Menstrual cycle (uterine cycle). Phases of menstrual cycles

Early stage of secretion. Phase proliferation of the menstrual cycle. Phase secretion of the uterine cycle

the menstrual cycle is a complex, biologically programmed process in the body of a woman aimed at ripening the egg and (with its fertilization) the possibility of implantation in the uterus cavity for further development.

Functions of menstrual cycles

The normal functioning of the menstrual cycle is due to the three components:

cyclic changes in the hypothalamus - pituitary system - ovaries;

cyclic changes in hormonal-dependent organs (uterine, uterine pipes, vagina, lactic glands);

cyclic changes in the nervous, endocrine, cardiovascular and other organism systems.

Changes in the body of a woman throughout the menstrual cycle are two-phase character, which is associated with the growth and ripening of the follicle, ovulation and the development of the yellow body in the ovaries. Against this background, cyclic changes in the endometrium of the uterus are also occurred as a target of action of all sex hormones.

The main function of the menstrual cycle in the body of a woman is reproductive. With an indispensable fertilization, the functional layer of the endometrium is rejected (in which the fertilized egg should be shed), and bleeding is appear - menstruation. Menstruation as it should be ends the next cyclic process in the body of a woman. The duration of the menstrual cycle is determined from the first day of the cycle of the menstruation until the first day of the next menstruation. The most common menstrual cycle is 26-29 days, but it can be from 23 to 35 days. The cycle is ideal, whose value is 28 days.

Levels of the Menstrual Cycle

Regulation and organization of the entire cyclic process in the body of a woman are carried out at 5 levels, each of which is regulated by the overlying structures by the feedback mechanism.

The first level of the menstrual cycle

This level is represented directly by the sexual organs, lactic glands, hair follicles, leather and adipose tissue, which is the impact of the hormonal status of the body. The impact is provided by certain receptors to the sex hormones located in these organs. The number of receptors to steroid hormones in these organs varies depending on the phase of the menstrual cycle. At the same level of the reproductive system, an intracellular mediator - CAMF (cyclic adenosine monophosphate) can be attributed, which regulates metabolism in target tissue cells. This includes prostaglandins (intercellular regulators) that implement their effect through the CAMF.

Phases of menstrual cycles

The phases of the menstrual cycle are distinguished, during which certain changes occur in the endometrium of the uterus.

Menstrual Cycle Proliferation Phase

Phase of proliferation, the essence of which is the growth of glands, stroma and endometrial vessels. The beginning of this phase falls on the end of menstruation, and its duration is on average 14 days.

The growth of the glands and the growing stroma occur under the influence of the gradually increasing concentration of estradiol. The view of the glands resembles straight tubes or several convoluted tubes with a straight lumen. A network of argirophilic fibers is located between stroma cells. This layer has little spiral artery. By the end of the phase of the proliferation of the endometrium gland become convulsions, sometimes they are corkscrew, their lumen is somewhat expanding. Often in the epithelium of individual glands, small subnuclear vacuoles containing glycogen can be detected.

Spiral arterys growing from the basal layer reach the surface of the endometrium, they are a few convolutions. In turn, the network of argirophilic fibers concentrates in the stroma around the endometrium glands and blood vessels. By the end of this phase, the thickness of the functional layer endometrial is 4-5 mm.

Phase secretion of the menstrual cycle

Phase of secretion (luteinova), the presence of which is associated with the functioning of the yellow body. By duration, this phase takes 14 days. In this phase, the epithelium of the glands formed into the previous phase occurs, and they begin to produce a secret containing acidic glycosaminoglycans. Initially, secretory activity is small, whereas in the future it increases an order of magnitude.

In this phase of the menstrual cycle on the endometrium surface, focal hemorrhages occurred during ovulation and associated with a short-term decrease in estrogen levels.

In the middle of this phase, the maximum concentration of progesterone and an increase in estrogen levels are noted, which leads to an increase in the functional layer of the endometrium (its thickness reaches 8-10 mm), and its distinct division into two layers. The deep layer (spongy) is represented by a large number of strongly convinced glands and a small amount of stroma. The dense layer (compact) is 1/4 thickness of the entire functional layer, it contains fewer glands and more connecting cells. In the lumen of glands in this phase, there is a secret containing glycogen and sour mucopolysaccharides.

It was noted that the secretion peak falls on the 20-21th day of the cycle, then the maximum number of proteolytic and fibrinolytic enzymes is revealed. On the same days, decidual-like transformations arise in the stroma of endometrial (the cells of the compact layer become larger, glycogen appears in their cytoplasm). Spiral arterys are even more convulsions at this point, form the cracks, also marks the expansion of the veins. All these changes are aimed at creating optimal conditions for the implantation of a fetal egg. It was on the 20-22th day of the 28-day menstrual cycle that the optimal time comes for this process. On the 24-27th day, the regression of the yellow body occurs and a decrease in the concentration of hormone produced by him. This leads to disturbances of endometrial trophy and gradually increasing degenerative changes in it. The size of the endometrium decreases, the stromter of the functional layer is wrinkled, the folding of the walls of the glands is enhanced. From the graincal cells of etometrial stroma, granules containing relaxin are distinguished. Relaxin is involved in relaxing the arginil fibers of the functional layer, thus preparing the menstrual rejection of the mucous membrane.

On the 26-27th day of the menstrual cycle in the surface layers of the compact layer there are lacunar expansions of capillaries and focal hemorrhages in stroma. This state of the endometrium is observed per day before the start of menstruation.

Phase bleeding menstrual cycle

The bleeding phase consists of desquamation and endometrial regeneration processes. Relief and the death of the endometrium leads to the further regression and the death of the yellow body, which causes a decline in the content of hormones, as a result of which hypoxic changes are progressing in endometrials. Due to the long-term spasm of the arteries, blood stasis is observed, the formation of thromboms, the permeability and fragility of the vessels increase, which leads to the formation of hemorrhages in the endometrium. Full rejection (desquamation) endometrial occurs by the end of the third day of the cycle. After that, regeneration processes begin, and with the normal course of these processes on the fourth day of the cycle, the wound surface of the mucous membrane is epithelized.

Second Level of Menstrual Cycle

This level is represented by sexual glands of the female organism - ovaries. It is responsible for the growth and development of the follicle, ovulation, the formation of a yellow body, the synthesis of steroid hormones. For a long time in the female body, only a small part of the follicles passes the development cycle from premority to the pre-amulator, ovulates and turns into a yellow body. In each menstrual cycle, only one follicle completely matures. The dominant follicle in the first days of the menstrual cycle has a diameter of 2 mm, and by the time of ovulation, its diameter increases to 21 mm (on average for fourteen days). The volume of follicular fluid increases almost 100 times.

The structure of the premordial follicle is represented by an egg, surrounded by one next to the flatbed cells of the follicular epithelium. In the ripening of the follicle, an increase in the size of the egg itself occurs, and the cells of the epithelium are multiplied, as a result, forming a grainy layer of the follicle. Follicular fluid appears due to secretion of the grainy shell. The egg cell is pushed with liquid to the periphery, it is surrounded by several rows of granules cells, an eggproof holmik occurs ( Cumulus oophhorus.).

In the future, the gap of the follicle and the output of the egg in the uterine pipe cavity. The follicle rupture is provoked by a sharp increase in the estradiol content of the follicularity of the hormone, prostaglandins and proteolytic enzymes, as well as oxytocin and relaxin in the follicular fluid.

On the site of a broken follicle formed a yellow body. It synthesizes progesterone, estradiol and androgens. Of great importance for the further flow of the menstrual cycle has the formation of a full-fledged yellow body, which can be formed only from a preventive follicle containing a sufficient amount of granular cells with a high content of receptors to luteinizing hormone. The immediate synthesis of steroid hormones is carried out by cells of granules.

The derivative of the substance from which steroid hormones is synthesized is cholesterol coming with blood flow to the ovary. It is started and adjusting this process follicle-sustamulating and luteinizing hormones, as well as enzyme systems - aromatases. With a sufficient amount of steroid hormones, a signal is received about the termination or reduction of their synthesis. After completing the yellow body of its function, its regression and diefing occurs. An important role in this process plays oxytocin that has luteolytic action.

Third level of menstrual cycle

Presented the level of front lipophysis (adenogipid). Here the synthesis of gonadotropic hormones - follicle-suite (FSH), luteinizing (LH), prolactin and many other (thyrotropic, thyrotropin, somatotropin, melanotropin, etc.) is carried out. The luteinizing and follicle-wing hormones are in their structure of glycoproteins, prolactin - polypeptide.

The main target for the action of FSH and LH is the ovary. FSH stimulates the growth of the follicle, the proliferation of the cells of granules, the formation of LH receptors on the surface of the magnet cells. In turn, LH stimulates the formation of androgens in the cell cells, as well as the synthesis of progesterone in luteinized granulose cells after ovulation.

Prolctin also stimulates the growth of the mammary glands and regulates the lactation process. It has a hypotensive effect, gives a fatobilizing effect. An unfavorable point is to increase the level of prolactin, as this inhibits the development of follicles and steroidogenesis in the ovaries.

Fourth Menstrual Cycle

The level of the hypotalamus hypophysotropic zone is presented - ventromedial, arousate and domdomial nuclei. They are in the synthesis of hypophisotropic hormones. Since follyiberin is not highlighted and at the moment is not synthesized, then they use the abbreviation of the general group of hypothalamic gonadotropic liberins (GT-RT). Nevertheless, it is known that the release-hormone stimulates the release of both LH and FSH anterior lipophise.

GT-RG hypotalamus comes at the endings of axons, closely in contact with the capillaries of the medial elevation of the hypothalamus, into the circulatory system, combining the hypothalamus and pituitary. A feature of this system can be called the possibility of blood flow in both directions, which is important in implementing the feedback mechanism.

Regulation of synthesis and receipts in the bloodstream GT-RG is quite complex, it matters the level of estradiol in the blood. It is noted that the magnitude of the GT-RG emissions in the preventive period (against the background of the maximum separation of estradiol) is significantly higher than in the early folliculine and lutein phase. Also noted the role in the regulation of the synthesis of prolactin of dopaminergic structures of the hypothalamus. Dopamine slows down the separation of prolactin from the pituitary.

Fifth level of menstrual cycle

The level of the menstrual cycle is presented with supegipothalamic cerebral structures. These structures perceive pulses from the external environment and from interoreceptors, transmit them through the system of transmitters of nerve pulses into the neurosecretory cores of the hypothalamus. In turn, the conducted experiments prove that in the regulation of the function of hypothalamic neurons secreting GT-RT, the leading role belongs to dopamine, noraderennylin and serotonin. And the function of neurotransmitters is performed by the neuropeptides of morphine-like action (opioid peptides) - endorphins (END) and enkephalins (ENC).

Also in the regulation of the menstrual cycle, the cerebral bark is not played. There are data on the participation of amygdaloid nuclei and the limbic system in the neurohumoral regulation of the menstrual cycle.

Features of the regulation of the menstrual cycle

As a result, summing up all the above described, it can be concluded that the regulation of the cyclic menstrual process is a very complex system. Regulation inside this system itself can be carried out both along the long feedback loop (GT-RT - the neural cells of the hypothalamus) and the short loop (the front proportion of the pituitary gland - the hypothalamus) or even ultrashort (GT-RT - the nervous cells of the hypothalamus).

In turn, feedback may be negative, and positive. For example, with a low level of estradiol in the early follicular phase, the highlight of the front fraction of the pituitary is enhanced - negative feedback. An example of a positive feedback is the peak of estradiol selection that causes the emission of FSH and LH. An example of the ultra-screwing of a negative connection may be an increase in the secretion of GT-RT with a decrease in its concentration in neurosecretory neurons of the hypothalamus.

Features of the regulation of the menstrual cycle

It should be noted that in the normal functioning of cyclic changes of the genital organs, an important value is given by cyclic changes in other organs and systems of the body of a woman, for example, the predominance of brake reactions of the central nervous system, a reduction in motor reactions, etc.

In the proliferation phase of the endometrial of the menstrual cycle, the predominance of parasympathetic, and in the secretory phase - the sympathetic departments of the autonomic nervous system are noted. In turn, the state of the cardiovascular system during the menstrual cycle is characterized by wave-like functional oscillations. Currently, it is proved that in the first phase of the menstrual cycle, the capillaries are somewhat narrowed, the tone of all vessels is elevated, and the blood flow is fast. And in the second phase of the capillaries, on the contrary, somewhat expanded, the tone of the vessels is reduced, and the blood current is not always uniform. Changes in blood system are noted.

Pathologist diagnostics of the endometrium status on biopsies / spitters V.A. Topchieva O.I. ; under. ed. prof. OK. Khmelnitsky. - Leningrad.

Diagnosis on biopsies endometrial is often great difficulties due to the fact that the same very similar microscopic picture of the endometrium is due to various reasons (O.I. Topchiyeva 1968). In addition, endometrial fabric is characterized by an exceptional variety of morphological structures, depending on the level of steroid hormones, secret-generable ovaries, and under the pathological conditions associated with the violation of endocrine regulation.

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Pathological diagnostics of the status of endometrials on biopsies: Methodical recommendations / Snidishmen V.A., Topchieva O.I. -.

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Pathoanatomic diagnostics of biopsies endometrial states

Accurate microscopic diagnostics on endometrial scrapings is of great importance for the daily work of the obstetrician-gynecologist. Biopsy (zoops) endometrials make up a significant part of the material sent by obstetric and gynecological hospitals for microscopic examination.

Diagnostics on biopsies of endometrial often represents great difficulties due to the fact that the same very similar microscopic picture of the endometrium is due to various reasons (O. I. Topchiyeva 1968). In addition, endometrial fabric features an exceptional variety of morphological structures, depending on the level of steroid hormones secreted by the ovaries, and in the pathological conditions associated with the violation of endocrine regulation.

Experience shows that the responsible and complex diagnosis of changes in the endometrium in the scrapings turns out to be full only if there is close contact in the work between the pathologist and the gynecologist.

The use of histochemical methods, along with the classical morphological methods of the study, significantly expands the possibilities of pathologist diagnostics and includes such histochemical reactions as a reaction to glycogen, alkaline and acid phosphatases, monoaminoxidase, etc. The use of these reactions allows you to more accurately assess the degree of disruption of the estrogen balance and gestagenists in the body Women, and also makes it possible to determine the degree and nature of the hormone sensitivity of the endometrium in hyperplastic processes and tumors, which is of great importance when choosing methods for the treatment of these diseases.

Methods of obtaining and preparation of material for research

Important for proper microscopic diagnostics on endometrial scrapings has the observance of a number of conditions during the material fence.

The first condition is the correct definition of time that is most favorable for the production of scraping. There are the following testimony for scraping:

• a) during sterility with suspicion of insufficiency of the function of the yellow body or an inhibular cycle - the scrapets takes 2-3 days before menstruation;
• b) with menorage, when slow motion of the endometrium mucosa is suspected; Depending on the duration of bleeding, the scrapets takes 5-10 days after the start of menstruation;
• c) with dysfunctional uterine bleeding type metro angry scraping should be taken immediately after the start of bleeding.

The second condition is technically correct implementation of the scraping of the uterus. The "accuracy" of the response of the pathologist largely depends on how the endometrium scraping is taken. If small, fragmented pieces of fabric come to study, it is extremely difficult or even impossible to restore the endometrium structure. This is eliminable with the right piece of scraping, the purpose of which is to obtain large unrecorded strips of the tissue of the mucous membrane. This is achieved by the fact that after holding a Kyu Retka along the wall of the uterus, it should be taken from the cervical of the canal each time, and the intricate the tedious of the muzzo is carefully folded into the gauze. In the event that the curette is not excreted every time, the mucosa separated from the wall during repeated movements of the cureti is crushed and part of it remains in the uterine cavity.

Full Diagnostic scraping of the uterus is made. After the expansion of the cervical canal is up to 10 numbers of the hegara expander. Usually scraping is carried out separately: first-cervical canal, and then the uterus cavity. The material is placed in a fixing liquid into two separate banks, marked from where it is taken from.

In the presence of bleeding, especially in women in the menopausal period or in menopause, you should scroll through the small curette of the tube angles of the uterus, remembering that it is precisely in these sites that the polynomials of the endometrium can be localized, in which the maligancy areas are most often found.

If, when scraping from the uterus, a large amount of tissue was removed, then it is necessary to send the entire material to the laboratory, and not part of it.

Tsugi. or so-called Rancheyskets They are taken in cases where it is necessary to determine the reaction of the uterus mucous membrane in response to the secretion of hormones with ovaries, to control the results of hormone therapy, when finding out the causes of the sterility of a woman. To obtain TsUGs, use a small curette without prior expansion of the cervical canal. When taking the TsUGA, it is necessary to carry out a curette until the bottom of the uterus, so that in the strip of the bar neighboring. The mucous membrane is up to bottom, that is, the lining all the separations of the uterus. To obtain the correct response of the Histologist on the Cugu, as a rule, it is enough to have 1-2 endometrium strips.

In no case should the TSG methodology should not be used in the presence of uterine bleeding, since in such cases it is necessary to have endometrium to study from the surface of all the walls of the uterus.

Aspiration biopsy - Obtaining pieces of endometrium tissue by suction from the uterine cavity can be recommended for mass prophylactic examinations of women in order to identify prematubic states and endometrial cancer in "increased risk groups". At the same time, the negative results of aspiration biopsy do not allow! With confidence, reject the initial forms of asymptomatic flowing cancer. In this regard, if the uterine cancer is suspected, the most reliable and uniquely shown diagnostic method remains [Full scraping of the uterine cavity (V. A. Mandelstam, 1970).

After the work of biopsy, a doctor sending material for the study must fill accompanying Direction L about the form offered by us.

The direction should indicate:

• a) the duration of the menstrual cycle, characteristic of this woman (21-28, or 31 days, cycle);
• b) the start date of bleeding (in the period of expected menstruation, ahead of time or late). In the presence of menopause or amenorrhea, it is necessary to specify its duration.

These are the value of the following data

• a) the constitutional type of patient (obesity is often accompanied by pathological changes in endometrial),
• b) endocrine disorders (diabetes, changes in the function of the thyroid gland and adrenal cortex),
• c) Did the patient of hormone therapy be subjected to what a hormone and which dosage?
• d) whether methods of hormonal contraception were used, the duration of using contraceptives.

Histological treatment Material 6IOs includes fixation in a 10% neutral solution of formalin, followed by dehydration and pouring into paraffin. You can also use the accelerated method of filling in paraffin on G.A. Merculus with fixation in formalin, heated to 37 ° C in thermostat in For 1-2 hours.

In everyday work, it is possible to limit the painting preparations with hematoxylin-eosin, van-Gizon, Mud Charmina or Alziane Oitam.

For a more subtle diagnosis of the state of the endometrium, especially in solving questions about sterility related to the defective ovarian function, as well as to determine the hormone-sensitivity of the endometrium in hyperplastic processes and tumors, it is necessary to use histochemical methods that allow to identify glycogen, to evaluate the activity of acidic, alkaline phosphatases and A number of other enzymes.

Cryostatic sections The endometrium obtained from non-fixed tissue, frozen at a temperature of liquid nitrogen (-196 °) can be used not only for research using conventional histological methods of color (hematoxylin-eosin, etc.), but also to determine the content of glycogen and the activity of enzymes in morphological structures mucous uterus.

For histological and histochemical studies with biopsy endometrial on cryostatic sections, the pathoanatomy laboratory must be equipped with the following equipment: MK-25 cryostat, liquid nitrogen or carbon dioxide ("dry ice"), Dewar vessels (or household thermos), pH meter, refrigerator on + 4 ° C, thermostat or water bath. To obtain cryostat sections, you can use the method developed by V.A. Polyshnikhnikov with employees (1974).

According to this method, the following stages of the preparation of cryostat sections are distinguished:

1. Endometrial pieces (without pre-washing with water and without fixation) are placed on a strip of filter paper moistened with water, and gently lowered into liquid nitrogen by 3-5 seconds.
2. Filter paper with frozen in nitrogen pieces of endometrial are transferred to the cryostat chamber (-20 ° C) and carefully with a few drops of water are fitted to the microtomes to the system.
3. 10 μm thick cuts obtained in a cryostate are mounted in a cryostat chamber to chilled substantive or covering glasses.
4. Framing of sections is carried out by melting of sections, which is achieved with the touch of the warm finge of the K.Nizhny surface of the glass.
5. Glass with flashes quickly (should not be made to frozen again) removed from the cryostat chamber, dried in air. And fixed in 2%, the glutaraldhyde solution (or vapor form) or in the formaldehyde mixture - alcohol - acetic acid - chloroform ratio in the 2: 6 ratio : 1: 1.
6. Fixed media are stained with hematoxylin-eosin, dehydrated, enlighten and enter into polystyrene or balm. The choice of the level of the studied histological structure of the endometrium is performed on time preparations (non-fixed cryostat sections) painted with toluidine blue or methylene blue and water prisoners. Their manufacturing takes 1-2 minutes.

For histochnotic determination of the content and localization of glycogen dried in air, cryostatic sections are fixed in cooled to + 4 ° C for 5 minutes, dried in air and painted according to the Mac-Manusa (Pier 1962).

To detect hydrolytic enzymes (acid and alkaline phosphatase), cryostat sections are used, fixed in cool to a temperature of + 4 ° C 2%. Neutral formal solution for 20-30 minutes. After fixing, the sections are rinsed in water and immersed in an incubation solution to identify the activity of acidic or alkaline phosphatases. The acid phosphatase is determined by Barkarka and Anderson (1963), and alkaline phosphatase - Berstone (BERSTON, 1965). Before conclusion, sections can be hematoxylin. Store drugs are necessary in the dark.

Changes in endometrials observed throughout the two-phase menstrual cycle

The mucous membrane of the uterus, lining her various sections - the body, and cervical, - has typical and functional features in each of these departments.

The endometrium of the bodies of the uterus consists of two layers: basal, deeper, located directly on the myometry of the I. Fast-functional.

Basal The layer contains a few narrow glands lined with cylindrical single-row epithelium whose cells have oval, intensively staining kernel hematoxylin. The reaction of the tissue of the basal layer on hormonal exposure is poorly and inconsistently.

From the fabric of the basal layer, the functional layer is regenerated after various disorders of its integrity: rejection into the menstrual phase of the cycle, during dysfunctional bleeding, after abortion, childbirth, and also after scraping.

Functional The layer is a cloth with a special, biologically due to high sensitivity to sex steroid hormones-estrogen and gestagenam, under the influence of which its structure and function changes.

The height of the functional layer in half-green women varies depending on the phase of the menstrual cycle: about 1 mm at the beginning of the proliferation phase and up to 8 mm in the secretion phase-at the end of the 3rd cycle week. In this period, a deep, spongy layer is most distinctly denoted in the functional layer, where the glands are closer, and the surface-compact, in which cyto-gene stromas prevails.

The basis of cyclic changes of the morphological picture of the endometrium observed during the menstrual cycle lies the ability of genital steroids-estrogen to cause characteristic changes in the structure and behavior of the tissue of the mucous membrane of the uterus.

So, Estrogen Stimulate the proliferation of glasses of glands and stroma, contribute to regenerative processes, possess the vasodilatory action and increase the permeability of endometrial capillaries.

Progesterone It has an action on endometrium only after the prior effect of estrogen. Under these conditions, gestagens (progesterone) cause: a) secretory changes in glands, b) decidual reaction of stroma cells, c) the development of spiral vessels in the functional layer of endometrial.

The above morphological features were based on the morphological division of the menstrual phase and stage data cycle.

According to modern ideas, the menstrual cycle is divided into:

• 1) Phase proliferation:
  • Early Stage - 5-7 Day
  • Central Stage - 8-10 Day
  • Late stage - 10-14 days
• 2) secretion phase:
  • Early Stage (the first signs of secretory transformations) - 15-18 day
  • Central Stage (the most pronounced secretion) - 19-23 days
  • Late stage (starting regression) - 24-25 days
  • Regress with ischemia - 26-27 days
• 3) Bleeding phase - menstruation:
  • Deskvamation - 28-2 day
  • Regeneration - 3-4 days

In assessing changes occurring in endometrials, respectively, the days of the menstrual cycle, must be considered:

• 1) the duration of the cycle in this woman (28- or 21-day cycle);
• 2) the term of ovulation that occurred, which in normal conditions is observed on average from 13th to the 16th day of the cycle; (Therefore, depending on the time of ovulation, the structure of the endometrial of one or another stage of the secretion phase fluctuates r; limits of 2-3 days).

Phase proliferation lasts 14 days, however, and in physiological conditions it can be elongated or shortened within 3 days. Changes observed in the endometrical phase of proliferation arise as a result of the action of the growing amount of estrogen secreted by the growing and ripening follicle.

The most pronounced morphological changes in the proliferation phase are marked in glands. At an early stage, the glands have a view of a straight or cast of convolve tubes with a narrow lumen, the contours of the glands are rounded or oval. The epithelium glands is a single-row low cylindrical, core oval, are located at the base of the cells are intensively painted with hematoxylin. In the late stage of the gland acquire winding, sometimes corkscrew outlines with a slightly advanced lumen. The epithelium becomes high prismatic, a large number of mitoses are observed. As a result of intensive division and increase the number of core epithelial cells, they are at different levels. For the epithelium cells of the early phase of the proliferation, the absence of glycogen and moderate activity of alkaline phosphatase is characteristic. By the end of the phase of the proliferation in the glands, the appearance of small dust-like glycogen granules and the high activity of alkaline phosphatase is noted.

In the stroma endometrial during the phase of proliferation there is an increase in dividing cells, as well as thin-walled vessels.

The structures of the endometrium corresponding to the proliferation phase observed in physiological conditions in the first half of the two-phase nicla can reflect.Gormonal disorders if they are detected:

• 1) during the second half of the menstrual cycle; This may indicate an annevulatory single-phase cycle or on an abnormal, elongated phase of proliferation with the late ovulation. In a two-phase cycle:
• 2) with iron hypeometrium hyperplasia in various sections of a hyperplasned mucous membrane;
• 3) Three dysfunctional uterine bleeding in women at any age.

The secretion phase, directly associated with the hormonal activity of the menstrual yellow body and the corresponding secretion of progesterone, lasts 14 ± 1 days. The shortening or elongation of the secretion phase is more than two days, in women in the reproductive period, should be considered as a pathological state, since such cycles are sterile.

Throughout the first week, the phase of secretion of the day of ovulation is determined by changes in the epithelium glands, while in the second week this day is most accurate to be determined by the state of the endometrium stroma cells.

So, on the 2nd day after ovulation (16th day of the cycle) in the epithelium glands appear Subnuclear vacuoles. On the 3rd day after ovulation (17th day of the cycle), subnuclear vacuoles push the kernels into the apical cells of the cells, as a result of which the latter are on the same level. On the 4th day after ovulation (18th day of the cycle), the vacuole is partially moving from the basal departments to the apical and the 5th day (19th day of the cycle) almost all vacuoles move to the apical cells of the cells, and nuclei are shifted to the basal Little departments. In the next 6th, 7th and 8th days after ovulation, i.e., on the 20th, 21st and 22nd days of the cycle in the cells of the epithelium glands, the pronounced processes of the apocryne secretion are noted, as a result of which apical " Paradise cells have as if notched, uneven. The absurpenses of the glands during this period are usually expanded, filled with eosinophilic secret, the walls of the glands become folded. On the 9th day after ovulation (23rd day of the menstrual cycle), the secretion of the glands is over.

The use of histochemical methods made it possible to establish that subnuclear vacuoles contain large granules of glycogen, which throughout the early and at the beginning of the average stage of secretion phase is thrown by apocryan secretion into the absurdity of the glands. Along with the glycogen in the lumen of the glands, acidic mucopolysaccharides are also contained. As the glycogen accumulates and the secretion of it in the absurd of the glands, a distinct decrease in the activity of alkaline phosphatase in the epithelium cells, which almost completely disappears to 20-23 day of the cycle.

In stroma Characteristic changes for the secretion phase begin to appear on the 6th, 7th day after ovulation (20th, 21st day of the cycle) in the form of a perivascular decidua-like reaction. This reaction in the cells of the strass of the compact layer is most pronounced and is accompanied by an increase in cell cytoplasm, they acquire polygonal or rounded outlines, glycogen accumulation is observed. The secretion phase characteristic of this stage is also the appearance of spiral vessels, not only in the deep departments of the functional layer, but also in the surface compact layer.

It should be emphasized that the presence of spiral arteries in the endometrium functional layer is one of the most reliable signs that determine the full gestagne effect.

On the contrary, subnuclear vacuolaization in the epitheliums of the glands is not always a sign indicating that the ovulation has occurred and the secretion of progesterone in the yellow body.

Subnuclear vacuoles can sometimes be detected in the glands of mixing of the hypoplastic endometrial at D.Is-functional uterine bleeding in women of any age, including the period of menopause (O. I. Topchieva, 1962). However, in endometrial, where the occurrence of vacuoles is not criticized with ovulation, they are contained in separate glands or in the gland group is usually only in the cells. Vacuol themselves have a different value, most often they are small.

In the late stage of the secretion phase, from the 10th day after Ov-Lyashiya, i.e., on the 24th day of the cycle, in whey, with the start of the yellow body regression and a decrease in the level of progesterone in the blood in the endometrium, morphological signs of regression are observed, and on 26 And on the 27th day they join signs of ischemia. As a result of wrinkling, the stroma of the functional layer of the gland acquire star-shaped outlines on transverse sections and saws on longitudinal.

In the phase of bleeding (menstruation) in endometrials, desquamation and regeneration processes occur. The morphological feature characteristic of the endometrial of the menstrual phase is the presence, in the penetrated hemorrhages, the disintegrating tissue of the sleeved glands or their fragments, as well as the trangles of the spiral arteries. Full rejection of the functional layer usually ends on the 3rd day of the cycle.

The endometrial regeneration occurs due to the proliferation of the cells of the basal departments of the glands and ends for 24-48 hours.

Changes endometrial in disruption of the endocrine function of the ovaries

From the point of view of etiology, pathogenesis, as well as taking into account the clinical symptoms, morphological changes in endometrials arising from violation of the endocrine function of the ovaries can be divided into three groups:

1. Changes endometrial in violation of secretion Estrogenic hormones.
2. Changes in endometrials in violation of secretion progestive hormones.
3. Changes in the mixed type endometrial, in which structures reflecting the impact of estrogen and progestative hormones are simultaneously found.

Regardless of the nature of the violations of the endocrine function of the ovaries listed above, the most common symptoms with which clinicians and morphologists are found are Uterine bleeding and amenorrhea.

A special place in its extremely important clinical meaning is occupied by uterine bleeding in women in menopause Since among a variety of reasons that binding such bleeding, about 30% are malignant endometrial neoplasms (V.A. Madelshtam 1971).

1. Changes in endometrial in violation of the secretion of estrogenic hormones

Violation of the secretion of estrogenic. Normonov manifests itself in two basic forms:

a) in the insufficient number of estrogen and the formation of non-functioning (resting) endometrial.

In physiological conditions, the restochy endometrium briefly exists during menstrual cycles-after the regeneration of the mucous membrane before the start of proliferation. Non-functioning endometrium. Also also in women of elderly, when the hormonal function of the ovaries is eased and is the stage of transition to atrophic endometrium. Morphological signs of non-functioning endometrials - glands have the kind of straight or slightly convoluted tubes. Epithelium is low, cylindrical, basophilina cytoplasm, elongated kernels, occupy most of the cell. Mitoses are absent or found extremely rare. Stromrom is rich in cells. When proteinating these changes, the endometrium from the non-functioning turns into atrophic with small glands lined with cubic epithelium.

b) in the long secretion of estrogen from persistent follicles, accompanied by anoint monophasic cycles. The elongated single-phase cycles arising from the long-term persistence of the follicle lead to the development of the dormriconal proliferation of endometrial type Ironistical or iron phones hyperplasia.

As a rule, endometriums under the vocal proliferation is thickened, its height reaches 1-1.5 cm or more. Microscopically lacks the separation of endometrial on the compact layers and spongy, there is also no correctness of the distribution of the glands in the stroma; Characters of cyutally applied glands. The amount of glands (more precisely ferrused tubes) does not increase (as opposed to atypical iron hyperplasia - adenomatosis). But due to the enhanced proliferation of the gland, they acquire an argument form and on a cut, passing through separate turns of one and that. More than a glandular tubule, the impression of a large amount of glands is created.

The structure of the iron hyperplasia of the endometrium, which does not contain a car-shaped extended glands, is called ". Excellent hyperplasia".

Depending on the severity of proliferative processes, the ferrous hyperplasia of the endometrium is divided into "active" and "rest" (which correspond to the states of "acute" and "chronic" estrogen). For the active form, a large number of mitoses are characterized in both the cells of the epithelium gland and in the cells of stroma, the high activity of alkaline phosphatase and the appearance of the clusters of "bright" cells in the glands. All these signs indicate intensive estrogen. The stimulation ("acute estrogen").

The "resting" form of iron hyperplasia corresponding to the state of "chronic estreaction" occurs in conditions of long-term exposure to the low level of estrogenic hormones. Under these conditions, the endometrium fabric acquires the similarity of the similarity of S.-binding, non-functioning endometrial: the epithelium cores are intensely painted, basophilic cytoplasm, mitoses are very rare or not found at all. The "resting" shape of the hardware hyperplasia is most often observed in the menopacteric period - when the ovarian function is fired.

It should be remembered that the occurrence of iron hyperplasia-especially its active form-in women after many years. After the occurrence of menopause, with a tendency to relapses, should be regarded as an unfavorable factor in relation to the possible occurrence of endometrial cancer.

It is also necessary to be borne in mind that the discharmal. The endometrium proliferation may occur in the presence of cilioepithelial and pseudomocyne cysts of the ovary, both malignant and benign, as well as in some other ovary neoplasms, for example, with a Brenner tumor (M. F. Glazunov 1961).

2. Changes to endometrial in violation of the secretion of gestagens

The violation of the secretion of the hormones of the menstrual yellow body appears both. In the form of the insufficient secretion of progesterone, and when it is enhanced and long secretion (the persistence of the yellow body).

Hypolyteine \u200b\u200bcycles in the insufficiency of the yellow body in 25% of cases are shortened; Ovulation usually occurs in a timely manner, but the secretory phase can be shortened to 8 days. The menstruation is associated with the premature death of an inferior yellow body and stopping the secretion of protesterone.

Histological changes in endometrials in hypolyteinic cycles are inenenial and insufficient secretory transformation of the mucous membrane. Thus, for example, unless before the onset of menstruation, Yaa 4th week of the cycle, along with glands, peculiar to the late stage of the secretion phase, there are glands, sharply lagging in their secretory function and corresponding only to the beginning phasesecretion.

Pre-comdonal transformations of connective tissue cells are being expressed extremely weakly or absent at all, spiral vessels are underdeveloped.

Persistence of a yellow body may be accompanied by a full secretion of progesterone. And the elongation of the phase of secretion. In addition, there are cases with reduced progesterone secretion with a coarse yellow body.

In the first case, changes arising in endometrials were named Ultranchanstrual hypertrophy and have similarities with structures observed during the pregnancy of the early term. The mucule is thickened to 1 cm, the secretion is intense, there is a pronounced decidua-like transformation of the stroma and the development of spiral arteries. Differential diagnosis with disturbed pregnancy (in women of reproductive age) is extremely difficult. The possibility of the occurrence of such changes and endometrials of women of the menopausal period (which pregnancy can be excluded).

In the case of a decrease in the hormonal function of the yellow body, when it is subjected to incomplete gradual regression, the process of rejection of the endometrium slows down and is accompanied by an elongation phase bleeding in the form of menorahia.

The microscopic pattern of the endometrium scrapings obtained during such bleeding after the 5th day, it seems very motley: the sections of necrotic tissue are found in the scraping, sections in the state of reverse development, secretory and proliferative endometrium. Such changes in endometrials can be detected in women with acyclic dysfunctional mortgage bleeding in the menopausal period.

Sometimes the effect of low concentrations of progesterone leads to a slowdown in its rejection, involution, i.e., the reverse development of deep departments of the functional layer. This process creates conditions for returning the endometrium to the initial structure, which was before the start of cyclic changes and occurs three amenorrhea, due to the so-called "hidden cycles" or hidden menstruation (E. I. Kvater 1961).

3. Endometrium "Mixed Type"

Endometrium is called mixed if it contains structures in its fabric, simultaneously reflecting the impact of estrogen and gestagenic hormones.

Two forms of mixed endometrials are distinguished: a) mixed hypoplastic, b) mixed hyperplastic.

The structure of mixed hypoplastic endometrial represents a motley picture: the functional layer is poorly developed and is represented by the iron of an indifferent type, and the tact of sections with secretory changes, mitoses are extremely rare.

Such endometries occurs in women of reproductive age with the pituitary glands, in women in a menopausal period with dysfunctional uterine bleeding, during bleeding in menopause.

An endometrial gland hyperplasia with pronounced signs of the effects of gestage hormones can be attributed to the hyperplastic mixed endometry. If among the tissues of the iron hyperplasia of the endometrium along with typical glands reflecting the estrogen effect, there are areas with groups of ammond glands, in which secretory signs, then such an endometrial structure is called a mixed form of iron hyperplasia. Along with the secretory changes in the glands, there are also changes in the stroma, namely: focal deciduous conversion of connective tissue cells and the formation of spiral vessels.

Preiodine and Endometrial Cancer

Despite the greater inconsistency of data on the possibility of endometrial cancer against the background of iron hyperplasia, most of the authors believe that the possibility of direct transition of iron hyperplasia in endometrial cancer is unlikely (A. I. Silver 1968; J. V. Bokhmai 1972), but unlike the usual (Typical) Endometrium Hyperplasia Atypical Form (adenomatosis) is considered by many researchers as a presets (A. I. Silver 1968, L. A. Novikova 1971, etc.).

Adenomatosis is a pathological proliferation of endometrial, in which traits characteristic of hormone hyperplasia are lost and atypical structures that have similarities with malignant growths appear. Adenomatosis is separated by the prevalence of diffuse and focal, and according to the severity of proliferative processes - on the unaware and pronounced forms (B.I. Iron, 1972).

Despite the significant variety of morphological signs of adenomatosis, most of the forms found in the practice of the pathologist has a number of characteristic morphological signs.

The glands are very convulsions, often have. Meal branches with numerous papillary protrusions in the lumen. Sevements of the gland are closely located near each other, almost not separated by the connective tissue. Epithelial cells have large or oval, elongated, pale painted kernels with signs of polymorphism. The structures corresponding to the endometrial adenomatosis can be detected by a large length or limited areas against the background of the endometrium glandular hyperplasia. Sometimes in the glands are detected by the nest of the arranged groups of light cells having a morphological similarity with a flat epithelium - adenosacanthosis. The foci of pseudo-globular structures are sharply excluded from the cylindrical epithelium of glands and connective tissue stroma cells. Such foci can occur not only with adenomatosis, but also at the endometrium adenocarcinoma (adenocantoma). In some rare adenomatosis forms in the epithelium of the glands, a large number of "bright" cells (fixed epithelium) is accumulated.

Significant difficulties arise from a morphologist when trying to conduct differential diagnosis between prolonged proliferative forms of adenomatosis and highly differentiated embodiments of endometrial cancer. For pronounced adenomatosis forms, an intensive proliferation and an atipatism of ferrous epithelium is characterized in the form of an increase in cell size and nuclei, which allowed Hertigu et al. (1949) Name such forms of adenomatosis of the "zero stage" of endometrial cancer.

However, due to the lack of clear morphological criteria for this form of endometrial cancer (unlike the similar shape of the cervical cancer), the use of this term in the diagnosis of endometrial scrapings is not justified (E. Novak 1974, B. I. Zheleznov 1973).

Endometrial cancer

Most of the existing classifications of epithelial malignant endometrial tumors are based on the principle of the severity of the tumor differentiation (M.F. Glazunov, 1947; P.V. Simpovsky and O.K. Khmelnitsky, 1963; E.N. Petrovsky, 1964; N. Karavsky , 1969).

The same principle is based on the first international classification of endometrial cancer developed by the World Health Organization Expert Group (Polesen and Taylor, 1975).

According to this classification, the following morphological forms of endometrial cancer are distinguished:

• a) adenocarcinoma (highly moderate and low-differentiated forms).
• b) lateral (mesonephroid) adenocarcinoma.
• c) flat-cell carcass.
• d) iron-flat flower cell (mucoepidermoid) cancer.
• e) undifferentiated cancer.

It must be emphasized that more than 80% of the malignant epithelial tumors of the endometrium are adenocarcinoma of varying degrees of differentiation.

A distinctive feature of tumors with histological structures of highly differentiated endometrial cancers is that the glandular tumor structures, although they have signs of atypics, nevertheless resemble the usual endometrial epithelium. The ferret of the epithelium endometrium with papillary growth is surrounded by scarce layers of connective tissue with a minor amount of vessels. The glands are highlighted with high and low-prismatic epithelium with a weakly pronounced polymorphism and relatively rare mitosis.

As the differentiation decreases, ferrous cancers lose signs characteristic of endometrial epithelium, the ferrous structures of alveolar, tubular or papillary structure, which do not differ in their structure from ferrous cancers of other localization begin to prevail.

According to histochemical features, highly differentiated ferrous cancers resemble the endometrium epithelium, since it contains glycogen in a significant percentage and give a reaction to alkaline phosphatase. In addition, the indicated forms of endometrial cancer have high sensitivity to hormone therapy with synthetic gestagenis preparations (17-oxyprogesterone Kapronoate), under the action of which secretory changes are developing in tumor cells, glycogen is accumulated, alkaline phosphatase activity is reduced (V. A. Sanishnikov, Ya. V. Bochman, O. F. Che-Peak 1976). Significantly less than the similar differentiation effect of gestagenov develops in cells of moderately-effect-rented endometrial cancers.

Changes in endometrials when prescribing hormonal drugs

Currently, estrogen and gestagenov preparations for the treatment of dysfunctional uterine bleeding are widely used in gynecological practice for the treatment of dysfunctional uterine bleeding, as well as contraceptives.

Using various combinations of estrogen and gestagens can be artificially obtained in human endometrial morphological changes inherent in the phase of the menstrual cycle with normally functioning ovaries. The principles underlying the hormone therapy of dysfunctional uterine bleeding and amenorrhea are based on common laws, characteristic of estrogen and gestagenis on normal human endometrials.

The introduction of estrogen leads, depending on the duration and dose, to the development of proliferative processes in the endometrium, up to the iron hyperplasia. With prolonged use of estrogen on the background of proliferation, abundant acyclic uterine bleeding may occur.

The introduction of progesterone in the proliferative phase of the cycle leads to the braking of the proliferation of the epithelium glands and suppresses ovulation. The effect of progesterone to the proliferating endometrium depends on the duration of the introduction of the hormone and manifests itself in the form of the following morphological changes:

• - Stage of "Stopped Proliferation" in the glands;
• - atrophic changes in glands with decidu-like transformation of stroma cells;
• - Atrophic changes in the epithelium glands and stroma.

With the joint introduction of estrogen and gestagens, changes in endometrial depend on the quantitative ratio of hormones, as well as the duration of their administration. Thus, for the endometrium proceeding, the daily dose of progesterone, causing secretory changes in glands in the form of accumulation of glycogen granules, is 30 mg. In the presence of a pronounced iron hypertension hyperplasia to achieve a similar effect, it is necessary to introduce 400 mg.Progesterone daily (Dallenbach-Helvig, 1969).

For the morphologist and clinician-gynecologist, it is important to know that the selection of dosages of estrogen and gestagennes in the treatment of disorders of the menstrual cycle and the pathological states of the endometrium should be carried out under histological control, by the fence of repeated endometrial tsugs.

When using combined hormone contraceptives in the normal endometrium, women occur regular morphological changes, depending first of all from the duration of the use of the drug.

First of all, there is a shortening of the proliferative phase with the development of defective glands, in which abortive secretion is developing. These changes are related to the fact that when receiving these drugs, the gestagens contained in them inhibit the processes of proliferation in glands, as a result of which the latter do not reach their full development, as is the case at a normal cycle. Secretor changes developing in such glands have an abortive unexpected character,

Another typical feature of changes in endometrials in the reception of hormonal contraceptives is a sharply pronounced foci, the distruting of the morphological picture of the endometrium, namely: the existence of various but degrees of maturity of glands and stroma, not corresponding to the day of the cycle. These patterns are characteristic of both proliferative and secretory phases of the cycle.

Thus, when receiving combined hormonal contraceptives in the endometrium of women, pronounced deviations from the morphological picture of the endometrium of the corresponding phases of the normal cycle occur. However, as a rule, after the abolition of drugs, the gradual and complete restoration of the morphological structure of the mucous membrane is observed (the exception is only cases when the drugs were taken very long - 10-15 years).

Changes in endometrials arising during pregnancy and its interruption

With the occurrence of pregnancy, the implantation of a fertilized egg - blastocysts occurs on the 7th day after ovulation, i.e. on the 20th - the 22nd day of the menstrual cycle. At this time, the overdometrium strassment reaction is still very weak. The most rapid formation of decidual tissue occurs in the implantation zone blastocysts. As for the endometrium changes outside the implantation, the decidual tissue becomes distinctly expressed only from the 16th day after ovulation and fertilization, i.e., when menstruation has already been delayed for 3-4 days. This is observed in endometrials equally both during pregnancy uterine and ectopic.

In the decidual shell, the cutting wall of the uterus in all its length, with the exception of the blastocyst implantation zone, distinguish the compact layer and spongy layer.

In the compact layer of deciduals of the fabric in the early pregnancy, there are two types of cells: large, bubble-shaped with a pale-colored core and smaller cells of oval or polygonal shape with a darker core. Large decidual cells are the final form of the development of small cells.

The spongiosis layer differs from the compact extremely strong development of glands, which closely add to each other and form a fabric, the general view of which can have some similarity with the adenoma.

With histological diagnosis on scraps and tissues that highlighted spontaneously from the uterine cavity, it is necessary to distinguish between the cells of the trophoblast from decidual cells, especially when the question is about the differential diagnosis between the uterine and ectopic pregnancy.

Cells trophoblast The components of the reservoir, polymorphic with the predominance of small polygonal. There are no vessels, fibrous structures, leukocytes in the reservoir. If there are single major syntial formations among the cells that make up the reservoir, it immediately decides the question of belonging to his trophoblast.

Cells Decidual Fabrics also have different sizes, but they are larger, oval. Homogenic cytoplasm, pale; Bubble cores. In the reservoir of decolation fabrics contain vessels and leukocytes.

With a pregnancy impairment, the formed cloth decidual O. Babes is necrotic and is usually completely discouraged. If pregnancy is violated in early terms, when the decidual fabric is even finally undeveloped, it is subjected to reverse development. An undoubted sign that the endometrium fabric was subjected to reverse development after pregnancy disturbed in early terms, the presence in the functional layer of clubs of spiral arteries. A characteristic, but not an absolute sign is also the presence of the arya-stella phenomenon (the appearance of cells with a very large hyperchromic kernel).

With a violation of pregnancy, one of the most important issues on which the morphologist has to be answered is the question of uterine or ectopic pregnancy. The absolute signs of the uterine pregnancy are the presence of a chorion vault, decidual fabric with invasion of chorial epithelium, the deposition of fibrinoid in the form of foci and heavyness in the decidual tissue and in the walls of venous vessels.

In cases where a decidual fabric is detected in the scraping without chorion elements, it is possible in the uterine and at ectopic pregnancy. In this regard, both a morphologist and a clinician doctor should be remembered that if the scraping was made not earlier than 50 days after the former last menstruation, when the area of \u200b\u200bthe arrangement of the fetal egg is large enough, then in the uterine form of pregnancy, the chorion naval is detected almost always. The absence of them gives reason to assume an ectopic pregnancy.

With an earlier period of pregnancy, the absence in the scrap elements of Chorion does not always indicate an ectopic pregnancy, since it is impossible to exclude unnoticed spontaneous miscarriage: during bleeding, a small flicer egg could be entirely standing out before scraping.

All-Union Scientific and Methodical Center for the Pathology Manufacture of Human Morphology Institute of AMN USSR
Leningrad State Order of Lenin Institute of Improvement of Doctors. CM. Kirov
I Leningrad Orders of the Labor Red Banner Medical Institute. I. P. Pavlova

Editor - Professor O. K. Khmelnitsky

Plan article

Endometrium is the inner mucosa of the uterus, penetrated by a thin and thick grid of blood vessels. It supplies a child blood organ. The endometrium of the proliferative type - mucosa in the process of rapid cell division before the new menstrual cycle starts.

Endometrial structure

In endometrials two layers. Basal and functional. The basal layer almost does not change. It contributes to the regeneration of the functional surface during the menstrual cycle. It consists of cells as adjacent to each other, equipped with a thin but dense vascular grid. up to one and a half centimeters. In contrast to the basal, the functional layer is constantly changing. Because during menstruation, generic activity, in surgical intervention, diagnosis, it is damaged. There are several cyclic stages of functional endometrial:

1. Proliferative
2. Menstrual
3. Secretoric
4. Prescecretoric

Stages are normal, consistently replace each other, according to the period passing in the body of a woman.

What structure is normal

The state of endometrial in the uterus depends on the phase of the menstrual cycle. When the proliferation time comes to an end, the main layer comes to 20 mm, and practically immune to the influence of hormones. When the cycle is just beginning, the endometrium is smooth, pinkish shade. With focal sites, not separated by the active layer of endometrial remaining from past menstruation. In the next seven days there is a gradual thickening of the proliferative endometric shell, due to the active cell division. Vessels are less, they are hiding behind the grooves, which appear due to inhomogeneous thickening of the endometrium. The thicker is the thickness of the mucous cover on the rear saint wall, at the bottom. On the contrary, the "kindergage" and the front uterine wall changes minimally. The mucous layer is about 1, 2 centimeters. When the menstrual cycle is completed, then the active cover of the endometrium is completely discounted completely, but as a rule, only part of the layer on some sites is rejected.

Forms deviation from the norm

Disorders of the normal thickness of the endometrium happens either for a natural reason, or have a pathological character. For example, in the first seven days after fertilization, the thickness of the endometric cover changes - the child's place becomes thicker. In pathology, the thickening of the endometrium happens during the incorrect cell division. As a result, an extra mucosa layer appears.

What is endometrial proliferation

Proliferation is the phase of rapid cellular division in tissues that do not exceed the normative indicators. During this process, the mucosa is regenerated, and expands. New cells are not atypical type, normal tissue is formed. Proliferation - the process is characteristic not only for endometrial. Some other fabrics also pass the proliferation process.

Causes of proliferation

The reason for the appearance of the endometrium of the proliferative type, due to the active rejection of the active layer of the mucous membrane of the uterus. After that, it becomes very thin. And must be regenerated before the next menstruation. The update of the active layer goes during proliferation. Sometimes it has pathological causes. For example, the process of proliferation occurs when endometrial hyperplasia. (If you do not treat hyperplasia, it prevents pregnant). With hyperplasia, the cell division occurs, and the thickening of the active layer of the uterine mucous membrane.

Flashing of endometrial proliferation

Endometrial proliferation is an increase in the cellular layer through active division, during which organic tissues are growing. At the same time, the mucous layer thickens in the uterus, during normal cellular division. The process lasts up to 14 days, it activates the female hormone - estrogen, synthesized during the ripening of the follicle. Proliferation consists of three stages:

• early
• middle
• late

Each stage lasts a certain period of time, and manifests itself in different ways on the mucous meter of the uterus.

Early

The early stage of the endometrium proliferation lasts from five to seven days. During this period, the endometric cover is staminated by a cellular epitheal layer of cylindrical type. The glands are dense straight, thin, in the diameter have a rounded or oval shape. The epitial iron layer is located low, the cell cores at the base, oval, painted in a bright red shade. Connecting cells (stromes) - have a spindle-shaped shape, they have a large diameter nucleus. Blood vessels are practically straight.

Average

The middle stage of proliferation comes to the eighth - the tenth of the cycle. Epithelium was lined with high prismatic cells of the epithelium. At this time, the glands are slightly bent, the kernels are pale, become larger, located at different levels. The number of cells generated through indirect division increases. The connecting fabric swells and becomes loose.

Late

Late proliferation stage begins with 11 or 14 days. The endometrium of the late phase stage is significantly different from what he is on the earlier. The glands acquire a winding shape, cell cores at different levels. The epitial layer is one, but it is multiple. In the cells ripen vacuole with glycogen. Vascular grid winding. Cell kernels are rounded and become greater. Connecting cloth nanite.

Phase secretion

Secretion is also divided into three steps:

1. Early - from 15 to 18 days cycle.
2. The average - 20 -23 day of the cycle, at this time the secretion is most active.
3. Late - from 24 to 27 days, when secretion fades.

The change in the secretory phase comes menstrual. It is also divided into two periods:

1. Deskvamation - from 28 days 2 days of a new cycle, if the egg cell fertilized.
2. Restoration - from 3 to 4 days, until the active layer is completely rejected, and before the new proliferation process.

After passing all the stages, the cycle is repeated again. This is happening before the occurrence of pregnancy, menopause, if there are no pathologies.

How to diagnose

Diagnosis will help identify the signs of pathological type proliferation. There are several ways to diagnose proliferation:

1. Visual inspection.
2. Colposcopic inspection.
3. Cytological analysis.

To avoid serious diseases, you need to regularly attend a gynecologist. Pathology can be seen during the usual gynecological inspection. Other methods allow you to more accurately determine the cause of incorrect proliferation.

Proliferation Diseases

Endometrium in the proliferation phase is actively growing, cell division occurs under hormonal influence. During this period, the appearance of pathologies occurring due to the rapid growth of cells. Tumors may appear, the fabric will begin to grow and so on. Diseases may appear if during the cyclic phases during proliferation that something went wrong in the secretory phase, the development of pathologies of the shell is practically excluded. Most often, during cell division, hyperplasia of the uterine mucous membrane develops, which in some cases can lead to infertility and cancer of the elementar body.

The disease provokes a hormonal failure occurring during the period of active cell division. As a result, its durability increases, cells become larger, and the mucous membrane becomes much thicker. Treatment of such diseases should be timely. Most often medication, physiotherapeutic treatment. In serious cases, they resort to surgical intervention.

Why slows down the proliferation process

The braking of the processes of the endometrium proliferation or the insufficiency of the second stage of the menstrual cycle is allocated by the fact that cell division stops or is much slower than usual. These are the main symptoms of the impending menopause, deactivating the ovaries and the termination of ovulation. This is a normal phenomenon characteristic of the climax. But if the braking occurs at a young woman, this is a sign of instability of a hormonal background. This pathological phenomenon should be treated, it leads to the termination of the menstrual cycle ahead of time and the impossibility of becoming pregnant.

Turn

Endometrium is an outer mucosa layer lining the uterus. It is completely hormone-dependent, and it is he who is subjected to the greatest changes during the menstrual cycle, it is its cells that are rejected and come out with the discharge during menstruation. All these processes go in accordance with certain phases, and deviations in the passage or duration of these phases can be considered pathology. Proliferative endometrium is a conclusion that can often be seen in the Uzi description is an endometrium in the proliferative phase. The fact that this phase is what stages is and what is characterized, told in this material.

Definition

What it is? The proliferative phase is the stage of active division of cells of any tissue (in this case, its activity does not exceed normal, that is, it is not pathological). As a result of this process, the tissue is restored, regenerated, expand. During division, normal, neatatic cells appear, from which a healthy tissue is formed, in this case, endometrium.

But in the case of the endometrium, this is the process of active increasing mucous membrane, its thickening. Such a process can be caused by both natural reasons (phase of the menstrual cycle) and pathological.

It is worth noting that proliferation is a term applicable not only to endometrial, but also to some other tissues in the body.

The reasons

The endometrium of the proliferative type, often appears because the many cells of the functional (updating) part of the endometrium rejected during the menstruation. As a result, he threaded significantly. The features of the cycle are such that for the onset of the following menstruation, this mucous layer must restore its thickness of the functional layer, otherwise it will be updated. This is what happens in the proliferative stage.

In some cases, such a process may be caused by pathological changes. In particular, endometrial hyperplasia (a disease capable of, without appropriate treatment, lead to infertility) is also characterized by reinforced cell division leading to the thickening of the endometrial functional layer.

Phase proliferation

Endometrial proliferation is a normal process that occurs with the passage of several stages. These stages are always present in the norm, the absence or violation of the flow of some of these stages speaks of the beginning of the development of the pathological process. Phases of proliferation (early, medium and late) differ depending on the rate of cell division, the nature of the growth of tissues, etc.

Total process lasts about 14 days. During this time, follicles begin to ripen, they produce estrogen, and it is under the action of this hormone and growing.

Early

This stage proceeds from the fifth to the seventh day of the menstrual cycle. The mucosa has the following signs on it:

1. On the surface of the layer there are epithelial cells;
2. The glands are elongated, straight, in cross section oval or round;
3. Irony epithelium is low, and the kernel of intense color, and are at the base of the cells;
4. Stroma cells have the form of spindle;
5. Circuit artery is not a sortie at all or sorties minimally.

The early stage ends 5-7 days after the end of menstruation.

Average

This is a short stage that lasts about two days in the interval from the eighth to the tenth day of the cycle. At this stage, the endometrium undergoes further changes. It acquires the following features and characteristics:

• Epithelial cells with which the outer layer of endometrial is enjoyed have a prismatic look, they are high;
• The glands become slightly more convicted compared to the previous stage, their kernels are less brightly painted, they become more sustainable trends to any arrangement there are no - they are all at different levels;
• Stroma becomes edema and loose.

The endometrium of the average phase of secretion is characterized by the appearance of a certain number of cells formed by the method of indirect division.

Late

The endometrium of the late stage of proliferation is characterized by convulsive glands, the kernel of all cells of which are located at different levels. Epithelium has one layer and many rows. In a number of epithelium cells, vacuoles with glycogen appear. The vessels are also convinced, the state of the stroma is the same as in the previous stage. Cells of cells round, large size. There is such a stage from the eleventh to the fourteenth day of the cycle.

Phase secretion

The secretion phase occurs almost immediately after proliferation (or after 1 day) and is inextricably connected with it. It also distinguishes a number of stages - early, medium and late. They are characterized by a number of typical changes that are prepared by endometrium and the body as a whole to the menstrual phase. Endometrium secretory type is dense, smooth, and, this applies to both basal and functional layers.

Early

This stage lasts from about the fifteenth to the eighteenth day of the cycle. It is characterized by a weak severity of secretion. At this stage, it just begins to develop.

Average

At this stage, secretion proceeds as actively as possible, especially in the middle of the phase. A small fading of secretory function is observed only at the very end of this stage. She lasts with twentieth to twenty-third day

Late

For the late stage of the secretion phase, a gradual extinction of a secretory function is characteristic, with complete consequence to not at the very end of this stage, after which the woman starts periods. This process lasts 2-3 days in the period from twenty-fourth to twenty-eighth day. It is worth noting the peculiarity characteristic of all stages - they last 2-3 days, while the exact duration depends on how many days in the menstrual cycle of a particular patient.

Proliferative diseases

Endometrium in the proliferation phase is very actively growing, its cells are divided under the action of various hormones. Potentially this condition is dangerous by the development of various kinds of diseases associated with the pathological division of cells - neoplasms, tissue growths, etc. The development of pathologies of this type can cause some faults in the process of passing stages. At the same time, the secretory endometrium of such a danger is almost completely impossible.

The most typical disease that develops as a result of the violation of the phase of the proliferation of the mucous membrane is hyperplasia. This is the state of pathological growth of endometrial. The disease is quite serious and requires timely treatment, as it causes severe symptoms (bleeding, pain) and can lead to full or partial infertility. The percentage of cases of rebirth into the oncology, however, very low.

Hyperplasia occurs in violations in the hormonal regulation of the division process. As a result, the cells are divided longer and more actively. The mucous layer is much thickened.

Why is the braking of proliferation processes?

The inhibition of endometrial proliferation processes is a process, also known as the insufficiency of the second phase of the menstrual cycle, characterized by the fact that the proliferation process is not actively or does not go well. This is a symptom of Klimaks, extinction of the ovarian function and the absence of ovulation.

The process is natural and helps to predict the onset of climax. But maybe it is pathological, if it develops in a woman of reproductive age, it speaks of a hormonal imbalance that needs to be eliminated, as it can lead to dysmanifier and infertility.

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During the menstrual cycle, called proliferative phase, the structure of the uterus mucous membrane has the above character in general. This period comes shortly after the menstrual separation of blood, and, as the name itself shows, proliferative processes leading to updating the functional part of the mucous membrane in the mucous membrane of the uterus occur.

As a result of breeding fabrics, preserved after menstruation in the residues of the mucous membrane (that is, in the basal part), the formation of the own plate of the functional zone begins again. From the thin mucosa layer, preserved in the uterus after menstruation, the entire functional part is gradually restored, and, due to the reproduction of ferrous epithelium, the uterine glands are also extended and also increased; However, in the mucous membrane, they still remain smooth.

The whole mucosa is gradually thickens, acquiring your normal structure and reaching medium height. The cilia (cinylony) of the surface epithelium of the mucous membrane at the end of the proliferative phase is disappearing, and the glands are prepared for secretion.

Simultaneously with phase proliferation The menstrual cycle in the ovary occurs ripening the follicle and egg cell. Follicular hormone (Follikulin, Estrin), isolated by the cells of the graon of the follicle, is a factor that determines the proliferative processes in the mucous membrane of the uterus. At the end of the proliferation phase, ovulation occurs; In place of the follicle, the yellow body of menstruation begins to form.

His hormone It has a stimulating effect on the endometrium, causing changes occurring in the subsequent phase of the cycle. The proliferation phase begins on the 6th day of the menstrual cycle and continues until the 14th day of the day inclusive (counting from the first day of the menstrual blood branch).

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Phase secretion of the uterine cycle

Under stimulating influence gormon. The yellow body (progesterone), which is formed in the ovary, begin to expand the glands of the uterus mucosa, especially in their basal departments, their corks are twisted, so that on the longitudinal sections, the internal configuration of their edges acquires a saw-shaped, geek. There is a typical spongy layer of the mucous membrane, characterized by spongy consistency.

Epithelium glands begins select the mucosal secretcomprising a significant amount of glycogen, which in this phase is deposited in the bodies of ferrous cells. Of some connective tissue cells of the compact layer of the mucous membrane, increased polygonal cells with a weakly colored cytoplasma and the kernel begin to form in the tissue of their own mucous plate.

These cells are scattered in fabrics A single or in the form of clusters, in their cytoplasm also contains glycogen. These are the so-called decidual cells, which in the case of the occurrence of pregnancy further multiply in the mucous membrane, so that their large quantity is a histological indicator of the initial phase of pregnancy (histological examination of pieces of the uterine mucous membrane obtained at the potential - removal of the fetic egg to the curette).

Conducting such research It is of great importance, especially when determining ectopic pregnancy. The fact is that changes in the mucous membrane of the uterus also occur when a fertilized egg cell, or rather the young embryo, is not in normal place (in the uterus mucous membrane), but at any other place outside the uterus (ectopic pregnancy).

Last update of Article 07.12.2019

The endometrium of the proliferative type is the intensive growth of the mucous membacity layer flowing against the background of hyperplastic processes due to excessive division of the cellular structures of the endometrium. In this pathology, diseases of a gynecological nature are developing, a reproductive function is disturbed. Faced with the concept of a proliferative type endometrial, it is necessary to figure it out what it means.

Endometrium - what is it? Under this term means a mucous layer, lining the inner uterine surface. This layer is distinguished by a complex structural structure that includes the following fragments:

• irony epithelial layer;
• basic substance;
• stroma;
• blood vessels.

Endometrium performs important functions in the female body. It is the mucous meal layer that is responsible for the attachment of the fetal egg and the offensive of successful pregnancy. After conception, the blood and endometrial vessels provide the fruit with oxygen and necessary nutrients.

The endometrium proliferation contributes to the growth of the vascular bed for normal blood supply to the embryo and the formation of the placenta. During the menstrual cycle, a number of cyclical changes are occurring in the uterus, divided into the following sequential stages:

• Endometrium in the proliferation phase - It is characterized by intense growth due to the reproduction of cellular structures by their active division. The endometrium proliferation phase is growing, which may be like a completely normal physiological phenomenon, part of the menstrual cycle, and a sign of dangerous pathological processes.
• Phase secretion - At this stage, the endometrial layer is prepared for the menstrual phase.
• The menstrual phase, desquamation of the endometrium - the lunch, rejection of the resulting endometrial layer and eliminating it from the body with menstrual blood.

For an adequate estimate of cyclic changes of the endometrium and how much its condition corresponds to the norm, it is necessary to take into account such factors such as the duration of the menstrual cycle, the stage of proliferation and the secret period, the presence or absence of uterine bleeding of dysfunctional nature.

Endometrial proliferation phases

The process of endometrial proliferation includes several consecutive stages, which corresponds to the concept of the norm. The absence of one of the phases or failures in its flow can mean the development of the pathological process. The entire period takes two weeks. During this cycle, follicles ripen, stimulating the secretion of hormone-estrogen, under the action of which the endometrial uterine layer is generated.

The following stages of the phase of proliferation are distinguished:

1. Early - lasts from 1 to 7 days of the menstrual cycle. At an early phase phase, the mucous membrane is changed. Epithelial cells are present on endometrials. Circuit artery practically does not appear, and stromal cells have a specific shape resembling spine.
2. The average is a short phase flowing in the interval from 8 to 10 days of the menstrual cycle. The endometrial layer is characterized by the formation of certain cellular structures formed during indirect division.
3. Late stage continues from 11 to 14 days a cycle. Endometrium is covered by convicted glands, the epithelium is distinguished by multi-layered, cell cores have a rounded shape and large dimensions.

The above step must comply with the established criteria of the norm, as well as they are inextricably linked with the secretory phase.

Phases of endometrial secretion

Secretor endometrium is distinguished by density and smoothness. Endometrium's secretory transformation begins immediately after completion of the proliferation stage.

Experts identify the following stages of the secretion of the endometrial layer:

1. Early stage - observed from 15 to 18 days of the menstrual cycle. At this stage, secretion is very weak, the process is just beginning to develop.
2. The middle stage of the secretion phase - flows from 21 to 23 days of the cycle. This phase is characterized by increased secretion. A minor process suppression is observed only at the completion of the stage.
3. Late - For the late stage of the secretion phase, typically suppressing a secretory function, which reaches its peak at the time of the menstruation itself, after which the process of reverse development of the endometrial uterine layer begins. Late phase is observed in the period from 24-28 days of the menstrual cycle.

Proliferative diseases

Diseases of the non-proliferative type endometrial - what does this mean? Usually endometry of a secretory type is practically not carrying any threats to the health of a woman. But the mucous meal in the period of the proliferative phase is intensively growing under the influence of certain hormones. This condition carries a potential danger in terms of the development of diseases due to pathological, increased division of cellular structures. The risks of formation of tumor neoplasms as a benign and malignant nature increase. Among the main pathologies of the proliferative type of doctor, the following are allocated:

Hyperplasia - pathological growth of the uterine endometrial layer.

This disease is manifested by such clinical signs as:

• menstrual disorders,
• uterine bleeding
• pain syndrome.

In hyperplasia, the opposite development of the endometrium is disturbed, the risks of infertility increase, violations of the reproductive function are developing, anemia (on the background of abundant blood loss). Also significantly increases the likelihood of malignant rebirth of endometrial tissues, the development of the oncological disease.

Endometritis - Inflammatory processes localized in the region of the mucous stock endometrial layer.

This pathology manifests itself:

• uterine bleeding
• abundant, painful menstruation,
• vaginal discharge of a purulent-bleeding character
• other painful sensations localized at the bottom of the abdomen,
• soreness of intimate contacts.

Endometritis also adversely affect the reproductive functions of the female organism, provoking the development of such complications, as problems with conception, placental insufficiency, threat of miscarriage and spontaneous interruption of pregnancy in early time.

Uterine cancer - One of the most dangerous pathologies developing in the proliferative period of the cycle.

The patients in the age category over 50 years old are most susceptible to the greatest degree of these malignant disease. The disease is manifested by active exofitu growth simultaneously with concomitant infiltrating germination into muscle tissue. The danger of this type of oncology is its practically asymptomatic flow, especially in the early stages of the pathological process.

The first clinical signs are blenced - vaginal excretion of a mucous nature, but, unfortunately, most women do not pay special attention to it.

Clearways should such clinical symptoms like:

• uterine bleeding
• paints localized at the bottom of the abdomen
• student urge to urination,
• vaginal bleeding,
• general weakness and increased fatigue.

Doctors noted that most proliferative diseases are developing against the background of hormonal, gynecological disorders. The main provoking factors include endocrine disorders, diabetes, uterine mioma, endometriosis, hypertensive disease, excess body weight.

The group of increased risk, gynecologists include women who have had abortions, miscarriages, scraping, operational interventions on the bodies of the reproductive system, abusing the hormonal means of contraception.

To prevent and timely detecting such diseases, it is necessary to follow their health, and at least 2 times during the year there is an inspection of the gynecologist for the purpose of prevention.

The risk of suppressing proliferation

The braking of the proliferative processes of the endometrial layer is a fairly common phenomenon, characteristic of the climacteric period and the extinction of the ovarian functions.

In patients of reproductive age, this pathology is fraught with the development of hypoplasia and dysmenorrhea. In the processes of the hypoplastic nature, the mystery of the mucous stocking layer occurs, as a result of which the fertilized egg can not normally fix it in the uterus wall, and the pregnancy does not occur. The disease is developing against the background of violations of hormonal nature and requires adequate, timely medical care.

Proliferative endometrium is the growing mucous meal layer, it may be a manifestation of the norm or a sign of dangerous pathologies. Proliferation is characteristic of a female body. During the menstruation period, the endometrial layer is rejected, after which it is gradually restored by active cell division.

Patients with impairment of reproductive functions are important to consider the endometrium development stage in diagnostic surveys, since in different periods, indicators may have significant differences.

The inner layer of the uterus is called endometrial. This fabric has a complex structural structure and a very important role. The reproductive functions of the body depend on the state of the mucous membrane.

Every month, the density, structure and size of the internal layer of the uterus change throughout the entire cycle. Phase proliferation is the very first stage of the beginning of the natural transformations of the mucous membrane. It is accompanied by an active cellular division and the growth of the uterine layer.

The state of the endometrial of the proliferative type directly depends on the intensity of the division. Disorders in this process lead to an abnormal thickening of the resulting tissues. Too much cells negatively affects health and promotes the development of serious diseases. Most often, during the examination, women's iron hyperplasia is detected. Other, more dangerous diagnoses and states requiring emergency medical care are possible.

For successful fertilization and trouble-free pregnancy, cyclic changes in the uterus must correspond to the indicators of the norm. In cases where the atypical structure of the endometrium is observed, pathological deviations are possible.

Learn about the unhealthy state of the mucous meat through symptoms and external manifestations is very difficult. Doctors will help, but that it is easier to understand that such an endometrial proliferation and how the growing fabric affects health, it is necessary to understand the features of cyclic changes.

Endometrium consists of functional and basal layers. The latter is tightly adjacent cell particles peam up with numerous blood vessels. The main function is to restore the functional layer, which, with a failed fertilization, exfoliates and is derived with blood.

The uterus after menstruation is self-cleaning, and the mucosa during this period has a smooth, thin, smooth structure.

The standard menstrual cycle is made to divide in 3 stages:

1. Proliferation.
2. Secretion.
3. Bleeding (monthly).

In such a manner of natural changes, proliferation is in the first place. The phase begins approximately from the 5th day of the cycle after the end of menstruation and lasts 14 days. During this period, cellular structures are multiplied by active division, which leads to the growth of tissues. The inner layer of the uterus can increase to 16 mm. This is the normal structure of the endometrial proliferative type layer. Such thickening contributes to the fastening of the embryo to the pillocks of the uterine layer, after which ovulation occurs, and the mucosa of the uterus passes into the secretion phase in the endometrium.

If the conception occurred, the yellow body is implanted in the uterus. With a failed pregnancy, the embryo ceases to function, the hormone level decreases, menstruation begins.

Normally, the cycle stage is followed by each other in such a sequence, but sometimes failures occur in this process. For various reasons, proliferation may not stop, that is, after 2 weeks, the cell division will continue to continue uncontrollably, and the endometrium to grow. Too dense and thick inner layer of the uterus often leads to problems with conception and development of severe diseases.

Proliferative diseases

The intensive growth of the uterine layer during the proliferative phase occurs under the action of hormones. Any failure in this system extends the period of cell division activity. The overabundance of new tissues becomes the cause of body cancer and the development of benign tumor formations. Wrivery the occurrence of diseases are capable of background pathologies. Among them:

• endometritis;
• endometriosis of the cervix;
• adenomatosis;
• myoma uterus;
• cysts and uterus polyps;

Hyperactive cell division is observed in women with detected endocrine disorders, diabetes and hypertensive disease. The abortion, scraping, overweight, abuse of hormonal contraceptives affect the condition and structure of the mucous membrane.

Against the background of hormone problems, hyperplasia is most often diagnosed. The disease is accompanied by an abnormal growth of the endometrial layer and has no age limit. The most dangerous periods are puberty and. In women under 35 years, the disease is rarely detected, as the hormonal background at this age is distinguished by stability.

Endometrium hyperplasia has clinical signs: the cycle is broken, uterine bleeding are observed, constant pain in the abdomen area appear. The danger of the disease is that the reverse development of the mucosa is broken. The dimensions of the scorched endometrial do not decrease. This leads to infertility, anemia, oncological diseases.

Depending on how the late and early stages of proliferation are effective, endometrial hyperplasia can be atypical and iron.

Endometrium iron hyperplasia

The high activity of proliferative processes and intensive cell division increases the volume and structure of the mucous membrane. In pathological growth and thickening of ferrous tissues, doctors diagnose ferrous hyperplasia. The main reason for the development of the disease is hormonal disorders.

Typical symptoms do not. Manifestations are characteristic of many gynecological diseases. Basically, women's complaints are associated with states during menstruation and after menstruation. The cycle changes and differs from the previous ones. Abundant bleeding is accompanied by painful sensations and contain bunches. Often, the allocation go beyond the cycle, which leads to anemia. Serious bloodstures cause weakness, dizziness and weight loss.

The feature of this form of the endometrial hyperplasia is that the new-forming particles are not divided. Pathology is rarely transformed into a malignant tumor. Nevertheless, this type of disease is characterized by typhic for tumor formations for the unemployment of growth and loss of function.

Atypical

Refers to intrauterine diseases that are associated with endometrial hypoplastic processes. Basically, the disease is revealed in women after 45 years. Each third of 100 pathology develops into a malignant tumor.

In most cases, this type of hyperplasia develops due to hormonal failures activating proliferation. The uncontrolled division of cells with a disturbed structure leads to the growth of the uterine layer. With atypical hyperplasia, the secretory phase is absent, since the size and thickness of the endometrium continue to grow. This leads to long, painful and abundant menstruation.

Pronounced atypia refers to the dangerous states of the endometrium. Not only active breeding of cells occurs, the structure and structure of the nuclear epithelium is changing.

Atypical hyperplasia is capable of developing in basal, functional and immediately in both layers of mucous. The latter option is considered the hardest, since the likelihood of cancer is high.

Flashing of endometrial proliferation

Typically, women are difficult to understand what the endometrium proliferation phases are and as a violation of the sequence of stages is associated with health. To understand the question help knowledge about the structure of the endometrium.

The mucosa consists of a basic substance, a ferrous layer, connective tissues (stroma) and numerous blood vessels. From about the 5th day of the cycle, when proliferation begins, the structure of each of the components is modified. The entire period lasts about 2 weeks and is divided into 3 phases: early, middle, late. Each of the stages of proliferation is manifested differently and occupies a certain time. The correct sequence is considered the norm. If at least one of the phases is missing or noted failure in its course, the probability of developing pathologies in the shell inside the uterus is very high.

Early

The early stage of proliferation is the 1-7th day of the cycle. The mucous membrane of the uterus during this period begins to gradually change and is characterized by the following structural conversion of fabrics:

• endometrium is lined with a cylindrical epithelial layer;
• blood vessels straight;
• the glands are dense, thin, straight;
• cell kernels have a rich red color and oval shape;
• stromas are oblong, spindle-shaped.
• endometrial thickness in the early polypripal phase - 2-3 mm.

Average

The average stage of the proliferative type endometrial is the shortest, usually this is the 8-10th day of the menstrual cycle. The form of the uterus changes, noticeable changes occur in the form and structure of other elements of the mucous:

• the epithelial layer is lined with cylindrical cells;
• pale kernels;
• glands are elongated and bend;
• connective tissue of loose structure;
• endometrial thickness continues to grow and reaches 6-7 mm.

Late

On the 11-14th day of the cycle (late stage), the cells inside the vagina increase in volume and swell. Significant changes occur with the uterine shell:

• epithelial layer high and multilayer;
• part of the glands is extended and has a wavy shape;
• vascular grid winding;
• cell nuclei increase in size and have a rounded form;
• endometrial thickness in the late proliferative phase reaches 9-13 mm.

All listed stages are closely related to the secretion phase and must correspond to the indicators of the norm.

Causes of body cancer

The uterus body cancer refers to the most dangerous pathology of the proliferative period. In the early stages, this type of disease proceeds asymptomatic. The first signs of the disease include abundant mucous allocations. Over time, such signs appear as pain at the bottom of the abdomen, uterine bleeding with endometrial fragments, frequent urge to urination, weakness.

The incidence of cancer increases with the advent of annotulatory cycles characteristic of age from 45 years. In the premenopause, the ovaries still identify follicles, but they rarely ripen. Ovulation does not occur, respectively, the yellow body is not formed. This leads to a hormone imbalance - the most common reason for the formation of cancer tumors.

In the risk group, who did not have pregnancy and childbirth, as well as with identified obesity, diabetes mellitus, exchange and endocrine disorders. The background diseases provoking the body cancer of the parent body are polyps in the uterus, endometrial hyperplasia, mioma, ovarian polycystosis.

The diagnosis of oncology complicates the state of the uterine wall with cancer defeats. Endometrium becomes loose, the fibers are located in different directions, muscle tissue is weakened. The borders of the uterus are blurred, polypo-shaped growths are noticeable.

Regardless of the pathological process, endometrial cancer is detected when ultrasound. To determine the presence of metastasis and the localization of the tumor, resort to hysteroscopy. In addition, a woman is recommended to undergo a biopsy, radiography and pass a number of analyzes (urine, blood, hemostasis study).

Timely diagnosis makes it possible to confirm either eliminate the growth of tumor neoplasm, its nature, size, type and degree of distribution to neighboring bodies.

Diseard therapy

Treatment of cancer pathology of the bodies of the uterus is prescribed individually, depends on the stage and form of the disease, as well as the age and general state of the woman.

Conservative therapy applies only at the initial stages. Women of reproductive age with a detected disease of the 1st stage conduct hormonal therapy. Throughout the course of treatment, you need to regularly pass tests. So doctors track the condition of the cell nucleus, changes in the structure of the mucous membrane and the dynamics of the disease.

The most efficient method is considered to remove the affected uterus (partial or complete). To eliminate single pathological cells after the operation, a course of radiation or chemical therapy is assigned. In cases of rapid growth of endometrial and rapid increase in cancerous tumor, doctors remove a native body, ovaries and appendages.

In early diagnosis and timely treatment, any of the therapeutic techniques gives positive results and increases the chances of recovery.

Table of contents of the topic "Ejaculation (ejaculation). Reproductive function of a female organism. Ovarian cycle. Menstrual cycle (uterine cycle). Female sexual intercourse.":
1. Ejaculation (ejaculation). Regulation of ejaculation. Seed liquid.
2. Orgasm. The stage of the orgasm of the male intercourse. Stage of the permission of the male sexual act. Refractory period.
3. Reproductive function of the female organism. Women's reproductive function. Woman's body preparation stage in egg fertilization.
4. OVARAL CYCLE. Oogenesis. Cycle phases. Follicular phase of the ovulatory cycle. Follitropine function. Follicle.
5. Ovulation. Ovulatory phase of the ovulatory cycle.
6. Lutheal phase of the ovulatory cycle. Phase of a yellow body. Yellow body. Functions of a yellow body. Local yellow body. Yellow pregnancy body.
7. Luteeolysis of the yellow body. Lisace yellow body. Destruction of a yellow body.
8. Menstrual cycle (uterine cycle). Phases of the menstrual cycle. Menstrual phase. Proliferative phase of the menstrual cycle.
9. The secretory phase of the menstrual cycle. Menstrual bleeding.
10. Female sexual intercourse. Stages of female sexual intercourse. Sex excitation of a woman. Stage of excitation. Manifestation of the stage of excitement.

Menstrual cycle (uterine cycle). Phases of the menstrual cycle. Menstrual phase. Proliferative phase of the menstrual cycle.

Menstrual cycle (uterine cycle)

The preparation of the female body to gestation is characterized by cyclic changes in the endometrium of the uterus, which consist of three consecutive phases: menstrual, proliferative and secretory - and are called uterine, or menstrual, cycle.

Menstrual phase

Menstrual phase With the duration of the uterine cycle, 28 days continues on average 5 days. This phase is a bleeding from the uterine cavity, which occurs at the end of the ovarian cycle, if the feroticization and implantation of the egg cell occurs. Menstruation is the process of rejection of the endometrium layer. The proliferative and secretory phases of the menstrual cycle include endometrial recovery processes for possible egg implantation during the next ovarian cycle.

Proliferative phase

Proliferative phase Varies duration from 7 to 11 days. This phase coincides with follycular and ovulatory phases of the ovarian cycleDuring which the level of estrogen is increasing, mainly EST radiol-17R, in blood plasma. The main function of estrogen in the proliferation phase of the menstrual cycle is the stimulation of organic proliferation of organs of organs reproductive system With the restoration of the functional layer of endometrial and the development of the epithelial liner of the mucous membrane. In this phase, under the influence of estrogen, the endometrium of the uterus occurs, an increase in the size of its glands, secreted mucus, the length of the spiral arteries is growing. Estrogens cause proliferation of the vaginal epithelium, strengthen the secretion of mucus in the cervix. The secretion becomes abundant, the amount of water increases in its composition, which makes it easier for spermatozoa in it.

Stimulation of proliferative processes Endometrials are associated with an increase in the number of progesterone receptors on the endometrial cell membrane, which increases the proliferative processes in it under the influence of this hormone. Finally, an increase in the concentration of estrogen in the blood plasma stimulates the reduction of smooth muscles and the microhorusin of phallopy pipes, which contributes to the promotion of sperm in the direction of the ampular dial of phallopying pipes, where the oxygellation fertilization should occur.

Early Phase Stage Proliferation. In this phase of the menstrual cycle, the mucosa is traced in the form of a narrow echoposive strip ("endometrial traces") of a homogeneous structure, a thickness of 2-3 mm, located centrally.

Colpocytology. The cells are large, bright, with medium sized cores. Moderate folding of the edges of the cells. The amount of eosinophilic and basophilic cells is approximately the same. Cells are located groups. Leukocytes are small.

Histology endometrial. The surface of the mucous membrane is eliminated by a split cylindrical epithelium, which has a cubic shape. Endometrium is thin, the separation of the functional layer on the zone is absent. The glands have a view of direct or several winding tubes with a narrow lumen. On transverse cuts, they have a round or oval shape. The epithelium of ferrous crypt prismatic, oval cores, are placed at the base, they are well stained. Basophilic cytoplasm, homogeneous. The apical edge of epithelial cells is smooth, clearly outlined. On its surface, long microvills are determined using electron microscopy, which contribute to an increase in the cell surface. Stroma consists of spindle-like or star reticular cells with gentle processes. Little cytoplasm. She barely noticeable around the cores. In the cells of stroma, as in the epithelial, single mitoses appear.

Hysteroscopy. In this phase of the total cycle (up to 7 days of the cycle), the endometrium is thin, smooth, pale pink, in some sections, small hemorrhages are shifted, seen a single portion of the endometrium of pale pink color, which have not rejected. Eyes of the uterine pipes are well traced.

The average phase of proliferation. The middle stage of the phase of the proliferation continues from 4-5 to 8-9 days after menstruation. The thickness of the endometrium is continued to be increased to 6-7 mm, its structure is homogeneous or with an elevated density zone in the center - the zone of contact of the functional layers of the upper and lower wall.

Colpocytology. A large amount of eosinophilic cells (up to 60%). Cells are placed dissipated. Leukocytes are small.

Histology endometrial. Endometrium is thin, the separation of the function layer is absent. The surface of the mucous membrane is eliminated by a high prismatic epithelium. The glands are somewhat winding. The cores of epithelial cells are located at different levels, they have numerous mitoses. Compared with the early phase of the nucleus proliferation, less intensively painted, some of them contain small nuclei. From the 8th day of the menstrual cycle on the apical surface of epithelial cells, a layer containing acidic mucoids is formed. Alkaline phosphatase activity is growing. The stromas of the exhaust, depleted, in the connecting tissues a narrow strip of cytoplasm is visible. The number of mitoses increases. The vessels of stroma is single, with thin walls.

Hysteroscopy. In the middle stage of the phase of the Phase of the endometrium gradually thickens, it becomes a pale pink color, the vessels are not visible.

Late Stage of Proliferation. In the late stage of the phase of the proliferation (lasts about 3 days) the thickness of the functional layer reaches 8-9 mm, the endometrium form, as a rule, a drop-shaped, the central echoposive line during the entire first phase of the menstrual cycle remains unchanged. On a general echonegative background, it is possible to distinguish short, very narrow echoposive layers of low and medium density, reflecting the delicate fibrous structure of the endometrium.

Colpocytology. In the smear predominantly eosinophilic surface cells (70%), basophilic few. In the cytoplasm of eosinophilic cells, graininess is found, small, picnotic kernels. Leukocytes are small. Characterized by a large amount of mucus.

Histology endometrial. Some thickening of the functional layer, but there is no separation for zones. The endometrium surface is removed with high cylindrical epithelium. Glands are more winding, sometimes corkscrew. Their clearance is somewhat extended, the epithelium glands is high, prismatic. Apical edges of cells are smooth, clear. As a result of intensive division and increase the number of epithelial cells, the kernels are at different levels. They are increased, still oval, contain small nucleists. Closer to the 14th day of the menstrual cycle, you can see a large number of cells containing glycogen. The activity of alkaline phosphatase in the epithelium glands reaches the highest degree. The cores of the connective tissue cells are larger, rounded, painted less intensively, there is an even more notable cytoplasm wench around them. Spiral arteries that grow from the basal layer at this time already reaches the surface of the endometrium. They are still slightly winding. Under the microscope defines only one or two placed near the peripheral vessels.

Pesteroscopy.. In the late phase of proliferation, the time on the endometrium of individual sites is determined in the form of thickened folds. It is important to note that if menstrual cycle It takes normally, in the phase of the proliferation of the endometrium may have different thickness, depending on the localization - thickened on the days and rear wall of the uterus, thinner on the front wall and in the lower third part of the body of the uterus.

Early stage of secretion phase. In this phase of the menstrual cycle (2-4 days after ovulation), the thickness of the endometrium reaches 10-13 mm. After ovulation, due to secretory changes (the result of progesterone products with the menstrual yellow binding body), the endometrium structure becomes uniform until the start of menstruation. During this period, the endometrium thickness increases faster than in the first phase (by 3-5 mm).

Colpocytology. Characteristic deformed cells - wavy, with curved edges, as if folded in half, cells are placed thick clusters, layers. Cells of cells are small, picnotic. The number of basophilic cells is growing.

Histology endometrial. The endometrium thickness moderately increases compared with the phase of proliferation. The glands become more winding, their lumen is expanded. The most characteristic sign of the secretion phase, in particular its early stage - the appearance of subnuclear vacuoles in the epithelium glands. Glycogen granules become large, cell cores are moved from basal departments to the central (indicative of what has occurred ovulation). The kernels are pushed by vacuoles to the central cells of the cells, initially located at different levels, but on the 3 day after ovulation (17th day of the cycle), the kernels that lie on large vacuoles are placed at one level. On the 18th day of the cycle in some cells, glycogen granules are moved to the apical cells of the cells, as if the nucleus is coming. As a result, the kernel falls down again to the base of the cell, and the groovens granules are placed above them, which are located in the apicial parts of the cells. The kernel is more rounded. Mitoses are missing in them. Basophilic cell cytoplasm. Sour mucoids continue to appear in their apical departments, while alkaline phosphatase activity decreases. Strom of endometrial slightly swollen. Spiral artery winding.

Hysteroscopy. In this phase of the menstrual cycle, the swollen endometrium, thickened, forms folds, especially in the upper third of the body of the uterus. The color of the endometrium becomes yellowish.

Middle stage of secretion phase. The duration of the average stage of the second phase from 4 to 6-7 days, which corresponds to the 18-24 day of the menstrual cycle. During this period, the greatest severity of the secretory changes of the endometrium is noted. Echographically, it is manifested by the thickening of the endometrium by another 1-2 mm, the diameter of which reaches 12-15 mm, and even greater density. At the endometrium and myometrium, the rejection zone in the form of a echonegative, clearly defined rim, the severity of which reaches the maximum before menstruation.

Colpocytology. The characteristic folding of cells, bent edges, cluster cells by groups, decreases the number of cells with picnotic nuclei. The number of leukocytes moderately increases.

Histology endometrial. The functional layer becomes higher. It is clearly divided into a deep and surface part. Deep layer - spongy. It contains highly developed glands and a small amount of stroma. The surface layer is compact, it is less winding glands and many connective tissue cells. On the 19th day of the menstrual cycle, most of the cores are located in the basal part of the epithelial cells. All kernels are rounded, bright. The apical epithelial cell department becomes domed, glycogen accumulates here and begins to stand out in the absurdity of the glands by apocryan secretion. The glands of the glands is expanding, the walls are gradually become more folded. The epithelium glands is single, with basal nuclei placed. As a result of intensive secretion, the cells become low, their apical edges are odorly expressed, as if with a tooth. Alkaline phosphatase completely disappears. In the lumen of the glands there is a secret that contains glycogen and acid mucopolysaccharides. On the 23 day, the secretion of the glands ends. The perivascular decidual reaction of the endometrium stroma appears, then the decidual reaction acquires diffuse character, especially in the superficial sections of the compact layer. Connectant cells of the compact layer around the vessels become large, rounded and polygonal shape. Glycogen appears in their cytoplasm. The islands of predocidal cells are formed. A reliable indicator of the average phase of secretion, which indicates a high concentration of progesterone, are changes from the spiral arteries. Spiral artery sharply winding, form "shots", they can be found not only in spongy, but also in the surface sections of the compact layer. Up to 23 days of the menstrual cycle, spiral arteries are pronounced. The insufficient development of "motors" of the spiral arteries in endometrials of the secretory phase is characterized as a manifestation of a weak function of the yellow body and insufficient endometrial preparation for implantation. The structure of the endometrium of the secretory phase, the average stage (22-23 days of the cycle), can be observed with a long and increased hormonal function of the menstrual yellow body - the pecission of the yellow body, and in the early period of pregnancy - during the first days after implantation, in the uterine pregnancy limits of the implantation zone ; With progressive ectopic pregnancy evenly in all parts of the mucous membrane of the uterus body.

Hysteroscopy. In the middle phase of the secretion stage, the hysteroscopic picture of the endometrium is not significantly different from that in the early phase of this stage. Often, the foldometrium folds acquire a polypovoid form. If the distal end of the hysteroscope is tight to the endometrium, you can consider the gonducts.

Late stage of secretion phase. Late stage of the second phase of the menstrual cycle (lasts 3-4 days). In endometrials there are pronounced trophic disorders due to a decrease in the concentration of progesterone. Echographic changes endometrials associated with polymorphic vascular reactions in the form of hyperemia, spasms and thrombosis with the development of hemorrhages, necrosis and other dystrophic changes, there is insignificant inhomogeneity (spottedness) of the mucous membrane due to the appearance of small areas (dark "spots" - vascular disorders), becomes well noticeable The rim of the rejection zone (2-4 mm), and the three-layer structure of the mucous phase characteristic of the proliferative phase is transformed into a homogeneous fabric. There are cases when echonegative zones of endometrial thickness in the pre-destructive period are mistakenly regarded with ultrasound as pathological changes.

Colpocytology. Cells are large, pale-painted, foam basophils, without inclusions in the cytoplasm, the contours of the cells are fuzzy, vague.

Histology endometrial. The folding of the walls of the glands is enhanced, has a dust shape on longitudinal sections, and on transverse - star-like. The nuclei of some epithelial cells of picnotic glands. The style of the functional layer is wrinkled. Precidual cells are brought closer and placed around the spiral vessels diffuse throughout the entire compact layer. Among pre-comid cells are small cells with dark nuclei - endometrial granular cells, which are transformed from connective tissue cells. On 26-27 days of the menstrual cycle in surface sections of the compact layer, there is a lacunar expansion of capillaries in stroma. In the premenstrual period, the spiralization becomes so pronounced that blood circulation slows down and stas and thrombosis occur. During the day, the endometrium state occurs during the start of menstrual bleeding, which shredder called "anatomical menstruation". At this time, it is possible to find not only extended and overflowing blood vessels, but also spasm and thrombosis of them, as well as small bone hemorrhages, edema, leukocyte stromium leukocyte infiltration.

Pesteroscopy.. In the late phase of the stages of secretion, the endometrium acquires a reddish tint. Due to the pronounced thickening and folding of the mucous membrane, the popeshes of the uterine pipes can not be seen. Before the menstruation itself, the view of the endometrium can be mistakenly interpreted as an endometrial pathology (polypovoid hyperplasia). Therefore, the time of hysteroscopy needs to be recorded for the Patomorphologist.

Phase bleeding (desquamation). During menstrual bleeding due to the disruption of the integrity of the endometrium due to its rejection, the presence of blood hemorrhages and blood clots in the uterine cavity, the echographic picture changes over the days of menstruation as the parts of the endometry with menstrual bleeding. At the beginning of menstruation, the rejection zone is still traced, although not completely. Endometrial structure is heterogeneous. Gradually, the distance between the walls of the uterus is reduced and until the end of menstruation they are "closed" among themselves.

Colpocytology. In the smear, foam basophilic cells with large nuclei. A large number of erythrocytes, leukocytes, endometrial cells, histocytes are found.

Histology endometrial (28-29 day). Tissue necrosis develops, autolysis. This process begins with surface layers of endometrial and carries a fire. As a result of the extension of the vessels, which occurs after a long spasm, a significant amount of blood comes into the endometrium fabric. This leads to the breaking of the vessels and detachment of necrotic departments of the functional layer of endometrial.

Morphological features characteristic of the endometrium of the menstrual phase are: the presence of tissue hemorrhages, necrosis, leukocyte infiltration sites, partially saved endometrial plot, as well as spiral arteries.

Hysteroscopy. In the first 2-3 days of menstruation, the uterine cavity filled with a large number of endometrial scraps from pale pink to dark-bugs, especially in the upper third. In the lower and middle third of the oral cavity, the endometrium is thin, pale pink, with fine-point hemorrhages and sections of old hemorrhages. If the menstrual cycle was full, then before the second day of menstruation, almost complete rejection of the uterus mucosa passes, only in its separate sections, small passages of the mucous membrane are determined.

Regeneration (3-4 day cycle). After rejection of the necrotic functional layer, the endometrium regeneration from the tissues of the basal layer is observed. The epithelialization of the wound surface occurs due to the boundary departments of the basal layer glands, from which epithelial cells are impaired into the wound surface and closed the defect. With normal menstrual bleeding in a normal two-phase cycle, the entire wound surface epithelized on the 4th day of the cycle.

Hysteroscopy. During the regeneration stage on the background of pink with the sites of hyperemia of the mucous membrane, small hemorrhages are shouted in separate areas, single sections of the endometrium of the pale pink color can occur. As endometrial regeneration, the hyperemia sections disappear by replacing the color on the pale pink. The corners of the uterus are well visible.

To find out what is the endometrium of proliferative type, it is necessary to understand how the female organism functions. The inner part of the uterus lined with endometrial is experiencing cyclic changes during the entire menstrual period.

Endometrium is the covering of the inner plane of the uterus mucosa layer, abundantly equipped with blood vessels and an employee for the supply of blood.

Appointment and structure of endometrial

On the structure of the endometrium can be divided into two reservoirs: basal and functional.

The peculiarity of the first layer is that it almost does not change and is the basis for the regeneration of the functional layer in the next menstrual period.

It consists of a layer of tightly adjacent one to another cells connecting tissues (stromes) equipped with glands and a large number of branched blood vessels. In normal condition, its thickness varies from one to one and a half centimeters.

Unlike the basal functional layer constantly experiencing changes. This is due to the damage to its integrity as a result of peeling while leakageing blood during the monthly, childbirth, artificial interruption of pregnancy, scraping during diagnostics.

The endometrium is designed to perform several functions, the main of which is to provide the necessary conditions for the offensive and prosperous course of pregnancy, when the size of the glands and blood vessels in the structure of the placenta increases. One of the prescriptions of the kindergarten is the supply of nutrition and oxygen embryo. Another function is to prevent the sticking of the opposite walls of the uterus.

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In the female body, changes occur monthly, during which favorable conditions are created for conception and to wear. The period between them is called a menstrual cycle and lasts from 20 to 30 days. The beginning of the cycle is the first day of menstruation.

Any deviations that have arisen during this period say the presence of any violations in the body of a woman. The cycle is divided into three phases:

• proliferation;
• secretion;
• menstruation.

Proliferation is the process of reproduction of cells by dividing leading to the growth of body tissues. The endometry proliferation is an increase in the tissues of the mucous membrane inside the uterus as a result of the division of normal cells. The phenomenon can flow as part of the menstrual cycle and have a pathological origin.

The duration of the phase of the proliferation is about 2 weeks. Changes occurring in endometrials during this period occur due to an increase in the number of estrogen hormone, which is produced by a ripening follicle. This phase includes three stages: early, middle and late.

For an early stage, which lasts from 5 days to 1 week, it is characteristic of the following: the surface of the endometrium is covered with epithelial cells of the cylindrical species, the gland of the mucous layer resemble straight tubes, in the cross section of the outlines of iron oval or rounded; The epithelium glands is low, cell cores are at their base, have an oval shape and intensive color. Cells connecting fabrics (stroma) spine-like shape with large nuclei. Circuit artery is almost no sortie.

The middle stage coming on the eighth - the tenth day is inherent in the fact that the plane of the mucous membrane is eliminated with high epithelial cells of the prismatic species.

Glands take a slightly convoluted form. The kernels are losing color, increase in size, are at different levels. A large number of cells obtained by indirect division appear. Stroma becomes loose and edema.

For late stage, lasting from 11 to 14 days, it is characteristic that the glands become winding, the kernel of all cells are in different levels. Single-layer epithelium, but with a variety of ranks. Some cells appear small vacuoles that contain glycogen. The vessels become winding. Cells of cells take more rounded shape and are greatly increasing in size. Stroma pillow.

The secretory cycle phase is divided into the stage:

• early, felt from 15 to 18 day cycle;
• middle, with the most pronounced secretion flowing from 20 to 23 days;
• late (fastening secretion), coming from 24 to 27 day.

The menstrual phase consists of two periods:

• deskvamation occurring from 28 to 2 days of the cycle and the coming in the event that no fertilization occurred;
• regeneration, based on 3 to 4 day and starting to complete separation of the endometrial functional layer, but together with the beginning of the growth of the epithelial cells of the proliferation phase.

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The normal structure of the endometry

Using hysteroscopy (inspection of the uterus), it is possible to estimate the structure of the glands, to evaluate the degree of new blood vessels in the endometrium, find out the thickness of the cellular layer. In different phases of the menstrual period, the results of the surveys differ from each other.

Normally, the basal layer has a thickness of 1 to 1.5 cm, but may increase to 2 cm at the end of the proliferation phase. For hormonal effects, his reaction is weak.

During the first week, the inner mucosa surface of the uterine is smooth, painted in light pink color, with small particles of the injustable functional layer of the past cycle.

In the second week there is a thickening of the endometrium of the proliferative type associated with the active division of healthy cells.

It becomes impossible to consider blood vessels. Due to the uneven thickening of the endometrium on the inner walls of the uterus, folds occur. In the proliferation phase, the rear wall and the bottom have the thick mucous membrane, and the front wall and the lower part of the kindergarten is the most subtle. The thickness of the functional layer ranges from five to twelve millimeters.

Normally, the full rejection of the functional layer should be observed almost to the basal. In reality, the full compartment does not occur, only external sections are rejected. If there is no clinical disorders of the menstruation phase, then we are talking about an individual norm.

Pathologist diagnostics of the endometrium status on biopsies / spitters V.A. Topchieva O.I. ; under. ed. prof. OK. Khmelnitsky. - Leningrad.

Diagnosis on biopsies endometrial is often great difficulties due to the fact that the same very similar microscopic picture of the endometrium is due to various reasons (O.I. Topchiyeva 1968). In addition, endometrial fabric is characterized by an exceptional variety of morphological structures, depending on the level of steroid hormones, secret-generable ovaries, and under the pathological conditions associated with the violation of endocrine regulation.

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Pathological diagnostics of the status of endometrials on biopsies: Methodical recommendations / Snidishmen V.A., Topchieva O.I. -.

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Pathoanatomic diagnostics of biopsies endometrial states

Accurate microscopic diagnostics on endometrial scrapings is of great importance for the daily work of the obstetrician-gynecologist. Biopsy (zoops) endometrials make up a significant part of the material sent by obstetric and gynecological hospitals for microscopic examination.

Diagnostics on biopsies of endometrial often represents great difficulties due to the fact that the same very similar microscopic picture of the endometrium is due to various reasons (O. I. Topchiyeva 1968). In addition, endometrial fabric features an exceptional variety of morphological structures, depending on the level of steroid hormones secreted by the ovaries, and in the pathological conditions associated with the violation of endocrine regulation.

Experience shows that the responsible and complex diagnosis of changes in the endometrium in the scrapings turns out to be full only if there is close contact in the work between the pathologist and the gynecologist.

The use of histochemical methods, along with the classical morphological methods of the study, significantly expands the possibilities of pathologist diagnostics and includes such histochemical reactions as a reaction to glycogen, alkaline and acid phosphatases, monoaminoxidase, etc. The use of these reactions allows you to more accurately assess the degree of disruption of the estrogen balance and gestagenists in the body Women, and also makes it possible to determine the degree and nature of the hormone sensitivity of the endometrium in hyperplastic processes and tumors, which is of great importance when choosing methods for the treatment of these diseases.

Methods of obtaining and preparation of material for research

Important for proper microscopic diagnostics on endometrial scrapings has the observance of a number of conditions during the material fence.

The first condition is the correct definition of time that is most favorable for the production of scraping. There are the following testimony for scraping:

• a) during sterility with suspicion of insufficiency of the function of the yellow body or an inhibular cycle - the scrapets takes 2-3 days before menstruation;
• b) with menorage, when slow motion of the endometrium mucosa is suspected; Depending on the duration of bleeding, the scrapets takes 5-10 days after the start of menstruation;
• c) with dysfunctional uterine bleeding type metro angry scraping should be taken immediately after the start of bleeding.

The second condition is technically correct implementation of the scraping of the uterus. The "accuracy" of the response of the pathologist largely depends on how the endometrium scraping is taken. If small, fragmented pieces of fabric come to study, it is extremely difficult or even impossible to restore the endometrium structure. This is eliminable with the right piece of scraping, the purpose of which is to obtain large unrecorded strips of the tissue of the mucous membrane. This is achieved by the fact that after holding a Kyu Retka along the wall of the uterus, it should be taken from the cervical of the canal each time, and the intricate the tedious of the muzzo is carefully folded into the gauze. In the event that the curette is not excreted every time, the mucosa separated from the wall during repeated movements of the cureti is crushed and part of it remains in the uterine cavity.

Full Diagnostic scraping of the uterus is made. After the expansion of the cervical canal is up to 10 numbers of the hegara expander. Usually scraping is carried out separately: first-cervical canal, and then the uterus cavity. The material is placed in a fixing liquid into two separate banks, marked from where it is taken from.

In the presence of bleeding, especially in women in the menopausal period or in menopause, you should scroll through the small curette of the tube angles of the uterus, remembering that it is precisely in these sites that the polynomials of the endometrium can be localized, in which the maligancy areas are most often found.

If, when scraping from the uterus, a large amount of tissue was removed, then it is necessary to send the entire material to the laboratory, and not part of it.

Tsugi. or so-called Rancheyskets They are taken in cases where it is necessary to determine the reaction of the uterus mucous membrane in response to the secretion of hormones with ovaries, to control the results of hormone therapy, when finding out the causes of the sterility of a woman. To obtain TsUGs, use a small curette without prior expansion of the cervical canal. When taking the TsUGA, it is necessary to carry out a curette until the bottom of the uterus, so that in the strip of the bar neighboring. The mucous membrane is up to bottom, that is, the lining all the separations of the uterus. To obtain the correct response of the Histologist on the Cugu, as a rule, it is enough to have 1-2 endometrium strips.

In no case should the TSG methodology should not be used in the presence of uterine bleeding, since in such cases it is necessary to have endometrium to study from the surface of all the walls of the uterus.

Aspiration biopsy - Obtaining pieces of endometrium tissue by suction from the uterine cavity can be recommended for mass prophylactic examinations of women in order to identify prematubic states and endometrial cancer in "increased risk groups". At the same time, the negative results of aspiration biopsy do not allow! With confidence, reject the initial forms of asymptomatic flowing cancer. In this regard, if the uterine cancer is suspected, the most reliable and uniquely shown diagnostic method remains [Full scraping of the uterine cavity (V. A. Mandelstam, 1970).

After the work of biopsy, a doctor sending material for the study must fill accompanying Direction L about the form offered by us.

The direction should indicate:

• a) the duration of the menstrual cycle, characteristic of this woman (21-28, or 31 days, cycle);
• b) the start date of bleeding (in the period of expected menstruation, ahead of time or late). In the presence of menopause or amenorrhea, it is necessary to specify its duration.

These are the value of the following data

• a) the constitutional type of patient (obesity is often accompanied by pathological changes in endometrial),
• b) endocrine disorders (diabetes, changes in the function of the thyroid gland and adrenal cortex),
• c) Did the patient of hormone therapy be subjected to what a hormone and which dosage?
• d) whether methods of hormonal contraception were used, the duration of using contraceptives.

Histological treatment Material 6IOs includes fixation in a 10% neutral solution of formalin, followed by dehydration and pouring into paraffin. You can also use the accelerated method of filling in paraffin on G.A. Merculus with fixation in formalin, heated to 37 ° C in thermostat in For 1-2 hours.

In everyday work, it is possible to limit the painting preparations with hematoxylin-eosin, van-Gizon, Mud Charmina or Alziane Oitam.

For a more subtle diagnosis of the state of the endometrium, especially in solving questions about sterility related to the defective ovarian function, as well as to determine the hormone-sensitivity of the endometrium in hyperplastic processes and tumors, it is necessary to use histochemical methods that allow to identify glycogen, to evaluate the activity of acidic, alkaline phosphatases and A number of other enzymes.

Cryostatic sections The endometrium obtained from non-fixed tissue, frozen at a temperature of liquid nitrogen (-196 °) can be used not only for research using conventional histological methods of color (hematoxylin-eosin, etc.), but also to determine the content of glycogen and the activity of enzymes in morphological structures mucous uterus.

For histological and histochemical studies with biopsy endometrial on cryostatic sections, the pathoanatomy laboratory must be equipped with the following equipment: MK-25 cryostat, liquid nitrogen or carbon dioxide ("dry ice"), Dewar vessels (or household thermos), pH meter, refrigerator on + 4 ° C, thermostat or water bath. To obtain cryostat sections, you can use the method developed by V.A. Polyshnikhnikov with employees (1974).

According to this method, the following stages of the preparation of cryostat sections are distinguished:

1. Endometrial pieces (without pre-washing with water and without fixation) are placed on a strip of filter paper moistened with water, and gently lowered into liquid nitrogen by 3-5 seconds.
2. Filter paper with frozen in nitrogen pieces of endometrial are transferred to the cryostat chamber (-20 ° C) and carefully with a few drops of water are fitted to the microtomes to the system.
3. 10 μm thick cuts obtained in a cryostate are mounted in a cryostat chamber to chilled substantive or covering glasses.
4. Framing of sections is carried out by melting of sections, which is achieved with the touch of the warm finge of the K.Nizhny surface of the glass.
5. Glass with flashes quickly (should not be made to frozen again) removed from the cryostat chamber, dried in air. And fixed in 2%, the glutaraldhyde solution (or vapor form) or in the formaldehyde mixture - alcohol - acetic acid - chloroform ratio in the 2: 6 ratio : 1: 1.
6. Fixed media are stained with hematoxylin-eosin, dehydrated, enlighten and enter into polystyrene or balm. The choice of the level of the studied histological structure of the endometrium is performed on time preparations (non-fixed cryostat sections) painted with toluidine blue or methylene blue and water prisoners. Their manufacturing takes 1-2 minutes.

For histochnotic determination of the content and localization of glycogen dried in air, cryostatic sections are fixed in cooled to + 4 ° C for 5 minutes, dried in air and painted according to the Mac-Manusa (Pier 1962).

To detect hydrolytic enzymes (acid and alkaline phosphatase), cryostat sections are used, fixed in cool to a temperature of + 4 ° C 2%. Neutral formal solution for 20-30 minutes. After fixing, the sections are rinsed in water and immersed in an incubation solution to identify the activity of acidic or alkaline phosphatases. The acid phosphatase is determined by Barkarka and Anderson (1963), and alkaline phosphatase - Berstone (BERSTON, 1965). Before conclusion, sections can be hematoxylin. Store drugs are necessary in the dark.

Changes in endometrials observed throughout the two-phase menstrual cycle

The mucous membrane of the uterus, lining her various sections - the body, and cervical, - has typical and functional features in each of these departments.

The endometrium of the bodies of the uterus consists of two layers: basal, deeper, located directly on the myometry of the I. Fast-functional.

Basal The layer contains a few narrow glands lined with cylindrical single-row epithelium whose cells have oval, intensively staining kernel hematoxylin. The reaction of the tissue of the basal layer on hormonal exposure is poorly and inconsistently.

From the fabric of the basal layer, the functional layer is regenerated after various disorders of its integrity: rejection into the menstrual phase of the cycle, during dysfunctional bleeding, after abortion, childbirth, and also after scraping.

Functional The layer is a cloth with a special, biologically due to high sensitivity to sex steroid hormones-estrogen and gestagenam, under the influence of which its structure and function changes.

The height of the functional layer in half-green women varies depending on the phase of the menstrual cycle: about 1 mm at the beginning of the proliferation phase and up to 8 mm in the secretion phase-at the end of the 3rd cycle week. In this period, a deep, spongy layer is most distinctly denoted in the functional layer, where the glands are closer, and the surface-compact, in which cyto-gene stromas prevails.

The basis of cyclic changes of the morphological picture of the endometrium observed during the menstrual cycle lies the ability of genital steroids-estrogen to cause characteristic changes in the structure and behavior of the tissue of the mucous membrane of the uterus.

So, Estrogen Stimulate the proliferation of glasses of glands and stroma, contribute to regenerative processes, possess the vasodilatory action and increase the permeability of endometrial capillaries.

Progesterone It has an action on endometrium only after the prior effect of estrogen. Under these conditions, gestagens (progesterone) cause: a) secretory changes in glands, b) decidual reaction of stroma cells, c) the development of spiral vessels in the functional layer of endometrial.

The above morphological features were based on the morphological division of the menstrual phase and stage data cycle.

According to modern ideas, the menstrual cycle is divided into:

• 1) Phase proliferation:
  • Early Stage - 5-7 Day
  • Central Stage - 8-10 Day
  • Late stage - 10-14 days
• 2) secretion phase:
  • Early Stage (the first signs of secretory transformations) - 15-18 day
  • Central Stage (the most pronounced secretion) - 19-23 days
  • Late stage (starting regression) - 24-25 days
  • Regress with ischemia - 26-27 days
• 3) Bleeding phase - menstruation:
  • Deskvamation - 28-2 day
  • Regeneration - 3-4 days

In assessing changes occurring in endometrials, respectively, the days of the menstrual cycle, must be considered:

• 1) the duration of the cycle in this woman (28- or 21-day cycle);
• 2) the term of ovulation that occurred, which in normal conditions is observed on average from 13th to the 16th day of the cycle; (Therefore, depending on the time of ovulation, the structure of the endometrial of one or another stage of the secretion phase fluctuates r; limits of 2-3 days).

Phase proliferation lasts 14 days, however, and in physiological conditions it can be elongated or shortened within 3 days. Changes observed in the endometrical phase of proliferation arise as a result of the action of the growing amount of estrogen secreted by the growing and ripening follicle.

The most pronounced morphological changes in the proliferation phase are marked in glands. At an early stage, the glands have a view of a straight or cast of convolve tubes with a narrow lumen, the contours of the glands are rounded or oval. The epithelium glands is a single-row low cylindrical, core oval, are located at the base of the cells are intensively painted with hematoxylin. In the late stage of the gland acquire winding, sometimes corkscrew outlines with a slightly advanced lumen. The epithelium becomes high prismatic, a large number of mitoses are observed. As a result of intensive division and increase the number of core epithelial cells, they are at different levels. For the epithelium cells of the early phase of the proliferation, the absence of glycogen and moderate activity of alkaline phosphatase is characteristic. By the end of the phase of the proliferation in the glands, the appearance of small dust-like glycogen granules and the high activity of alkaline phosphatase is noted.

In the stroma endometrial during the phase of proliferation there is an increase in dividing cells, as well as thin-walled vessels.

The structures of the endometrium corresponding to the proliferation phase observed in physiological conditions in the first half of the two-phase nicla can reflect.Gormonal disorders if they are detected:

• 1) during the second half of the menstrual cycle; This may indicate an annevulatory single-phase cycle or on an abnormal, elongated phase of proliferation with the late ovulation. In a two-phase cycle:
• 2) with iron hypeometrium hyperplasia in various sections of a hyperplasned mucous membrane;
• 3) Three dysfunctional uterine bleeding in women at any age.

The secretion phase, directly associated with the hormonal activity of the menstrual yellow body and the corresponding secretion of progesterone, lasts 14 ± 1 days. The shortening or elongation of the secretion phase is more than two days, in women in the reproductive period, should be considered as a pathological state, since such cycles are sterile.

Throughout the first week, the phase of secretion of the day of ovulation is determined by changes in the epithelium glands, while in the second week this day is most accurate to be determined by the state of the endometrium stroma cells.

So, on the 2nd day after ovulation (16th day of the cycle) in the epithelium glands appear Subnuclear vacuoles. On the 3rd day after ovulation (17th day of the cycle), subnuclear vacuoles push the kernels into the apical cells of the cells, as a result of which the latter are on the same level. On the 4th day after ovulation (18th day of the cycle), the vacuole is partially moving from the basal departments to the apical and the 5th day (19th day of the cycle) almost all vacuoles move to the apical cells of the cells, and nuclei are shifted to the basal Little departments. In the next 6th, 7th and 8th days after ovulation, i.e., on the 20th, 21st and 22nd days of the cycle in the cells of the epithelium glands, the pronounced processes of the apocryne secretion are noted, as a result of which apical " Paradise cells have as if notched, uneven. The absurpenses of the glands during this period are usually expanded, filled with eosinophilic secret, the walls of the glands become folded. On the 9th day after ovulation (23rd day of the menstrual cycle), the secretion of the glands is over.

The use of histochemical methods made it possible to establish that subnuclear vacuoles contain large granules of glycogen, which throughout the early and at the beginning of the average stage of secretion phase is thrown by apocryan secretion into the absurdity of the glands. Along with the glycogen in the lumen of the glands, acidic mucopolysaccharides are also contained. As the glycogen accumulates and the secretion of it in the absurd of the glands, a distinct decrease in the activity of alkaline phosphatase in the epithelium cells, which almost completely disappears to 20-23 day of the cycle.

In stroma Characteristic changes for the secretion phase begin to appear on the 6th, 7th day after ovulation (20th, 21st day of the cycle) in the form of a perivascular decidua-like reaction. This reaction in the cells of the strass of the compact layer is most pronounced and is accompanied by an increase in cell cytoplasm, they acquire polygonal or rounded outlines, glycogen accumulation is observed. The secretion phase characteristic of this stage is also the appearance of spiral vessels, not only in the deep departments of the functional layer, but also in the surface compact layer.

It should be emphasized that the presence of spiral arteries in the endometrium functional layer is one of the most reliable signs that determine the full gestagne effect.

On the contrary, subnuclear vacuolaization in the epitheliums of the glands is not always a sign indicating that the ovulation has occurred and the secretion of progesterone in the yellow body.

Subnuclear vacuoles can sometimes be detected in the glands of mixing of the hypoplastic endometrial at D.Is-functional uterine bleeding in women of any age, including the period of menopause (O. I. Topchieva, 1962). However, in endometrial, where the occurrence of vacuoles is not criticized with ovulation, they are contained in separate glands or in the gland group is usually only in the cells. Vacuol themselves have a different value, most often they are small.

In the late stage of the secretion phase, from the 10th day after Ov-Lyashiya, i.e., on the 24th day of the cycle, in whey, with the start of the yellow body regression and a decrease in the level of progesterone in the blood in the endometrium, morphological signs of regression are observed, and on 26 And on the 27th day they join signs of ischemia. As a result of wrinkling, the stroma of the functional layer of the gland acquire star-shaped outlines on transverse sections and saws on longitudinal.

In the phase of bleeding (menstruation) in endometrials, desquamation and regeneration processes occur. The morphological feature characteristic of the endometrial of the menstrual phase is the presence, in the penetrated hemorrhages, the disintegrating tissue of the sleeved glands or their fragments, as well as the trangles of the spiral arteries. Full rejection of the functional layer usually ends on the 3rd day of the cycle.

The endometrial regeneration occurs due to the proliferation of the cells of the basal departments of the glands and ends for 24-48 hours.

Changes endometrial in disruption of the endocrine function of the ovaries

From the point of view of etiology, pathogenesis, as well as taking into account the clinical symptoms, morphological changes in endometrials arising from violation of the endocrine function of the ovaries can be divided into three groups:

1. Changes endometrial in violation of secretion Estrogenic hormones.
2. Changes in endometrials in violation of secretion progestive hormones.
3. Changes in the mixed type endometrial, in which structures reflecting the impact of estrogen and progestative hormones are simultaneously found.

Regardless of the nature of the violations of the endocrine function of the ovaries listed above, the most common symptoms with which clinicians and morphologists are found are Uterine bleeding and amenorrhea.

A special place in its extremely important clinical meaning is occupied by uterine bleeding in women in menopause Since among a variety of reasons that binding such bleeding, about 30% are malignant endometrial neoplasms (V.A. Madelshtam 1971).

1. Changes in endometrial in violation of the secretion of estrogenic hormones

Violation of the secretion of estrogenic. Normonov manifests itself in two basic forms:

a) in the insufficient number of estrogen and the formation of non-functioning (resting) endometrial.

In physiological conditions, the restochy endometrium briefly exists during menstrual cycles-after the regeneration of the mucous membrane before the start of proliferation. Non-functioning endometrium. Also also in women of elderly, when the hormonal function of the ovaries is eased and is the stage of transition to atrophic endometrium. Morphological signs of non-functioning endometrials - glands have the kind of straight or slightly convoluted tubes. Epithelium is low, cylindrical, basophilina cytoplasm, elongated kernels, occupy most of the cell. Mitoses are absent or found extremely rare. Stromrom is rich in cells. When proteinating these changes, the endometrium from the non-functioning turns into atrophic with small glands lined with cubic epithelium.

b) in the long secretion of estrogen from persistent follicles, accompanied by anoint monophasic cycles. The elongated single-phase cycles arising from the long-term persistence of the follicle lead to the development of the dormriconal proliferation of endometrial type Ironistical or iron phones hyperplasia.

As a rule, endometriums under the vocal proliferation is thickened, its height reaches 1-1.5 cm or more. Microscopically lacks the separation of endometrial on the compact layers and spongy, there is also no correctness of the distribution of the glands in the stroma; Characters of cyutally applied glands. The amount of glands (more precisely ferrused tubes) does not increase (as opposed to atypical iron hyperplasia - adenomatosis). But due to the enhanced proliferation of the gland, they acquire an argument form and on a cut, passing through separate turns of one and that. More than a glandular tubule, the impression of a large amount of glands is created.

The structure of the iron hyperplasia of the endometrium, which does not contain a car-shaped extended glands, is called ". Excellent hyperplasia".

Depending on the severity of proliferative processes, the ferrous hyperplasia of the endometrium is divided into "active" and "rest" (which correspond to the states of "acute" and "chronic" estrogen). For the active form, a large number of mitoses are characterized in both the cells of the epithelium gland and in the cells of stroma, the high activity of alkaline phosphatase and the appearance of the clusters of "bright" cells in the glands. All these signs indicate intensive estrogen. The stimulation ("acute estrogen").

The "resting" form of iron hyperplasia corresponding to the state of "chronic estreaction" occurs in conditions of long-term exposure to the low level of estrogenic hormones. Under these conditions, the endometrium fabric acquires the similarity of the similarity of S.-binding, non-functioning endometrial: the epithelium cores are intensely painted, basophilic cytoplasm, mitoses are very rare or not found at all. The "resting" shape of the hardware hyperplasia is most often observed in the menopacteric period - when the ovarian function is fired.

It should be remembered that the occurrence of iron hyperplasia-especially its active form-in women after many years. After the occurrence of menopause, with a tendency to relapses, should be regarded as an unfavorable factor in relation to the possible occurrence of endometrial cancer.

It is also necessary to be borne in mind that the discharmal. The endometrium proliferation may occur in the presence of cilioepithelial and pseudomocyne cysts of the ovary, both malignant and benign, as well as in some other ovary neoplasms, for example, with a Brenner tumor (M. F. Glazunov 1961).

2. Changes to endometrial in violation of the secretion of gestagens

The violation of the secretion of the hormones of the menstrual yellow body appears both. In the form of the insufficient secretion of progesterone, and when it is enhanced and long secretion (the persistence of the yellow body).

Hypolyteine \u200b\u200bcycles in the insufficiency of the yellow body in 25% of cases are shortened; Ovulation usually occurs in a timely manner, but the secretory phase can be shortened to 8 days. The menstruation is associated with the premature death of an inferior yellow body and stopping the secretion of protesterone.

Histological changes in endometrials in hypolyteinic cycles are inenenial and insufficient secretory transformation of the mucous membrane. Thus, for example, unless before the onset of menstruation, Yaa 4th week of the cycle, along with glands, peculiar to the late stage of the secretion phase, there are glands, sharply lagging in their secretory function and corresponding only to the beginning phasesecretion.

Pre-comdonal transformations of connective tissue cells are being expressed extremely weakly or absent at all, spiral vessels are underdeveloped.

Persistence of a yellow body may be accompanied by a full secretion of progesterone. And the elongation of the phase of secretion. In addition, there are cases with reduced progesterone secretion with a coarse yellow body.

In the first case, changes arising in endometrials were named Ultranchanstrual hypertrophy and have similarities with structures observed during the pregnancy of the early term. The mucule is thickened to 1 cm, the secretion is intense, there is a pronounced decidua-like transformation of the stroma and the development of spiral arteries. Differential diagnosis with disturbed pregnancy (in women of reproductive age) is extremely difficult. The possibility of the occurrence of such changes and endometrials of women of the menopausal period (which pregnancy can be excluded).

In the case of a decrease in the hormonal function of the yellow body, when it is subjected to incomplete gradual regression, the process of rejection of the endometrium slows down and is accompanied by an elongation phase bleeding in the form of menorahia.

The microscopic pattern of the endometrium scrapings obtained during such bleeding after the 5th day, it seems very motley: the sections of necrotic tissue are found in the scraping, sections in the state of reverse development, secretory and proliferative endometrium. Such changes in endometrials can be detected in women with acyclic dysfunctional mortgage bleeding in the menopausal period.

Sometimes the effect of low concentrations of progesterone leads to a slowdown in its rejection, involution, i.e., the reverse development of deep departments of the functional layer. This process creates conditions for returning the endometrium to the initial structure, which was before the start of cyclic changes and occurs three amenorrhea, due to the so-called "hidden cycles" or hidden menstruation (E. I. Kvater 1961).

3. Endometrium "Mixed Type"

Endometrium is called mixed if it contains structures in its fabric, simultaneously reflecting the impact of estrogen and gestagenic hormones.

Two forms of mixed endometrials are distinguished: a) mixed hypoplastic, b) mixed hyperplastic.

The structure of mixed hypoplastic endometrial represents a motley picture: the functional layer is poorly developed and is represented by the iron of an indifferent type, and the tact of sections with secretory changes, mitoses are extremely rare.

Such endometries occurs in women of reproductive age with the pituitary glands, in women in a menopausal period with dysfunctional uterine bleeding, during bleeding in menopause.

An endometrial gland hyperplasia with pronounced signs of the effects of gestage hormones can be attributed to the hyperplastic mixed endometry. If among the tissues of the iron hyperplasia of the endometrium along with typical glands reflecting the estrogen effect, there are areas with groups of ammond glands, in which secretory signs, then such an endometrial structure is called a mixed form of iron hyperplasia. Along with the secretory changes in the glands, there are also changes in the stroma, namely: focal deciduous conversion of connective tissue cells and the formation of spiral vessels.

Preiodine and Endometrial Cancer

Despite the greater inconsistency of data on the possibility of endometrial cancer against the background of iron hyperplasia, most of the authors believe that the possibility of direct transition of iron hyperplasia in endometrial cancer is unlikely (A. I. Silver 1968; J. V. Bokhmai 1972), but unlike the usual (Typical) Endometrium Hyperplasia Atypical Form (adenomatosis) is considered by many researchers as a presets (A. I. Silver 1968, L. A. Novikova 1971, etc.).

Adenomatosis is a pathological proliferation of endometrial, in which traits characteristic of hormone hyperplasia are lost and atypical structures that have similarities with malignant growths appear. Adenomatosis is separated by the prevalence of diffuse and focal, and according to the severity of proliferative processes - on the unaware and pronounced forms (B.I. Iron, 1972).

Despite the significant variety of morphological signs of adenomatosis, most of the forms found in the practice of the pathologist has a number of characteristic morphological signs.

The glands are very convulsions, often have. Meal branches with numerous papillary protrusions in the lumen. Sevements of the gland are closely located near each other, almost not separated by the connective tissue. Epithelial cells have large or oval, elongated, pale painted kernels with signs of polymorphism. The structures corresponding to the endometrial adenomatosis can be detected by a large length or limited areas against the background of the endometrium glandular hyperplasia. Sometimes in the glands are detected by the nest of the arranged groups of light cells having a morphological similarity with a flat epithelium - adenosacanthosis. The foci of pseudo-globular structures are sharply excluded from the cylindrical epithelium of glands and connective tissue stroma cells. Such foci can occur not only with adenomatosis, but also at the endometrium adenocarcinoma (adenocantoma). In some rare adenomatosis forms in the epithelium of the glands, a large number of "bright" cells (fixed epithelium) is accumulated.

Significant difficulties arise from a morphologist when trying to conduct differential diagnosis between prolonged proliferative forms of adenomatosis and highly differentiated embodiments of endometrial cancer. For pronounced adenomatosis forms, an intensive proliferation and an atipatism of ferrous epithelium is characterized in the form of an increase in cell size and nuclei, which allowed Hertigu et al. (1949) Name such forms of adenomatosis of the "zero stage" of endometrial cancer.

However, due to the lack of clear morphological criteria for this form of endometrial cancer (unlike the similar shape of the cervical cancer), the use of this term in the diagnosis of endometrial scrapings is not justified (E. Novak 1974, B. I. Zheleznov 1973).

Endometrial cancer

Most of the existing classifications of epithelial malignant endometrial tumors are based on the principle of the severity of the tumor differentiation (M.F. Glazunov, 1947; P.V. Simpovsky and O.K. Khmelnitsky, 1963; E.N. Petrovsky, 1964; N. Karavsky , 1969).

The same principle is based on the first international classification of endometrial cancer developed by the World Health Organization Expert Group (Polesen and Taylor, 1975).

According to this classification, the following morphological forms of endometrial cancer are distinguished:

• a) adenocarcinoma (highly moderate and low-differentiated forms).
• b) lateral (mesonephroid) adenocarcinoma.
• c) flat-cell carcass.
• d) iron-flat flower cell (mucoepidermoid) cancer.
• e) undifferentiated cancer.

It must be emphasized that more than 80% of the malignant epithelial tumors of the endometrium are adenocarcinoma of varying degrees of differentiation.

A distinctive feature of tumors with histological structures of highly differentiated endometrial cancers is that the glandular tumor structures, although they have signs of atypics, nevertheless resemble the usual endometrial epithelium. The ferret of the epithelium endometrium with papillary growth is surrounded by scarce layers of connective tissue with a minor amount of vessels. The glands are highlighted with high and low-prismatic epithelium with a weakly pronounced polymorphism and relatively rare mitosis.

As the differentiation decreases, ferrous cancers lose signs characteristic of endometrial epithelium, the ferrous structures of alveolar, tubular or papillary structure, which do not differ in their structure from ferrous cancers of other localization begin to prevail.

According to histochemical features, highly differentiated ferrous cancers resemble the endometrium epithelium, since it contains glycogen in a significant percentage and give a reaction to alkaline phosphatase. In addition, the indicated forms of endometrial cancer have high sensitivity to hormone therapy with synthetic gestagenis preparations (17-oxyprogesterone Kapronoate), under the action of which secretory changes are developing in tumor cells, glycogen is accumulated, alkaline phosphatase activity is reduced (V. A. Sanishnikov, Ya. V. Bochman, O. F. Che-Peak 1976). Significantly less than the similar differentiation effect of gestagenov develops in cells of moderately-effect-rented endometrial cancers.

Changes in endometrials when prescribing hormonal drugs

Currently, estrogen and gestagenov preparations for the treatment of dysfunctional uterine bleeding are widely used in gynecological practice for the treatment of dysfunctional uterine bleeding, as well as contraceptives.

Using various combinations of estrogen and gestagens can be artificially obtained in human endometrial morphological changes inherent in the phase of the menstrual cycle with normally functioning ovaries. The principles underlying the hormone therapy of dysfunctional uterine bleeding and amenorrhea are based on common laws, characteristic of estrogen and gestagenis on normal human endometrials.

The introduction of estrogen leads, depending on the duration and dose, to the development of proliferative processes in the endometrium, up to the iron hyperplasia. With prolonged use of estrogen on the background of proliferation, abundant acyclic uterine bleeding may occur.

The introduction of progesterone in the proliferative phase of the cycle leads to the braking of the proliferation of the epithelium glands and suppresses ovulation. The effect of progesterone to the proliferating endometrium depends on the duration of the introduction of the hormone and manifests itself in the form of the following morphological changes:

• - Stage of "Stopped Proliferation" in the glands;
• - atrophic changes in glands with decidu-like transformation of stroma cells;
• - Atrophic changes in the epithelium glands and stroma.

With the joint introduction of estrogen and gestagens, changes in endometrial depend on the quantitative ratio of hormones, as well as the duration of their administration. Thus, for the endometrium proceeding, the daily dose of progesterone, causing secretory changes in glands in the form of accumulation of glycogen granules, is 30 mg. In the presence of a pronounced iron hypertension hyperplasia to achieve a similar effect, it is necessary to introduce 400 mg.Progesterone daily (Dallenbach-Helvig, 1969).

For the morphologist and clinician-gynecologist, it is important to know that the selection of dosages of estrogen and gestagennes in the treatment of disorders of the menstrual cycle and the pathological states of the endometrium should be carried out under histological control, by the fence of repeated endometrial tsugs.

When using combined hormone contraceptives in the normal endometrium, women occur regular morphological changes, depending first of all from the duration of the use of the drug.

First of all, there is a shortening of the proliferative phase with the development of defective glands, in which abortive secretion is developing. These changes are related to the fact that when receiving these drugs, the gestagens contained in them inhibit the processes of proliferation in glands, as a result of which the latter do not reach their full development, as is the case at a normal cycle. Secretor changes developing in such glands have an abortive unexpected character,

Another typical feature of changes in endometrials in the reception of hormonal contraceptives is a sharply pronounced foci, the distruting of the morphological picture of the endometrium, namely: the existence of various but degrees of maturity of glands and stroma, not corresponding to the day of the cycle. These patterns are characteristic of both proliferative and secretory phases of the cycle.

Thus, when receiving combined hormonal contraceptives in the endometrium of women, pronounced deviations from the morphological picture of the endometrium of the corresponding phases of the normal cycle occur. However, as a rule, after the abolition of drugs, the gradual and complete restoration of the morphological structure of the mucous membrane is observed (the exception is only cases when the drugs were taken very long - 10-15 years).

Changes in endometrials arising during pregnancy and its interruption

With the occurrence of pregnancy, the implantation of a fertilized egg - blastocysts occurs on the 7th day after ovulation, i.e. on the 20th - the 22nd day of the menstrual cycle. At this time, the overdometrium strassment reaction is still very weak. The most rapid formation of decidual tissue occurs in the implantation zone blastocysts. As for the endometrium changes outside the implantation, the decidual tissue becomes distinctly expressed only from the 16th day after ovulation and fertilization, i.e., when menstruation has already been delayed for 3-4 days. This is observed in endometrials equally both during pregnancy uterine and ectopic.

In the decidual shell, the cutting wall of the uterus in all its length, with the exception of the blastocyst implantation zone, distinguish the compact layer and spongy layer.

In the compact layer of deciduals of the fabric in the early pregnancy, there are two types of cells: large, bubble-shaped with a pale-colored core and smaller cells of oval or polygonal shape with a darker core. Large decidual cells are the final form of the development of small cells.

The spongiosis layer differs from the compact extremely strong development of glands, which closely add to each other and form a fabric, the general view of which can have some similarity with the adenoma.

With histological diagnosis on scraps and tissues that highlighted spontaneously from the uterine cavity, it is necessary to distinguish between the cells of the trophoblast from decidual cells, especially when the question is about the differential diagnosis between the uterine and ectopic pregnancy.

Cells trophoblast The components of the reservoir, polymorphic with the predominance of small polygonal. There are no vessels, fibrous structures, leukocytes in the reservoir. If there are single major syntial formations among the cells that make up the reservoir, it immediately decides the question of belonging to his trophoblast.

Cells Decidual Fabrics also have different sizes, but they are larger, oval. Homogenic cytoplasm, pale; Bubble cores. In the reservoir of decolation fabrics contain vessels and leukocytes.

With a pregnancy impairment, the formed cloth decidual O. Babes is necrotic and is usually completely discouraged. If pregnancy is violated in early terms, when the decidual fabric is even finally undeveloped, it is subjected to reverse development. An undoubted sign that the endometrium fabric was subjected to reverse development after pregnancy disturbed in early terms, the presence in the functional layer of clubs of spiral arteries. A characteristic, but not an absolute sign is also the presence of the arya-stella phenomenon (the appearance of cells with a very large hyperchromic kernel).

With a violation of pregnancy, one of the most important issues on which the morphologist has to be answered is the question of uterine or ectopic pregnancy. The absolute signs of the uterine pregnancy are the presence of a chorion vault, decidual fabric with invasion of chorial epithelium, the deposition of fibrinoid in the form of foci and heavyness in the decidual tissue and in the walls of venous vessels.

In cases where a decidual fabric is detected in the scraping without chorion elements, it is possible in the uterine and at ectopic pregnancy. In this regard, both a morphologist and a clinician doctor should be remembered that if the scraping was made not earlier than 50 days after the former last menstruation, when the area of \u200b\u200bthe arrangement of the fetal egg is large enough, then in the uterine form of pregnancy, the chorion naval is detected almost always. The absence of them gives reason to assume an ectopic pregnancy.

With an earlier period of pregnancy, the absence in the scrap elements of Chorion does not always indicate an ectopic pregnancy, since it is impossible to exclude unnoticed spontaneous miscarriage: during bleeding, a small flicer egg could be entirely standing out before scraping.

All-Union Scientific and Methodical Center for the Pathology Manufacture of Human Morphology Institute of AMN USSR
Leningrad State Order of Lenin Institute of Improvement of Doctors. CM. Kirov
I Leningrad Orders of the Labor Red Banner Medical Institute. I. P. Pavlova

Editor - Professor O. K. Khmelnitsky

Turn

Endometrium is an outer mucosa layer lining the uterus. It is completely hormone-dependent, and it is he who is subjected to the greatest changes during the menstrual cycle, it is its cells that are rejected and come out with the discharge during menstruation. All these processes go in accordance with certain phases, and deviations in the passage or duration of these phases can be considered pathology. Proliferative endometrium is a conclusion that can often be seen in the Uzi description is an endometrium in the proliferative phase. The fact that this phase is what stages is and what is characterized, told in this material.

Definition

What it is? The proliferative phase is the stage of active division of cells of any tissue (in this case, its activity does not exceed normal, that is, it is not pathological). As a result of this process, the tissue is restored, regenerated, expand. During division, normal, neatatic cells appear, from which a healthy tissue is formed, in this case, endometrium.

But in the case of the endometrium, this is the process of active increasing mucous membrane, its thickening. Such a process can be caused by both natural reasons (phase of the menstrual cycle) and pathological.

It is worth noting that proliferation is a term applicable not only to endometrial, but also to some other tissues in the body.

The reasons

The endometrium of the proliferative type, often appears because the many cells of the functional (updating) part of the endometrium rejected during the menstruation. As a result, he threaded significantly. The features of the cycle are such that for the onset of the following menstruation, this mucous layer must restore its thickness of the functional layer, otherwise it will be updated. This is what happens in the proliferative stage.

In some cases, such a process may be caused by pathological changes. In particular, endometrial hyperplasia (a disease capable of, without appropriate treatment, lead to infertility) is also characterized by reinforced cell division leading to the thickening of the endometrial functional layer.

Phase proliferation

Endometrial proliferation is a normal process that occurs with the passage of several stages. These stages are always present in the norm, the absence or violation of the flow of some of these stages speaks of the beginning of the development of the pathological process. Phases of proliferation (early, medium and late) differ depending on the rate of cell division, the nature of the growth of tissues, etc.

Total process lasts about 14 days. During this time, follicles begin to ripen, they produce estrogen, and it is under the action of this hormone and growing.

Early

This stage proceeds from the fifth to the seventh day of the menstrual cycle. The mucosa has the following signs on it:

1. On the surface of the layer there are epithelial cells;
2. The glands are elongated, straight, in cross section oval or round;
3. Irony epithelium is low, and the kernel of intense color, and are at the base of the cells;
4. Stroma cells have the form of spindle;
5. Circuit artery is not a sortie at all or sorties minimally.

The early stage ends 5-7 days after the end of menstruation.

Average

This is a short stage that lasts about two days in the interval from the eighth to the tenth day of the cycle. At this stage, the endometrium undergoes further changes. It acquires the following features and characteristics:

• Epithelial cells with which the outer layer of endometrial is enjoyed have a prismatic look, they are high;
• The glands become slightly more convicted compared to the previous stage, their kernels are less brightly painted, they become more sustainable trends to any arrangement there are no - they are all at different levels;
• Stroma becomes edema and loose.

The endometrium of the average phase of secretion is characterized by the appearance of a certain number of cells formed by the method of indirect division.

Late

The endometrium of the late stage of proliferation is characterized by convulsive glands, the kernel of all cells of which are located at different levels. Epithelium has one layer and many rows. In a number of epithelium cells, vacuoles with glycogen appear. The vessels are also convinced, the state of the stroma is the same as in the previous stage. Cells of cells round, large size. There is such a stage from the eleventh to the fourteenth day of the cycle.

Phase secretion

The secretion phase occurs almost immediately after proliferation (or after 1 day) and is inextricably connected with it. It also distinguishes a number of stages - early, medium and late. They are characterized by a number of typical changes that are prepared by endometrium and the body as a whole to the menstrual phase. Endometrium secretory type is dense, smooth, and, this applies to both basal and functional layers.

Early

This stage lasts from about the fifteenth to the eighteenth day of the cycle. It is characterized by a weak severity of secretion. At this stage, it just begins to develop.

Average

At this stage, secretion proceeds as actively as possible, especially in the middle of the phase. A small fading of secretory function is observed only at the very end of this stage. She lasts with twentieth to twenty-third day

Late

For the late stage of the secretion phase, a gradual extinction of a secretory function is characteristic, with complete consequence to not at the very end of this stage, after which the woman starts periods. This process lasts 2-3 days in the period from twenty-fourth to twenty-eighth day. It is worth noting the peculiarity characteristic of all stages - they last 2-3 days, while the exact duration depends on how many days in the menstrual cycle of a particular patient.

Proliferative diseases

Endometrium in the proliferation phase is very actively growing, its cells are divided under the action of various hormones. Potentially this condition is dangerous by the development of various kinds of diseases associated with the pathological division of cells - neoplasms, tissue growths, etc. The development of pathologies of this type can cause some faults in the process of passing stages. At the same time, the secretory endometrium of such a danger is almost completely impossible.

The most typical disease that develops as a result of the violation of the phase of the proliferation of the mucous membrane is hyperplasia. This is the state of pathological growth of endometrial. The disease is quite serious and requires timely treatment, as it causes severe symptoms (bleeding, pain) and can lead to full or partial infertility. The percentage of cases of rebirth into the oncology, however, very low.

Hyperplasia occurs in violations in the hormonal regulation of the division process. As a result, the cells are divided longer and more actively. The mucous layer is much thickened.

Why is the braking of proliferation processes?

The inhibition of endometrial proliferation processes is a process, also known as the insufficiency of the second phase of the menstrual cycle, characterized by the fact that the proliferation process is not actively or does not go well. This is a symptom of Klimaks, extinction of the ovarian function and the absence of ovulation.

The process is natural and helps to predict the onset of climax. But maybe it is pathological, if it develops in a woman of reproductive age, it speaks of a hormonal imbalance that needs to be eliminated, as it can lead to dysmanifier and infertility.

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Changes in hormonal background (the content in the blood of estrogen and progesterone in different days of the ovarian cycle directly affect the state of the endometrium, mucous membrane of the uterine pipe, cervical canal and vagina. The uterus mucous membrane is subjected to cyclic changes (menstrual cycle). In each cycle, the endometrium passes menstrual, proliferative and the secretory phases. In endometrials differ functional (disappearing during menstruation) and basal (persistent menstruation) layers.

Proliferative phase

Proliferative (follicular) phase - the first half of the cycle - lasts from the first day of menstruation until ovulation; At this time, the influence of estrogen (mainly estradiol) occur proliferation of the base layer cells and the restoration of the functional endometrial layer. The duration of the phase can vary. Basal body temperature is normal. The epithelial cells of the grooves of the basal layer migrate to the surface, proliferate and form a new epithelial endometrium lunch. In endometrials also occur the formation of new uterine glands and the rotation of the spiral arteries from the basal layer.

Secretor phase

Secretor (Luteinova) Phase - the second half - continues from ovulation before menstruation starts (12-16 days). The high level of progesterone secreted by the yellow bodies creates favorable conditions for the implantation of the embryo. Basal body temperature above 37 ° C.

Epithelial cells cease division, hypertrophy. The uterine glands are expanding, become more extensive. Breeding cells begin to secrete glycogen, glycoproteins, lipids, mucin. The secret rises to the mouth of the uterine glasses and stands out in the absurd of the uterus. Spiral artery acquire a more convoluted character, approach the surface of the mucous membrane. In the surface parts of the functional layer, the number of connective tissue cells increases, in the cytoplasm of which glycogen and lipids accumulate. Collagen and reticular fibers are formed around the cells. Stromic cells acquire the features of the decidual cells of the placenta. Due to such changes, the endometrium, in the functional layer there are two zones: compact - addressed to the clearance, and deeper - spongy. If implantation did not occur, the decrease in the content of steroid hormones of the ovary leads to twisting, sclerosis and decrease in the lumen of the spiral arteries supplying the upper two-thirds of the functional layer of the endometrium. As a result, the blood flow in the functional layer of the endometrium is deteriorating - ischemia, which leads to the rejection of the functional layer and genital bleeding.

Menstrual phase

Menstrual phase - rejection of the functional layer of endometrial. With a cycle duration 28 days, menstruation continues 5 + 2 days.

U.BEK

"Phases of the menstrual cycle" article from the section