An immunohistochemical study of metroplastic surgical specimens from patients with a septate uterus
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ORIGINAL ARTICLE
An immunohistochemical study of metroplastic surgical specimens from patients with a septate uterus Tsunehisa Makino • Li-yi Cai • Shun-ichiro Izumi Masanori Yasuda
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Received: 22 April 2011 / Accepted: 5 July 2011 / Published online: 3 August 2011 Ó Japan Society for Reproductive Medicine 2011
Abstract Purpose To elucidate the etiology of recurrent pregnancy loss in patients with congenital uterine anomalies, an immunohistochemical technique was used to quantitatively evaluate the vascular arrangement of septate uteri with respect to vascular density and morphology. Methods Nine specimens obtained from patients who had undergone metroplastic surgery for the treatment of a septate uterus and 10 control specimens from patients who had undergone a hysterectomy because of cervical carcinoma were used in this study. Formalin-fixed paraffinembedded uterine specimens were then immunostained for CD34, which is specifically expressed in vascular endothelial cells. Results The mean blood vessel count (mean ± SD) for the myometrium was 149.7 ± 22.7/field in the septate uteri and 162.2 ± 36.4/field in the control uteri; these values were not significantly different. However, the total vessel cross-sectional areas, as evaluated quantitatively using the KS400 image analysis system, were 10350.4 ± 1024.3 lm2/field for the septate uteri and 12002.9 ± 2232.3 lm2/ field for the control uteri; these values were significantly different (p \ 0.05). The vessel morphology expressed by
T. Makino L. Cai S. Izumi Department of Obstetrics and Gynecology, School of Medicine, Tokai University, Isehara, Kanagawa, Japan T. Makino (&) Tohbu Hospital, 1180-2 Gumisawa, Gotemba, Shizuoka 412-0041, Japan e-mail: [email protected] M. Yasuda Department of Pathology, School of Medicine, Tokai University, Isehara, Kanagawa, Japan
vessel irregularity and deformity showed a characteristic change in the septate uterus. Conclusions A significant difference in the distribution of the blood vessels existed between the septate and control uteri, presumably impairing blood flow in the myometrium and the adverse pregnancy outcome. Keywords Congenital uterine anomaly Immunohistochemistry Metroplasty Recurrent pregnancy loss Uterine vessel distribution
Introduction In women, uterine development starts during the 4th to 5th week of gestation with the emergence of the metanephric ducts and their connection with the cloacae, followed by the union of the two Mu¨llerian ducts during the 10th week of gestation. Fusion starts in the middle part of the conjugated area and extends caudally. By the 20th week of human gestation, the typical human uterine shape has been completed as a result of cellular proliferation in the upper part of the original uterus and the dissolution of the cells in the lower part [1]. Thus, the fusion of the Mu¨llerian ducts, which develop into a single reproductive tract in humans, is induced at three different embryonal levels over three different periods of time. Therefore, uterine malformations can easily b
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