ENDOMETRIAL POLYPS IN WOMEN OF REPRODUCTIVE AGE: CLINICAL AND PATHOGENE-TIC VARIATIONS.

Area of Science:

• Reproductive Endocrinology
• Immunology
• Gynecologic Pathology

Background:

• Endometrial polyps (EP) are common gynecological conditions often associated with infertility and miscarriage.
• Understanding the interplay between endometrial morphology, hormonal status, and the local immune environment is crucial for managing EP.

Purpose of the Study:

• To investigate the relationship between endometrial morphofunctional characteristics, hormonal homeostasis, and reproductive system microbiocenosis in patients with endometrial polyps.
• To differentiate pathogenetic variations of endometrial polyps based on their clinical presentation.

Main Methods:

• Hysteroscopy and aspiration biopsy for endometrial sampling.
• Immunohistochemistry for markers of immune cells (CD138, CD56, CD16, CD45, CD68), proliferation (Ki-67), and hormone receptors (ER, PR).
• Hormonal assays (FSH, LH, estradiol, prolactin, progesterone) and endometrial microbiome analysis (PCR, culture).

Main Results:

• Progesterone deficiency and local immune imbalance, particularly hypofunctional NK cells, contribute to endometrial cell proliferation and isolated polyp formation.
• The merging of polyps with micropolyps exacerbates inflammation.
• Micropolyps, indicative of chronic endometritis, show leukocyte infiltration and abnormal endometrial proliferation, even without hormone receptor issues.

Conclusions:

• Distinct clinical-pathogenetic variations of endometrial polyps exist (isolated, micropolyps, combined).
• Progesterone deficiency and immune dysregulation are key factors in polyp pathogenesis.
• Inflammation plays a significant role, especially in micropolyps and combined polyp presentations.