Abstract

The endometrium undergoes marked morphologic and functional changes in very short periods of time, and these are controlled by ovarian hormones. These changes of the endometrium are fundamentally based on biochemical alterations. The endometrium is composed of surface and glandular epithelium, connective tissue and blood vessels, all of which participate in the morphologic alteration during the cyclic changes. Thus, to understand the mechanisms of morphologic alterations and the basis of endometrial function, histochemical studies concerning the localization of specific chemical and enzymatic activity are very important (Mckay, et al., 1956; Levine, 1963). It is the purpose of this report (1) to evaluate histochemical patterns during the normal cyclic Processes of the endometrium, and (2) to search for the histochemical differences in various conditions of endometrium compared with normal endometrium. Material and Methods ; Ninety specimens of endometrium removed by curette were obtained from patients for diagnosis of disease, and sterility at the Department of Gynecology, Yonsei University Medical Center. The histologic criteria of Noyes, et al. (1951) were used to establish the state of each specimen. Of the 25 normal specimens, 9 were proliferative, 14 were secretory, and 2 were menstrual. The 65 abnormal endometriums consisted of 16 with intrauterine pregnancies, 16 with ectopic pregnancies, 25 with hyperplasia, 3 with atypical hyperplasia, 3 with adenocarcinoma, and 2 with endometrial polyp. A portion of each specimen was frozen-sectioned and prepared for the activity of alkaline phosphatase by Gomori’s metal-salt method (1939). The remainder of each specimen was fixed in 10% neutral formalin solution. The paraffin-embedded sections were stained by hematoxylin and eosin, periodic acid-Schiff reaction for glycogen and glycoprotein, alcian blue stain for acid mucopoly-saccharides, and methylgreen pyronin stain for ribonucleic acid.
Result
and Summary ; 1. The PAS positive material, regarded as glycogen, or glycoprotein, underwent cyclic change in surface as well as in glandular epithelium of the normal endometrium. The amount of the material was greater in the secretory endometrium than in the proliferative endometrium and was also large in the endometrium of intra as well as ectopic pregnancies. However, in hyperplasia and adenocarcinoma, the PAS positive material was small in amount as in the proliferative endometrium. 2. The acid mucopolysaccharides which were located chiefly along the brush border of epithelium and in the stroma, revealed its cyclicity, and increased in the secretory endometrium. 3. The most interesting observation relates to the uterine change in hyperplasia and adenocarcinoma of endometrium, where diffuse staining of cytoplasm of the epithelial cells was observed with the acid mucopolysaccharides method. 4. No significant histochemical differences were found in the endometrium between intrauterine pregnancy and ectopic pregnancy. 5. Arias-Stella atypias were observed in 62.5% of ectopic pregnancies and in 31.3% of intrauterine pregnancies. These cells consisted of actively secreting cells, which possibly was due to apocrine secretion. 6. The large quantity of ribonucleic acid granules, which were observed diffusely in the cytoplasm of epithelial cells in proliferative and hyperplastic endometrium, was interpreted as an index of active protein synthesis in these conditions. Those which were concentrated above or near the nuclei of the epithelial cells seemed to be concerned with the secretory function in secretory and pregnant endometrium. 7. The cyclicity of the alkaline phosphatase activity was well demonstrated in the cell membrane of the epithelium, whereas the enzymatic activity in the blood vessels did not show cyclic change. In the proliferative endometrium the epithelial activity was higher than in the secretory or pregnant endometrium but in hyperplasia and adenocarcinoma it varied from gland, or from cell to cell. 8. Estrogen was considered to contribute more to the development of hyperplasia and adenocarcinoma than progesterone because the histochemical findings of these abnormal conditions were more or less similar to those of proliferative endometrium, although irregular findings were also noted in hyperplasia or adenocarcinoma. 9. The staining reactions of the endometrium in the secretory phase of the cycle and in ectopic pregnancy are quantitatively different because they are both under the influence of progesterone. Acknowledgement ; This study was partly supported by the Population Council, New York, N.Y., U.S.A.(Grant No. M69.184 and M71.0136 to Soon O Chung).