Narolska A. Optimization of diagnostics and treatment of uterine cervical dysplasia on the background of hyper proliferative disease of the corpus uteri in women of reproductive age

The work is devoted to increasing the effectiveness of treatment the dysplastic lesions of the cervical epithelium on the background of hyper proliferative diseases of the uterine body in women of reproductive age by developing a complex of diagnostic and therapeutic measures based on the study of clinical, cytological, colposcopy, microbiological, virological, morphological and immune histochemical features of the cervical epithelium. Cytological examination of cervical epithelium showed significant pathological changes: koylocytosis intermediate and surface layers, two / multi-cell multi symplasts, keratinocytes, parakeratosis. Colposcopically was established the presence of abnormal pictures in 66,8% of patients: acetic white epithelium - in 96,7% of cases, warts - in 11,1% of patients. Patients with dysplasia of the cervical epithelium and hyper proliferative uterine disease the genital tract infection frequency of HSV-ІІ was 41,1 %, CMV - 36,7 % of cases. Light dysplasia of multilayer flat epithelium (CIN I), characterized by a weakly positive expression of the proliferative antigen Kі-67 (1 point), uneven focal expression of ER and moderate expression of RP in the nuclei of cells of multilayered planar epithelium was established in 19,4% of cases. In 55,6 % of patients, it was histologically confirmed the presence of dysplasia the cervical epithelium of moderate severity (CIN II), positive expression of Ki-67 proliferative antigen (2 points), expression of RP and ER in the nuclei of stromal and single nuclei of multilayered squamous epithelial cells. In 25,0% of the patients examined by histological and immune histochemical tests were diagnosed with severe dysplasia (CIN III) and significant expression of the proliferative Ki-67 antigen (3 points), expressed by expression of RP and ER in the nuclei of cervical stromal cells and practically absence of their expression in nuclei of basal cells of flat epithelium. The intensity of the oxidative modification of proteins had a linear growth pattern in accordance with the histologically verified degree of dysplasia the cervical epithelium. The use of the developed diagnostic algorithm and new approaches of treatment has contributed to the increase in the effectiveness of surgical treatment the dysplastic lesions of the cervical epithelium in 1,2 times, which made it possible to safely carry out hormonal treatment of hyper proliferative pathology of the uterus body.