Neurovascular relationships in uterine wall in adenomyosis complicated with pelvic pain syndrome.
DOI:
https://doi.org/10.26641/1997-9665.2015.1.52-57Keywords:
adenomyosis, nerves, angiogenesis, remodelingAbstract
Background. Pelvic pain is one of the most frequent complications of adenomiosis. Objective. To investigate the neurovascular relationships in uterine adenomyosis complicated with pelvic pain syndrome. Methods. Material was received after hysterectomy from 16 patients of reproductive age with diffuse adenomyosis of 2-3 degrees in the phase of proliferation. The group of comparison included the material obtained from patients with asymptomatic leiomyoma. Morphological and immunohistochemical methods were used. Results. An increase in nerve number and density was demonstrated in perivascular region around ectopic endometrium as well as in zones of myometrium remodeling in patients with adenomyosis (p <0,001). Nerve growth was associated with degenerative changes in the uterine vessels, lack of a-SMA expression and reduction of estrogen receptors in arteries. These changes were accompanied with stimulation of angiogenesis and increased expression of vascular endothelial growth factor VEGF (p<0,01). The main sources of VEGF were ectopic endometrium epithelium and inflammatory cells in areas of myometrium remodeling. Conclusion. Remodeling of vascular bed and endometrium on the background of dystrophic changes of large vessels and increased VEGF expression could be one of the factors determining nerve growth in uterine adenomyosis.
References
- Taylor RN, Hummelshoj L, Stratton P, Vercellini P. Pain and endometriosis: Etiology, impact, and therapeutics. Middle East Fertil Soc J. 2012 Dec 1;17(4):221-25. PMID: 23730148; PMCID: PMC3665417.
- Tulandi T, Felemban A, Chen MF. Nerve fibers and histopathology of endometriosis-harboring peritoneum. J Am AssocGynecolLaparosc. 2001 Feb;8(1):95-8. PMID: 11172122.
- Atwal G, du Plessis D, Armstrong G, Slade R, Quinn M. Uterine innervation after hysterectomy for chronic pelvic pain with, and without, endometriosis. Am J Obstet Gynecol. 2005 Nov;193(5):1650-5. PMID: 16260205.
- Anaf V, Simon P, El Nakadi I, Fayt I, Simonart T, Buxant F, Noel JC. Hyperalgesia, nerve infiltration and nerve growth factor expression in deep adenomyotic nodules, peritoneal and ovarian endometriosis. Hum Reprod. 2002 Jul;17(7):1895-900. PMID: 12093857.
- Laschke MW, Giebels C, Menger MD. Vasculogenesis: a new piece of the endometriosis puzzle. Hum Reprod Update. 2011 Sep-Oct;17(5):628-36. doi: 10.1093/humupd/dmr023. PMID: 21586449.
- Khan KN, Kitajima M, Hiraki K, Fujishita A, Sekine I, Ishimaru T, Masuzaki H. Changes in tissue inflammation, angiogenesis and apoptosis in endometriosis, adenomyosis and uterine myoma after GnRH agonist therapy. Hum Reprod. 2010 Mar;25(3):642-53. doi: 10.1093/humrep/dep437. PMID: 20008888.
- Li Y, Zhang S, Xu L. [Expression of nerve growth factor produced by ectopic endometrium from patients with adenomyosis and its relationship with pain scales and innervation]. Zhonghua Fu Chan Ke Za Zhi. 2014 Feb;49(2):120-4. Chinese. PMID: 24739644.
- Zhang XM, Huang XF, Xu H, Quinn M. Endometriosis: a consequence of varying injuries to pelvic autonomic nerves. Fertil Steril. 2012 Dec;98(6):e29. doi: 10.1016/j.fertnstert.2012.10.002. PMID: 23084268.
- Huang TS, Chen YJ, Chou TY, Chen CY, Li HY, Huang BS, Tsai HW, Lan HY, Chang CH, Twu NF, Yen MS, Wang PH, Chao KC, Lee CC, Yang MH. Oestrogen-induced angiogenesis promotes adenomyosis by activating the Slug-VEGF axis in endometrial epithelial cells. J Cell Mol Med. 2014 Jul;18(7):1358-71. doi: 10.1111/jcmm.12300. PMID: 24758741; PMCID: PMC4124020.
- Vercellini P, Viganò P, Somigliana E, Fedele L. Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol. 2014 May;10(5):261-75. doi: 10.1038/nrendo.2013.255. PMID: 24366116.
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