ETIOPATHOGENIC ASPECTS AND COMPLEX ULTRASONOGRAPHY OF ENDOMETRIAL HYPERPLASTIC PROCESSES
Kharkov Medical Academy of Postgraduate Education, Ukraine
Endometrial hyperplasia (EH) is a heterogeneous group of pathological processes, ranging from benign estrogen−dependent proliferation of the glands to monoclonal growth of altered tissue of the uterus membrane. Endometrial hyperplastic processes deserve special attention because of the risk of malignancy such as atypical hyperplasia, endometrial adenomatosis (diffuse and focal form). According to modern ideas, there are two main pathogenetic mechanism of endometrial hyperplasia. The first mechanism results from development of long−term estrogen stimulation of the endometrium in the absence of anti−proliferative effect of progesterone with anovulatory dysfunction against a background of absolute or relative hyperestrogenemia. The second mechanism of EH is due to the lack of hormonal effects, and the important role played by metabolic disorders, systemic and local changes in the endometrium at the cellular and intracellular levels as well as hyperinsulinemia and insulin resistance. The aim of the work was to study the ultrasonographic criteria of EHy in women of reproductive age using color Doppler mapping (CDM). The study involved 54 women of reproductive age with histologically verified diagnosis of endometrial hyperplasia who underwent ultrasonography integrated with the CDM in the first phase (day 5−7) of menstrual cycle with assessment of the thickness and structure of the endometrium, endometrial−uterine coefficient (EUC), resistance index (IR) and the character of the blood flow in the investigated area. Ultrasonography with CDM in 48 (88.9 %) patients with endometrial hyperplasia, revealed endometrial thickness averaging 13.6±2.4 mm, increase in echogenicity ranging from 0.9 to 1.2, anehogennoe inclusions to 2.5−3 mm, increased vascularization of the endometrium, peripheral blood flow type; IR was 0.58±0.06, the rate of blood flow amounted 8.3 cm/s. In 17 (31.4 %) patients, both endometrial polyps measuring 0.2−0.4 cm, increased echogenicity, homogeneous structure, presence of a small amount of fluid around the formation, presence of deformation of the site of joining of the frontal and posterior walls of the uterus and irregular thickening of the endometrium circulation were visualized. The presence of the pedicle of the polyp was found in 9 (16.6 %) women, IR was 0.67±0.03. To clarify the pathogenic mechanisms of development of endometrial hyperplasia in women of reproductive age, it is appropriate to study the metabolism of sex steroid hormones, the functional state of the endometrium at the cellular and intracellular levels. The use of complex ultrasonography with CDM allows to determine the structural changes in the endometrium, to assess the extent of its vascularization, assess the blood flow in the study area, which greatly improves the accuracy of diagnosis of endometrial hyperplasia in women of reproductive age.
Key words: endometrial hyperplasia, endometrial polyps, hormonal profile, receptor apparatus, complex ultrasonography.