Endometriosis, which occupies the 3rd place in the structure of gynecological pathology among women of reproductive age, is an actual problem of current medicine. Nearly half of those affected have chronic pelvic pain, while in 70% pain occurs during menstruation. One of the reasons of the origin of this pain can be ingrowths of the ectopic endometrium deep into the uterine wall. Equally interesting is the concept of inflammatory remodeling of the uterine wall, with the participation of macrophages secreting not only a wide range of cytokines and enzymes, but is also a source of growth factors. The aim of the research was to determine the role of macrophages in the remodeling of the uterine wall during the adenomyosis. Material and methods. For morphological investigation we used fragments of the wall of the uterus after hysterectomy among women with adenomyosis. Assessment of the quantity and spatial distribution of nerve fiber and macrophages was performed using monoclonal antibodies to proteins of neurofilaments and to macrophageal marker CD68. The general morphological evaluation of sections was performed by Hematoxylin & Eosin Staining. Statistical data processing was performed in the program MedCalc. Results of research. While studying the innervation apparatus of the uterine with adenomyosis accompanied by severe pain it was able to identify a variety of thickness, density and colour intensity of the nerve fibres. The greatest number of nerve fibres in the wall of the uterus in patients with adenomyosis were detected around the large arteries of the vascular layer of the myometrium and in the spaces between it. Research intraorganic of blood stream of the uterus revealed intense angiogenesis in the endometrium and myometrium on a background of leukocyte infiltration. According to the modern concept of neuro-immune interactions, one of the potential causes of enhanced angiogenesis, the growth of the nerves and pain, and may be hyperactivation of macrophages. Immunohistochemical evaluation showed the presence of a diffuse network of macrophages in the endometrium and myometrium of patients with adenomyosis. During morphometric analysis revealed heterogeneity of distribution of macrophages in the different functional areas. Perivascular localization of CD68 positive cells was predominant. In addition, a large number of macrophages identified in regions of the leukocyte infiltration of stroma – especially around the outbreaks adenomyosis with signs of dystrophy and desquamation cells. A small number of single macrophages were located diffusely between bundles of smooth muscle cells in the stroma of the myometrium. Conclusion. The data indicate that one of the key links of adenomyosis pain pathogenesis is immunopathological process, accompanied by increase in the number of macrophages in the wall of the uterus that leads to stimulation of angiogenesis and nerves growth. Perspectives of future investigation. To sum up, in the future the elucidation the molecular mechanisms of activation of macrophages in endometriosis will develop an optimal strategy for the prevention of disease progression and the development of pain.
Keywords: adenomyosis, nerve fibres, angiogenesis, macrophages
Full text: PDF (Rus) 1.15M