endometrium, endometrial hyperplasia, scanning electrone microscopy, ciliated cells, «implantation window»

Abstract

Introduction

There is an increasing interest in the role of hyperplastic processes of endometrium in the “implantation window” disturbance and unsuccessful implantation rate. The endometrium represents a barrier to implantation except under appropriate and defined hormonal conditions.

There is no doubt that endometrium has an important role for embryo implantation at early stages of development.  Successful implantation requires a functionally normal embryo at the blastocyst stage and receptive endometrium, while the communication between them is also vital.

Endometrium shows dynamic and cyclic morphological changes throughout the follicular phase and in the secretory phase. The progesterone-driven differentiative changes in the endometrial epithelium lead to the ‘opening’ of the “window of receptivity” for blastocyst implantation. Morphologically, progesterone-dependent apical cellular protrusions known as pinopods (uterodomes) become visible by scanning electron microscopy on 20th–21st days of human menstrual cycle and then are lost.

Materials and methods

A total of 180 endometrial specimens from women with simple hyperplasia (I gr.), endometrial polyps (II gr.) and asynchronous endometrium (III gr.) have been examined by scanning electron microscopy. Biopsies were obtained from fundus of the uterus and processed for light and scanning electron microscopy. Tissues for light microscopy were fixed in 1,25% glutardialdehyde, embedded in paraffin, sectioned and stained with hematoxylin and eosin.

Results

In I group with simple hyperplasia the ratio of glands and stroma is now increased. Most or all of the endometrial glands are more or less cystically dilated and lined by pseudostratified, highly proliferating epithelium with enlarged, elongated, nuclei in scanty, basophilic cytoplasm.  Mitoses are frequent in the

epithelium.

II group shows endometrial polyps with proliferation of stromal cells incorporating a non-neoplastic glandular component. They were pedunculated with a central fibrovascular core which, when visible in the plane of the section, will be a characteristic diagnostic sign.The hyperplastic polyps contained areas of simple hyperplasia without atypia.

In the III group morphology of the deficient secretory phase with coordinated true delay was evaluated and there were no significant changes in ciliated cells quality and quantity. We revealed only “implantation window” disturbance as delay in pinopodes formation or absence of uterodomes.

Present study revealed isolated pathological changes of ciliated cells and its conjunction with abnormalities in pinopodes formation (“implantation window”) in women with simple hyperplasia (I group) and polyps (II group) in compare to endometrium of III group.

Discussion

We observed that significant increasing of ciliated cells quantity, cilliar hyperplasia and irregular distribution in women with simple hyperplasia of endometrium can cause breaking of embryo implantation (apposition and attachment) even in case of regular pinopodes formation.

References

Агаджанова Л. Эндометриальные пиноподии как маркеры имплантации человека (обзор литературы) / Л. Агаджанова // Пробл. репрод. – 2004. – № 3. – С. 6–11.

Фаллер Д. Молекулярная биология клетки / Д.М. Фаллер, Д. Шилдс. – М.: Бином, 2003. – 272 с.

Задорожная Т.Д. Сканирующая электронная микроскопия эндометрия у женщин с бесплодием воспалительного ґенеза / Т.Д. Задорожная, О.И. Ильина, И.Е. Ильин // Здоровье женщины. – 2005. – Т. 23. – № 3. –С. 128–130.

Acosta A. Endometrial dating and determination of the window of implantation in healthy fertile women / A. Acosta, L. Elberg, M. Borghi // Fertil.Steril. – 2001. – Vol. 73. – № 4. – P. 788 798.

Aghajanova L. Coexpression of pinopodes and leukemia inhibitory factor, as well as its receptor, in human endometrium / L. Aghajanova, A. Stavreus-Evers, Y. Nicas [et al.] // Fert. and Steril. – 2003. – Vol. 79. – P. 808–814.

Donaghay M. Uterine receptivity: alterations associated with benignngynecological disease / M. Donaghay, B.A. Lessey // Semin.Reprod. Med. – 2007. – Vol. 25. – № 6. – P. 461–475.

Lessey B.A. Paracrine signaling in the endometrium: integrins and the establishment of uterine receptivity / B.A. Lessey, J.T. Arnold // Journal of Reproductive Immunology. –1998. – Vol. 39. – № 1. – P. 105–116.

Nikas G. Endometrial receptivity: changes in cell-surface morphology / G. Nikas // Semin. Reprod. Med. – 2000. – Vol. 18. – P. 229–235.

Ozturk S. Particular functions of estrogen and progesterone in establishment of uterine receptivity and embryo implantation / S. Ozturk, R. Demir // Histol. Histopathol. – 2010. – Vol. 25. – № 9. – P. 1215–1228.

How to Cite

1.
Parnytska OI. «Implantation window» disturbance in patients with hyperplastic processes of endometrium. Pathologia [Internet]. 2014Mar.5 [cited 2024Mar.29];(3). Available from: http://pat.zsmu.edu.ua/article/view/22349

Issue

Section

Original research