Slyva A. Pathomorphological features of endometrial hyperplastic processes in pre- and menopausal women

The dissertation is devoted to increasing the efficiency of diagnosis of hyperplastic processes of the endometrium in women of pre- and menopausal age on the basis of a complex of pathohistological and immunohistochemical features in conjunction with changes in general immunity. The thesis first performed a comprehensive study of endometrial hyperplastic processes using anamnestic, histological, histochemical, submicroscopic, morphometric, immunohistochemical, and immunological information and statistical methods. It is established that the main risk factors for the development of endometrial hyperplastic processes are three or more pregnancies, a large number of obstetric and gynecological interventions and the use of intrauterine contraception in the anamnesis. It is determined that in the endometrium with different variants of hyperplastic processes without atypia of glandular epithelium, the stromal component dominates over the parenchymal, and changes in parenchymal-stromal connection are characterized by a progressive increase in the share of epithelial component and growth of nuclear-cytoplasmic endometrial index endometrial hyperplasia. Electron microscopic examination proved the preservation of cellular contacts between glandular cells; basement membrane and fibroblast-like cells, for all types of endometrial hyperplasia. Apoptosis of endometrial stromal fibroblast-like cells was observed in simple endometrial hyperplasia and was absent in complex endometrial hyperplasia in combination with cellular and nuclear glandular epithelial polymorphism. The relationship between structural changes in the endometrium and the proliferative activity of the epithelium of glands and cells of its stroma was established, which was manifested by a positive correlation between changes in the epithelial-stromal ratio and the expression ratio of the marker of proliferative activity Ki-67 in the epithelium and endometrium, which can serve as a differential diagnostic and prognostic criterion. The combination of increased proliferative activity and decreased ER and PR expression is unfavorably prognostic, and patients with endometrial hyperplasia themselves are at risk of malignancy. Signs of secondary immunodeficiency formation were revealed, which were manifested by T-lymphocytopenia, imbalance of T-cell subpopulation, decrease in cytotoxic lymphocytes and macrophages with inhibition of phagocytic activity of neutrophilic granulocytes. It was determined that the combination of increased levels of Ig M, C4-2 complement, immunoregulatory index (CD4 / CD8) and NK cells, as well as decreased levels of Ig A, Ig E, T-suppressors and monocytes / macrophages is the most important for predicting the progression of simple endometrial hyperplasia.