The significance of the immunohistochemical method in diagnosing atypical endometrial polyps as manifestations of localized hyperplasia

O.V. Poslavska; D.A. Khaskhachykh; I.S. Shponka; V.O.  Potapov

doi:10.26641/2307-0404.2024.4.319330

Authors

O.V. Poslavska Dnipro State Medical University, Volodymyra Vernadskoho str., 9, Dnipro, 49044, Ukraine https://orcid.org/0000-0002-3133-8413
D.A. Khaskhachykh Dnipro State Medical University, Volodymyra Vernadskoho str., 9, Dnipro, 49044, Ukraine https://orcid.org/0000-0001-5097-6667
I.S. Shponka https://orcid.org/0000-0002-7561-6489
V.O. Potapov Dnipro State Medical University, Volodymyra Vernadskoho str., 9, Dnipro, 49044, Ukraine https://orcid.org/0000-0001-7498-7416

DOI:

https://doi.org/10.26641/2307-0404.2024.4.319330

Keywords:

endometrial polyps, endometrial hyperplasia,, endometrial neoplasms, benign tumors, malignant transformation, diagnostics, immunohistochemistry

Abstract

The article explores the role of immunohistochemical methods in diagnosing atypical endometrial polyps as manifestations of localized hyperplasia. Endometrial polyps are a widespread pathology among women of reproductive age, frequently accompanied by hyperplastic tissue changes. The aim of the work was to investigate the expression of diagnostic markers in endometrial polyps, which may be manifestations of local endometrial hyperplasia, with the aim of improving differential diagnosis in their atypia.. The research material consisted of histological samples from 37 patients aged 38 to 52 with abnormal uterine bleeding, treated at a clinical hospital in Dnipro. The methods included histological tissue analysis, immunohistochemical studies using a panel of antibodies, and statistical data analysis. Antibodies targeting markers such as ER, PR, PAX-2, PAX-8, PTEN, Ki-67, p16, and p53 were used to evaluate proliferative activity and the degree of tissue atypia. The results showed that polyps associated with atypical hyperplasia are characterized by complex morphological changes, including abnormal glandular architecture, stromal atypia, and increased mitotic activity in both glandular and stromal components. Epithelial differentiation of tubal, mucinous, or mixed types was frequently observed. More than half of the cases exhibited partial atypical changes, while diffuse atypia was noted in fewer instances. The control group of glandular-fibrous polyps with hyperplasia without atypia demonstrated low mitotic activity and no cellular atypia. Immunohistochemical studies confirmed the high sensitivity of markers in identifying pathological changes, particularly in diagnostically challenging cases. The conclusions emphasize that immunohistochemistry is an effective tool for detecting endometrial atypia, and the diagnosis of atypical polyps should be based on a comprehensive analysis of morphological and molecular changes. Polyps associated with hyperplasia and atypia require further observation due to the risk of recurrence and potential malignant transformation. Utilizing markers such as PAX-2, PTEN, and Ki-67 enhances diagnostic accuracy. Additional studies are needed to develop more reliable risk stratification models.

References

Dreisler E, Kjer JJ. Management of endometrial hyperplasia and polyps. Maturitas. 2019;124:64-7. doi: https://doi.org/10.1016/j.maturitas.2019.04.036

NijkangNP, Anderson L, Markham R, Manconi F. Endometrial polyps: Pathogenesis, sequelae and treatment. SAGE Open Med. 2019;7:2050312119848247. doi: https://doi.org/10.1177/2050312119848247

Vitale SG, Haimovich S, Laganà AS, Alonso L, Di Spiezio Sardo A, Carugno J. Endometrial polyps. An evi-dence-based diagnosis and management guide. Eur J Obstet Gynecol Reprod Biol. 2021;260:70-7. doi: https://doi.org/10.1016/j.ejogrb.2021.03.017

Khaskhachikh DA, Potapov VO, Poslavska OV. [Immunohistochemical characteristics of endometrium hyperplasia in comparison with secretory endometrium]. Morphologia. 2023;17(2):66-74. Ukrainian. doi: https://doi.org/10.26641/1997-9665.2023.2.66-74

Chapel DB, Howitt BE, Sholl LM, Dal Cin P, Nucci MR. Atypical uterine polyps show morphologic and molecular overlap with mullerian adenosarcoma but follow a benign clinical course. Mod Pathol. 2022;35(1):106-16. doi: https://doi.org/10.1038/s41379-021-00946-z

Yang JH, Yang PK, Chen MJ, Chen SU, Yang YS. Management of endometrial polyps incidentally diagnosed during IVF: a case-control study. Reprod Biomed Online. 2017;34(3):285-90. doi: https://doi.org/10.1016/j.rbmo.2016.12.012

Venturella R, Miele G, Cefalì K, Lico D, D'Ales-sandro P, Arduino B, et al. Subcutaneous Progesterone for Endometrial Polyps in Premenopausal Women: A Preli-minary Retrospective Analysis. J Minim Invasive Gynecol. 2019;26(1):143-7. doi: https://doi.org/10.1016/j.jmig.2018.04.023

Cetin F, Kayar İ, Birge Ö, Goc G. Malignancy risk factors based on endometrial polyp. BMC Womens Health. 2024;24(1):567.

doi: https://doi.org/10.1186/s12905-024-03406-3

Shen Y, Feng W, Yang J, Yi J. Effect of Hystero-scopic Polypectomy Combined with Mirena Placement on Postoperative Adverse Reactions and Recurrence Rate of Endometrial Polyps: Based on a Large-Sample, Single-Center, Retrospective Cohort Study. Biomed Res Int. 2022;2022:1232495. doi: https://doi.org/10.1155/2022/1232495

Xu J, Rao X, Lu W, Xie X, Wang X, Li X. Nonin-vasive Predictor for Premalignant and Cancerous Lesions in Endometrial Polyps Diagnosed by Ultrasound. Front Oncol. 2022;11:812033. doi: https://doi.org/10.3389/fonc.2021.812033

Chou AJ, Bing RS, Ding DC. Endometrial Atypical Hyperplasia and Risk of Endometrial Cancer. Diagnostics. 2024;14(22):2471. doi: https://doi.org/10.3390/diagnostics14222471

Vareniuk IM, Dzerzhynskyi ME. [Methods of cytohistological diagnosis: study guide]. Kyiv; 2019. Ukrainian.

Nguyen T. Immunohistochemistry: A Technical Guide to Current Practices. Cambridge: Cambridge University Press; 2022.

Lucas E, Niu S, Aguilar M, Molberg K, Carrick K, Rivera-Colon G, et al. Utility of a PAX2, PTEN, and β-ca-tenin Panel in the Diagnosis of Atypical Hyperpla-sia/Endometrioid Intraepithelial Neoplasia in Endometrial Polyps. Am J Surg Pathol. 2023;47(9):1019-26. doi: https://doi.org/10.1097/PAS.0000000000002076

Patrizi L, Ticconi C, Borelli B, Finocchiaro S, Chiaramonte C, Sesti F, et al. Clinical significance of endometrial abnormalities: an observational study on 1020 women undergoing hysteroscopic surgery. BMC Womens Health. 2022;22(1):106. doi: https://doi.org/10.1186/s12905-022-01682-5

Lu L, Luo J, Deng J, Huang C, Li C. Polycystic ovary syndrome is associated with a higher risk of prema-lignant and malignant endometrial polyps in premeno-pausal women: a retrospective study in a tertiary teaching hospital. BMC Womens Health. 2023;23(1):127. doi: https://doi.org/10.1186/s12905-023-02269-4

Uglietti A, Buggio L, Farella M, Chiaffarino F, Dridi D, Vercellini P, et al. The risk of malignancy in uterine polyps: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2019;237:48-56. doi: https://doi.org/10.1016/j.ejogrb.2019.04.009

Li X, Wang F, Chen M, Ling L, Zhao F, Peng D. The association between endometrial polyps and insulin resistance from the expression of PI3K and AKT proteins perspective. BMC Womens Health. 2024;24(1):366. doi: https://doi.org/10.1186/s12905-024-03218-5

Jose AA, Daniel M, Phansalkar MD. Hysteropa-thological Correlation in Abnormal Uterine Bleeding in a Tertiary Care Hospital in South India. J Obstet Gynaecol India. 2024;74(2):150-7. doi: https://doi.org/10.1007/s13224-023-01888-z

Xu J, Rao X, Lu W, Xie X, Wang X, Li X. Nonin-vasive Predictor for Premalignant and Cancerous Lesions in Endometrial Polyps Diagnosed by Ultrasound. Front Oncol. 2022;11:812033. doi: https://doi.org/10.3389/fonc.2021.812033

Antomonov M Yu. [Mathematical processing and analysis of biomedical data]. Kyiv: MIC "Medinform"; 2018. 579 р. Ukrainian.