Histološke karakteristike i regeneratorni kapacitet endocervikalnih žlezda

Abstract

U grliću materice se histološki razlikuju dva regiona: ektocerviks (vaginalna porcija) i endocervikalni deo. Osnovna histološka razlika između ovih delova se ogleda u epitelu koji oblaže sluznicu. Histološke osobenosti endocervikalnog dela grlića materice u dostupnoj literaturi nisu detaljno proučene i postoje mnoga neodgovorena pitanja u pogledu opštih kvantitativnih morfoloških karakteristika, kao i u pogledu dobno zavisnih promena ovih parametara. Takođe, podaci u vezi odeljka i tipa ćelijske populacije odgovorne za regeneracija epitela u endocerviksu su u dostupnoj literaturi heterogeni i nisu jasno precizirani. U ovoj studiji su morfometrijskim metodama (linearnim i stereološkim merenjem) analizirani histološki preparati grlića materice obojeni standarnim hematoksilin /eozin bojenjem i imunohistohemijskim metodama (Ki-67, p63 i CK17) s ciljem da se odrede prosečne i referentne vrednosti opštih histoloških parametara i ćelijske populacije odgovorne za regeneraciju epitela endocervikalnog dela grlića materice. Analiziran je broj endocervikalnih žlezda po santimetru dužine endocerviksa, dubina endocervikalnih žlezda, visina endocervikalnog epitela, volumenske gustine strome, žlezda, lumena žlezda i epitela, kao i volumenske gustine proliferativnih ćelija (p63+/CK17+ u odnosu na p63-/CK17-) u endocervikalnom epitelu. Obrađeno je ukupno 140 isečaka grlića materice, koji su podeljeni u dve grupe: grupa bez patoloških promena i grupa sa odabranim benignim procesima u endocerviksu. Isečci bez patoloških promena su podeljeni na osnovu godina starosti pacijentkinja u 5 podgrupa kako bi se utvrdilo da li postoje dobno zavisne razlike u vrednostima navedenih parametara. Na osnovu rezultata ovog istraživanja referentna vrednost broja endocervikalnih žlezda po santimetru dužine je 13 - 29 žl/cm, dubine endocervikalnih žlezda je 1,3 - 4 mm a visine epitelnih ćelija endocerviksa je 24 - 46 μm. Kod žena starosti preko 60 godina broj bazalnih ćelija endocervikalnog epitela opada u odnosu na mlađe pacijentkinje. Kod perimenopauzalnih žena, starosti od 40 do 49 godina, je nađena najveća prosečna vrednost dubine endocervikalnih žlezda, prosečne visine epitela endocerviksa, kao i najveći ukupni proliferativni indeks u endocervikalnom epitelu. U svim ispitivanim grupama, analizom volumenskih gustina regeneratornih ćelija endocervikalne sluznice (Ki-67 pozitivnih ćelija) u odnosu na druge imunohistomijske karakteristike (p63 i CK17 pozitivnost), rezultati dobijeni u ovoj disertaciji ukazuju na činjenicu da u endocervikalnom delu grlića materice postoje dva izvora regeneratornih ćelija.

In histologic terms, there are two different regions in the cervix: ectocervix (vaginal portion) and endocervical part. The main histologic difference between these two parts is reflected in the epithelium that coats the mucous. Histologic irregularities of the endocervical part of the cervix have not been studied in details in the available literature and there are many unanswered questions relating to general quantitative morphological features, as well as regarding age-dependent changes of such parameters. In addition, data from the available literature relating to the section and type of cell population responsible for epithelium regeneration in endocervix is heterogenous and not sufficiently precise. In this study, morphometric methods were used (by linear and stereologic measuring) to conduct histologic analysis of cervical preparations stained by standard hematoxylin/eosin stains, and immunohistochemical methods (Ki-67, p63 and CK17) with a goal to determine the average and reference values of general histologic parameters and cell populations responsible for regeneration of the epithelium of the endocervical part of cervix. The number of endocervical glands per centimetre of endocervix lenght, the depth of endocervical glands, the hight of endocervical epithelium, volumetric densities of stroma, glands, glands' lumen and epithelium, as well the volumetric densities of proliferative cells (p63+/CK17+ in relation to p63-/CK17-) in endocervical epithelium were analysed. A total of 140 cervical cuttings was processed, and they were divided into two groups: a group without pathologic changes and a group with chosen benign processes in the endocervix. Cuttings with no pathologic changes were divided into 5 subgroups on the basis of patients' age in order to determine if there are any age-dependent differences in the values of the mentioned parameters. On the basis of the results of this research, the reference value for the number of endocervical glands per centimetre of lenght is 13 - 29 gl/cm, for the depth of endocervical glands is 1.3 - 4 mm and for the hight of endocervical epithelium cells is 24 - 46 μm. With women older than 60, the number of basal cells of endocervical epithelium drops compared to younger patients. The biggest average value of the depth of endocervical glands, average hight of endocervical epithelium, as well as the biggest total proliferative index in the endocervical epithelium were found with women in perimenopause, age between 40 and 49. In all examined groups, by analysing the volumetric densities of regenerative cells of the endocervical mucus (Ki-67 positive cells) in relation to other immunohistochemical features (p63 and CK17 positivity), the results obtained in this dissertation indicate that there are two sources of regerative cells in the endocervical part of the cervix.