Bonduki Cláudio Emílio, Dornelas Junior Gilmar de Oliveira, Bernardo André, Simões Manuel de Jesus, Castro Rodrigo de Aquino, Gomes Mariano Tamura Vieira, Girão Manoel João Batista Castello
Departamento de Ginecologia, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
Rev Bras Ginecol Obstet. 2009 Dec;31(12):598-603.
To analyze histomorphometric consequences of the uterine arteries embolization (UAE) in the uterine tissue, especially by collagen tissue quantification through uterine biopsy, before and after treatment of uterine leiomyoma.
15 patients with symptomatic leyomioma and/or infertility, submitted to UAE, participated in the study according to the study exclusion criteria, after having signed an informed consent. Uterine biopsy was performed in the secretory phase of the menstrual cycle, before and three months after the procedure, to evaluate the collagen. After the histological processing of the material, 3 micro slices were prepared, some of them dyed with hematoxiline-eosin (HE) and others with the specific dye for collagen fibers (Picrosirius red). Then, the slides were examined and interpreted, and the collagen quantified. The amount was calculated as the percent of the area composed by collagen, and the result expressed in mean+/-standard deviation (SD). Data has then been submitted to statistical analysis by Student's paired t test (p<0.05).
The presence of smooth muscle cells was observed in the biopsies performed before the treatment, surrounded by a rich network of collagen fibers, which are part of the tumor, blood vessels and fibroblast nuclei. On the slides of biopsies performed after the treatment, it was observed the presence of widespread coagulation necrosis, vascular thrombosis, calcification and lymphoplasmocitary infiltration areas and clear reduction of the collagen component. The percentage of collagen fibers was higher in the pre-UAE group (84.07+/-1.41), than in the post-UAE (81.05+/-1.50) group, with p<0.0001, and 95% confidence interval (CI95%) from 2.080 to 3.827.
The quantitative and qualitative collagen reduction clearly shows that the proposed treatment is efficient in reducing the tumoral mass, composed mainly by collagen fibers intermingled with neoplasic smooth muscle cells. Nevertheless, complementary studies are needed to investigate the functional and biological consequences of these histological changes.
分析子宫平滑肌瘤治疗前后子宫动脉栓塞术（UAE）对子宫组织的组织形态计量学影响，尤其是通过子宫活检对胶原组织进行定量分析。
15例有症状的平滑肌瘤和/或不孕症患者，在签署知情同意书后，根据研究排除标准参与了UAE研究。在月经周期的分泌期，于手术前及术后三个月进行子宫活检，以评估胶原。材料经组织学处理后，制备3张显微切片，其中一些用苏木精-伊红（HE）染色，另一些用胶原纤维特异性染料（天狼星红）染色。然后，对玻片进行检查和解读，并对胶原进行定量分析。量的计算方法为胶原组成面积的百分比，结果以平均值±标准差（SD）表示。数据随后通过配对t检验进行统计分析（p<0.05）。
治疗前活检中观察到平滑肌细胞的存在，周围有丰富的胶原纤维网络，这些胶原纤维是肿瘤、血管和成纤维细胞核的一部分。在治疗后活检的玻片上，观察到广泛的凝固性坏死、血管血栓形成、钙化和淋巴细胞浆细胞浸润区域，并且胶原成分明显减少。UAE术前组胶原纤维百分比（84.07±1.41）高于UAE术后组（81.05±1.50），p<0.0001，95%置信区间（CI95%）为2.080至3.827。
胶原的定量和定性减少清楚地表明，所提出的治疗方法在减少主要由与肿瘤性平滑肌细胞交织的胶原纤维组成的肿瘤块方面是有效的。然而，需要进行补充研究来调查这些组织学变化的功能和生物学后果。
