Department of Pathology of Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP 01246-903, Brazil.
Eur J Obstet Gynecol Reprod Biol. 2013 Sep;170(1):152-6. doi: 10.1016/j.ejogrb.2013.05.012. Epub 2013 Jun 14.
Functional polyps and chronic endometritis are among the most common abnormalities seen in the endometrium of patients with implantation failures and recurrent miscarriages. In this study we describe morphological vascular changes in endometrial samples from asymptomatic infertile patients and their association with chronic endometritis and polyp.
We selected 435 asymptomatic infertility patients submitted to office-based diagnostic hysteroscopy and endometrial biopsy. We described vascular changes and searched for histologic signs of endometritis and functional polyps in the endometrial samples. We explored the associations between these conditions.
Signs of endometritis, vascular changes and polyps were identified in 176 (40.5%), 168 (38.6%) and 102 (23.4%) cases, respectively. There was a significant association between endometritis and vascular changes. The more frequent vascular alteration (70%) was the hyaline thickening of vessels, a morphological pattern very similar to the thick-walled vessels of polyps. Polyps were associated with endometritis in 28 (27.4%) cases and with other vascular changes besides the vascular stalk in 14 (13.7%). All the polyps with vascular changes had histologic evidence of endometritis. There was a significant association between inflammatory phenomena and vascular changes, even among cases of polyps.
Endometrial samples from infertile patients present a broad spectrum of vascular changes, most of them associated with endometritis. This association is also identified in functional polyps. Our results suggest that these alterations may be etiologically related. It is possible that the vessel axis of functional polyps actually may originate from the evolution of the vascular changes associated with endometritis. This would place functional polyps among the spectrum of inflammatory endometrial diseases.
在着床失败和反复流产患者的子宫内膜中，功能性息肉和慢性子宫内膜炎是最常见的异常之一。本研究描述了无症状不孕患者子宫内膜标本的形态血管变化及其与慢性子宫内膜炎和息肉的关系。
我们选择了 435 名无症状不孕患者进行门诊宫腔镜和子宫内膜活检。我们描述了血管变化，并在子宫内膜标本中寻找子宫内膜炎和功能性息肉的组织学迹象。我们探讨了这些情况之间的关联。
分别在 176 例（40.5%）、168 例（38.6%）和 102 例（23.4%）患者中发现了子宫内膜炎、血管变化和息肉的迹象。子宫内膜炎和血管变化之间存在显著关联。更常见的血管改变（70%）是血管的透明增厚，这一形态模式与息肉的厚壁血管非常相似。息肉与子宫内膜炎相关的有 28 例（27.4%），与除血管干外的其他血管变化相关的有 14 例（13.7%）。所有有血管变化的息肉都有子宫内膜炎的组织学证据。炎症现象与血管变化之间存在显著关联，即使在息肉病例中也是如此。
不孕患者的子宫内膜标本存在广泛的血管变化，其中大多数与子宫内膜炎有关。这种关联也存在于功能性息肉中。我们的结果表明，这些改变可能在病因上是相关的。功能性息肉的血管轴实际上可能起源于与子宫内膜炎相关的血管变化的演变，这将使功能性息肉成为炎症性子宫内膜疾病的范畴之一。
