Endometrial mitosis and apoptosis in patients with dysfunctional uterine bleeding

الملخص EN

Apoptosis plays a critical role in maintaining tissue homeostasis during the menstrual cycle by eliminating senescent cells from the functional layer of the uterine endometrium.

The balance between apoptosis and mitotic activity is thought to regulate normal endometrial development.

Errors in this mechanism can result in endometrial diseases such as dysfunctional uterine bleeding (DUB), adenomyosis, hyperplasia or carcinoma.

Simple proliferative phase pattern is the usual pattern in DUB so; it is difficult to differentiate it from normal proliferative endometrium.

Many studies showed endometrial apoptosis above the normal range in most of DUB sections stained by haematoxylin and eosin (H & E) stains .We aim in this study to confirm this finding and to prove that apoptotic and mitotic count can be used as a routine simple tool to solve this problem as well as an aid in dating of endometrium.

For that we examined, 35 endometrial biopsies from patients diagnosed as DUB compared with 25 biopsies from normally looking endometrium in patients suffering from unrelated causes.

All biopsies were processed and stained by H&E and as proliferative endometrium data (early, mid, and late phases).

Mitotic and apoptotic figures were counted in a minimum of 100 transversely cut endometrial glands .Mitotic figures were detected in most cases with a slight difference in count between DUB group (average 28.4 per 100 glands) and control group (average 29.2 per 100 glands).

The count tends to be lower in late proliferative phase (averaging 1.2 mitotic figures / 100 glands) in both groups On the other hand ; the apoptotic figure count showed a distinct variation between control and DUB cases in all three phases .The highest count was recorded in late proliferative phase, the average was (178.8 apoptosis / 100 gland) in DUB group versus( 5.6 apoptosis / 100 glands) in control group.

These results indicate that mitotic count can help in dating of endometrial biopsies but it is of no benefit in differentiation between normal and abnormal proliferative endometria.

While, apoptotic count but not mitosis may have an important role in the diagnosis of DUB.

Further studies to correlate the apoptosis with the hormonal assay and detailed clinical data are recommended.