Study of immunohistochemical markers in recurrence of endometrial hyperplasia without atypia in women of reproductive age after treatment with progestins

Keywords: endometrium, receptors, endometrial hyperplasia, immunohistochemistry, resistance to progesterone, relapse

Abstract

ABSTRACT. The high frequency of hyperplastic processes of the endometrium (EН), the lack of proper effectiveness of hormonal therapy, and the possibility of their malignancy place EH among the most relevant issues in modern medicine. The clinical significance of EH lies in the fact that they are one of the most common causes of uterine bleeding and hospitalization of women. It is known that along with hormonal disorders, other activators of proliferative activity, such as growth factors, proliferation and apoptosis markers, and extracellular matrix components, play a significant role in the development          of         EН.
The study investigated the immunohistochemical markers in the endometrial tissue of reproductive-aged women with endometrial hyperplasia without atypia who were diagnosed with recurrent hyperplasia without atypia after 6 months of continuous therapy with a daily dose of 200 mg of progesterone. The following markers were selected for the study: PR, ER, p21, dcl-2, KI-67, eNOS, cycl-D1, BAX, b-catenin, E-cadgerin і Caspasa3, whose expression was examined by immunohistochemical methods before and after therapy. The control group consisted of women with secretory changes in the endometrium. The expression of receptors for PR, ER, p21, dcl-2, KI-67, eNOS, cycl-D1, BAX, b-catenin, E-cadgerin і Caspasa3 was studied primarily in women with non-neoplastic endometrial lesions (hyperplasia without atypia) and may be of greater significance in predicting the risk of progression and recurrence. Objective. The aim of the study was to determine changes in the expression of immunohistochemical markers in the endometrium in cases of hyperplasia without atypia before and after the use of progesterone therapy, and to identify the most predictive markers for therapy response. Results. The histological examination revealed significant changes in the endometrial biomarkers after therapy in women with no response to the treatment. The expression of receptors in the endometrium after therapy showed the following indicators: ER: a 20 % increase in glandular cells compared to baseline and a 63.3 % increase compared to the control group. In stromal cells, there was a 63.3% increase compared to baseline. PgR: An 85 % decrease compared to baseline. An 85 % decrease compared to the control group. p21: A 114 % increase in glandular cells compared to baseline and a 5% increase in stromal cells. Overall, there was a 29.3 % increase in expression compared to the control group. bcl-2: An 80 % decrease compared to baseline in glandular cells and a 90 % decrease compared to baseline in stromal cells. Ki-67: A 114 % increase compared to baseline in glandular cells and an expression more than 67% higher than the control group. eNOS: A 69 % increase compared to baseline in glandular cells and an 85% increase compared to baseline in stromal cells. Cyclin D1: A 15% increase compared to baseline in both glandular and stromal cells. BAX: A 10 % increase compared to baseline in both glandular and stromal cells. Beta-catenin: Remained stable compared to baseline in both glandular and stromal cells. E-cad: A 50% increase compared to baseline in glandular cells and a 60% increase compared to baseline in stromal cells. Caspasa3: Showed a 76 % increase compared to baseline and an 80 % increase after therapy in stromal cells, which may be associated with increased apoptosis processes. Conclusions. 1. Markers ER, PgR, b-catenin, p21, cyclin D1, Ki-67, Caspase-3 demonstrated differences between the non-glandular endometrium (EH) group and the control group in the glandular component, and ER, PgR, b-catenin in the stromal component (all p<0.05). This provides a basis for their use as primary diagnostic markers. 2. Markers ER, b-catenin, p21, cyclin D1, Ki-67, eNOS showed differences between the NGE group after treatment and the control group in the glandular component, and ER, b-catenin, and eNOS in the stromal component (all p<0.05). This supports their use as primary diagnostic markers. 3. Markers PgR, Ki-67, Caspase- 3, eNOS demonstrated differences between the NGE group before therapy and the control group in the glandular component, and eNOS in the stromal component (all p<0.05). This indicates their potential as primary diagnostic and prognostic markers. 4. Bcl-2 and BAX markers did not show statistically significant differences in the study groups, suggesting their inability to be used individually as diagnostic or prognostic markers for endometrial hyperplastic processes. Interpretation of the expression results of these markers should consider them in conjunction with other indicators.

Downloads

Download data is not yet available.

Author Biographies

Dmytro Khaskhachikh, Dnipro State Medical University

PhD, Associate Professor of the Department of Obstetrics and Gynecology at Dnipro State Medical University, 9 Volodimira Vernadskoho str., Dnipro, Ukraine, 49044

Valentin Potapov, Dnipro State Medical University

MD, Professor of the Department of  Obstetrics and Gynecology at Dnipro State Medical University, 9 Volodimira Vernadskoho str., Dnipro, Ukraine, 49044

Olesandra Poslavska, Dnipro State Medical University

MD, Associate Professor of the Department of Morfology at Dnipro State Medical University, 9 Volodimira Vernadskoho str., Dnipro, Ukraine, 49044

Irina Garagulia, Dnipro State Medical University

PhD , Associate Professor of the Department of Obstetrics and Gynecology at Dnipro State Medical University, 9 Volodimira Vernadskoho str., Dnipro, Ukraine, 49044

References

Ring KL, Mills AM, Modesitt SC. Endometrial Hyperplasia. Obstetrics and gynecology. 2022;140(6):1061-1075. doi: https://doi.org/10.1097/AOG.0000000000004989

De Silva PM, Gallos ID. Predicting risk of relapse in endometrial hyperplasia. BJOG: an international journal of obstetrics and gynaecology. 2019;126(7):944. doi: https://doi.org/10.1111/1471-0528.15671

Sanderson PA, Critchley HO, Williams AR, Arends MJ, Saunders PT. New concepts for an old problem: the diagnosis of endometrial hyperplasia. Hum Reprod Update. 2017;23(2):232-254. doi: https://doi.org/10.1093/humupd/dmw042

Khaskhachykh D, Potapov V. Molecular mechanisms of endometrial hyperplasia and therapy based on the study of receptor expression, cell markers of proliferation, differentiation, and apoptosis of endometrial cells in the hormone-dependent signal path. O Grail of Science. 2022;12-13:620-623. doi: https://doi.org/10.36074/grail-of-science.29.04.2022.109

Khaskhachykh D, Potapov V, Poslavskaya O. Molecular criteria for the diagnosis of hormone-resistant forms of endometrial hyperplasia without atypia in women of reproductive age]. Morphologia. 2022;16(3):118- 126. [Ukrainian]. DOI: https://doi.org/10.26641/1997-9665.2022.3.118-126

Khaskhachykh D, Potapov V, Kukina G, Garagulya I. Prospective study of the effectiveness of differentiated therapy of endometrium hyperplasia without atypia in women in reproductive age. The Grail of Science. 2021;(9):406-412. doi: https://doi.org/10.36074/grail-of-science.22.10.2021.73

Chandra V, Kim JJ, Benbrook DM, Dwivedi A, Rai RJ. Therapeutic options for management of endometrial hyperplasia. Gynecol Oncol. 2016;27(1):88-98. doi: https://doi.org/10.3802/jgo.2016.27.e8

McKinnon B, Mueller M, Montgomery G. Progesterone Resistance in Endometriosis: An Acquired Property? Trends Endocrinol Metab. 2018;29:535-548. doi: https://doi.org/10.1016/j.tem.2018.05.006

Patel BG, Rudnicki M, Yu J, Shu Y, Taylor RN. Progesterone resistance in endometriosis: Origins, consequences and interventions. Acta Obstet Gynecol Scand. 2017;96:623-632. doi: https://doi.org/10.1111/aogs.13156

Li X, Feng Y, Lin JF, Billig H, Shao R. Endometrial progesterone resistance and PCOS. J Biomed Sci. 2014;21:2. doi: https://doi.org/10.1186/1423-0127-21-2

Gromova OL, Potapov VO, Khaskhachykh DA, Finkova OP, Gaponova OV, Kukina GO, Penner KV. Epigenetic profile of endometrial proliferation in different morphotypes of endometrial hyperplasia. Reproductive Endocrinology. 2021;57:68-78.

Singh G, Puckett Y. Endometrial Hyperplasia. StatPearls; 2021. PMID: 32809528.

Laas E, Ballester M, Cortez A, Gonin J, Canlorbe G, Daraï E, Graesslin O. Supervised clustering of immunohistochemical markers to distinguish atypical and non-atypical endometrial hyperplasia. Gynecol Endocrinol. 2015;31(4):282-285. doi: https://doi.org/10.3109/09513590.2014.989981

Singh G, Puckett Y. Endometrial Hyperplasia. StatPearls; 2023. doi: https://doi.org/10.2139/ssrn.3835254

Nguyen T. Immunohistochemistry: A Technical Guide to Current Practices. Cambridge: Cambridge University Press; 2022.

Antunes A, Vassallo J, Pinheiro A, Leao R, Pinto Neto AM, Costa-Paiva L. Immunohistochemical expression of estrogen and progesterone receptors in endometrial polyps: A comparison between benign and malignant polyps in postmenopausal patients. Oncol Lett. 2014;7(6):1944-1950. doi: https://doi.org/10.3892/ol.2014.2004

Ahmed RH, Ahme E, Muhammad MS. E-cadherin and CD10 expression in atypical hyperplastic and malignant endometrial lesions. Journal of the Egyptian National Cancer Institute. 2014;26(4):211-217. doi: https://doi.org/10.1016/j.jnci.2014.08.002

Peiró G, Diebold J, Baretton GB, Kimmig R, Löhrs U. Cellular apoptosis susceptibility gene expression in endometrial carcinoma: correlation with Bcl-2, Bax, and caspase-3 expression and outcome. Int J Gynecol Pathol. 2001;20(4):359-367. doi: https://doi.org/10.1097/00004347-200110000-00008

Brucka A, Bartczak P, Ratyńska M, Sporny S. Immunohistochemical pattern of protein P21, cyclin D1 and cyclin E in endometrial hyperplasia. Pol J Pathol. 2009;60(1):19-25.

Shevra CR, Ghosh A, Kumar M. Cyclin D1 and Ki-67 expression in normal, hyperplastic and neoplastic endometrium. J Postgrad Med. 2015;61(1):15-20. doi: https://doi.org/10.4103/0022-3859.147025

Najafi T, Ghaffari Novin M, Pakravesh J, Foghi K, Fadayi F, Rahimi G. Immunohistochemical localization of endothelial nitric oxide synthase in endometrial tissue of women with unexplained infertility. IJRM. 2012;10(2):121-126. URL: http://ijrm.ir/article-1-263-en.html

Khaskhachykh DA, Potapov VO, Kukina GA, Garagulya IS. Prospective study of the effectiveness of differentiated therapy of endometrial hyperplasia without atypia in women in reproductive age. Grail Of Science. 2021;3:4.

Berx G, Van Roy F. The E-cadherin/catenin complex: an important gatekeeper in breast cancer tumorigenesis and malignant progression. Breast Cancer Res. 2001;3(5):289-293.

Khaskhachikh DA, Potapov VO, Poslavska OV. Factors of resistance to progestin therapy in endometrial hyperplasia in women. Morphologia. 2023;17(1):56-62. doi: https://doi.org/10.26641/1997-9665.2023.1.56-62

Kim J, Cho K, Lee Y, Kim J, Kim Y. Endometrial hyperplasia: molecular pathogenesis and new therapeutic opportunities. Korean J Med Sci. 2020;35(4):e37. doi: https://doi.org/10.3346/jkms.2020.35.e37

Sakai K, Yoshida T. Mechanisms of progesterone resistance in endometrial hyperplasia and their impact on pathogenesis and treatment. Biomed Pharmacother. 2020;1(3):44-53. doi: https://doi.org/10.1016/j.biopha.2019.109204

Xu L, Hu C, Qiu C, Yang Z, Xu Q. Progesterone resistance and endometrial hyperplasia: latest research and treatment prospects. J Med Sci. 2021;41(2):41-47. doi: https://doi.org/10.3779/j.issn.1009-6574.2021.02.01

Zhang Y, Guo H, Cui X, Song X, Wang Y. Molecular mechanisms of progesterone resistance and their clinical significance in endometrial hyperplasia. J Gynecol Obstet. 2022;1(1):15-22. doi: https://doi.org/10.31083/j.jgo.2022.01.003

Published
2023-11-28
How to Cite
Khaskhachikh, D., Potapov, V., Poslavska, O., & Garagulia, I. (2023). Study of immunohistochemical markers in recurrence of endometrial hyperplasia without atypia in women of reproductive age after treatment with progestins. Actual Problems of Modern Medicine, (12). https://doi.org/10.26565/2617-409X-2023-12-01
Section
Original Researches