ENDOMETRIAL HYPERPLASIA: CONTROVERSIAL ISSUES OF PATHOGENESIS AND THERAPY

Traditional attitude towards the role of hyperestrogenia in endometrial hyperplasia pathogenesis can be considered cogent only in case of simple endometrial hyperplasia (SEH). In case of complex endometrial hyperplasia (CEH) and atypical endometrial hyperplasia (AEH) excessive proliferation occurs only in endometrial glands not diffusely but as pockets. The signs of atrophy are often registered outside these pockets that reflects the state of hypoestrogens. The aim. To justify a differentiated approach to treatment tactics of patients with EH. Material. Pathological changes adjacent to the lesions AEH in 274 patients have been studied. Results. The structure of the endometrium outside the foci of the CEH and the AEH represents a wide spectrum of pathological changes – SEH, proliferative and secretory endometrium, polyps, atrophic endometrium, that's not confirms the role of hyperestrogenic in the pathogenesis of the CEH and AEH. Conclusion. SEH, as a result of imbalance of estrogen and progesterone, is subject to cyclic hormone therapy with progestin for the prevention of acyclic bleeding. In the case of the absence of abnormal uterine bleeding after uterine curettage under SEH and CEH without atypia valid only observation with regular control. At AEH surgical treatment is required

THE MAIN DIRECTIONS OF PSYCHOLOGICAL REHABILITATION OF ONСOGYNEСOLOGIC PATIENTS

Psychological rehabilitation of gynecological cancer patients is an important problem of modern medicine. Today, without the qualified psychological help is impossible to imagine the effectiveness of the therapeutic process in oncology. The use of modern methods of diagnosis and treatment has increased the life expectancy of patients. In turn, the use of these technologies have contributed to numerous complications and serious psychosocial disturbances seen in cancer patients. There is a need to change the approach to the recovery of patients by implementing the rehabilitation process of complex psycho programs aimed at the adaptation of the patients to the new conditions of life. The process of psychological rehabilitation it should be viewed as a set of individual and group psychotherapeutic interventions, the main purpose of which is to restore the cancer patient personal and social status, taking into account existing pathologies and restrictions. status, taking into account existing pathologies and restrictions. Thus, the provision of adequate psychotherapeutic assistance on the basis of oncological institutions and rehabilitation centers will improve quality and create favorable living conditions for patients in the community

PECULIARITIES OF ENDOMETRIAL STATE OF THE PATIENTS WITH ABNORMAL UTERINE BLEEDING

Abnormal uterine bleeding (AUB) is one of the main clinical symptoms of the diseases of female internal reproductive organs. AUB cannot be considered as the specific symptom of a particular disease. To know the causes of AUB is necessary for rational treatment strategy. Aim. to study the peculiarities of endometrial state of the patients suffering from AUB and the combination of different forms of pathological endometrial (E) changes on the background of AUB. Material. the results of histological examination of endometrium (E) samples taken from 688 patients. Results. the structure of pathological changes of endometrium in case of AUB was identified. Conclusion. complex endometrial hyperplasia and atypical endometrial hyperplasia occur without any regularity on the background of various changes of E reflecting the state of both hypo- and hyper-estrogenia

Computer morphometry: experience in the study of clinical value in endometrial precancer

The differential diagnosis of simple endometrial hyperplasia (SEH), complex endometrial hyperplasia (CEH), atypical endometrial hyper- plasia (AEH), and endometrial cancer (EC) is associated with a number of difficulties, frequently giving rise to different interpretations of the same histology specimens.Objective: to assess the possibilities of computed morphometry in endometrial hyperplasia.Subjects and methods. The investigation included 35 patients, including 12 with SEH, 11 with CEH, 7 with AEH, and 5 with EC. Endome- trial computed morphometry was performed using the ImageScope Color.Conclusion. The morphometric changes in endometrial hyperplasia, which are expressed in quantitative indicators, are much more diverse than their schematic image in the current classification, which may be a reason for a difference between the diagnoses

Results of surgical treatment of atypical endometrial hyperplasia

The results of surgical treatment in 132 patients with atypical endometrial hyperplasia have been studied. Post-operative diagnosis was: en- dometrial cancer – in 19 %, atypical hyperplasia – in 35 %, simple and complex hyperplasia – in 33 %, only atrophic endometrial changes – in 13 % of patients. The tumor was within the endometrium in 5 patients, the superficial invasion of the myometrium (1–2 mm) were in 8 patients, invasion to half of the myometrium – in 9 patients, invasion of more than half of the myometrium – in 3 patients. The questions of tactics of treatment of atypical endometrial hyperplasia is under discussion

ABNORMAL UTERINE BLEEDING (AUB) – MODERN POSSIBILITIES OF OPTIMIZATION OF TACTICS OF TREATMENT

Abnormal uterine bleeding is one of the most frequent manifestations of diseases of female genital organs and cause 2/3 of all hysterectomies. The results of study of the surgical specimens show that 40-69% of patients not detected no organic changes. In these cases, hysterectomy may be considered excessive interference that leads to an unjustified increase the cost of treatment and risk of complications. It is very important to determine the optimal volume of diagnostic procedures necessary to exclude and/or reduce the number of unnecessarily radical surgery in patients with AUB according to the modern nomenclature AUB

To the question of the pathogenesis of endometrial hyperplasia

Traditional attitude towards the role of hyperestrogenia in endometrial hyperplasia pathogenesis can be considered cogent only in case of simple endometrial hyperplasia (SEH). In case of complex endometrial hyperplasia (CEH) and atypical endometrial hyperplasia (AEH) excessive proliferation occurs only in endometrial glands not diffusely but as pockets. The signs of atrophy are often registered outside these pockets that reflects the state of estrogens.The aim: is to study the structure of pathological endometrial changes that patients with abnormal uterine bleeding (AUB) have and natural combination of various forms of pathological endometrial changes.Material. The results of histological examination of endometrium collected from 668 patients have been studied.Results. The structure of pathological changes that occur in case of AUB has been identified. Various endometrial changes outside CEH and AEH pockets against the background of SEH, polyposis, atrophic endometrium have been detected without any regularity; the fact that does not confirm the role of hyperestrogenia in CEH and AEH pathogenesis.Conclusion. SEH being the result of estrogen and progesterone imbalance is subjected to cyclic progestin hormone therapy to prevent acyclic bleeding. Observation with regular control is acceptable in the absence of AUB after the curettage in case of SEH and CEH without atypia. In case of AEH surgical treatment is required

THE RESULTS OF COMPUTER MORPHOMETRY USED IN ENDOMETRIAL HYPERPLASIA

Differencial diagnostics of simple, complex and atypical hyperplasia and endometrial cancer(SEH, CEH, AEH, EC) presents a number of difficulties which often lead to a different interpretation of the same histologic samples. Theaim: to evaluate the ability of computer morphometry(CM) used in case of endometrial hyperplasia. Material: 36 patients, including 12 patients with SEH, 11 patients with CEH, 7 patients with AEH and 5 patients with EC. Method of ImaScopeColor morphometric programme. Conclusion: morphometric changes that occur in case of endometrial hyperplasia expressed in quantitative terms are more varied than their schematic definition in modern classification which in its turn may be the cause of the discrepanies in diagnoses