인체자궁내막기질세포에 관한 전자현미경적 연구

Abstract

[한글]

[영문]

In these days of intense interest in gynecologic and endocrine disorders the

knowledge of endometrial histology has become a great clinical value. The

endometrium is under the physiologic subservience of the overian homones and

therefore it fairly reflects the endocrine activites(Novak, et al., 1970).

Numerous studies have been made about endometrial glandular epithelial cells

including ultrastructural observation (Birch and Collins, 1961; Gompel, 1962; De

Brux and Ancia, 1964; Cavazos, et al., 1967; Thrasher & Richart, 1972), but there

are few studies reported about the endometrial stromal cells, especially in

electron microscopic aspects (Wienke, et al., 1968; Lawn, et al., 1971), although

the endometrial stromal cell responds to the cyclic change of the ovarian hormones

and shows the corresponding morphologic alteration as well (Noyes, et al., 1951;

Wienke, et al., 1968). Most of the studies in the morphologic change of stromal

cells dealt little about the fine structure of human stromal cells (Finn and Keen,

1962; De Feo, 1963; Marcus and Shelesnyak, 1967). Lawn et al. (1971) observed the

human decidual and predecidual cells electron microscopically, and Orsini et al.

(1970) and Brinsfield et al. (1972) described the fine structure of the decidua of

the pregnancy and pseudopregnancy in the rat, but as yet there are no other reports

which are able to support the findings of them. In addition, the terminology of the

endometrial decidual cell in ectopic (tubal) pregnancy is confused in usage, having

the name of pseudodecidua by some (Anderson, 1971) and true decidua by others

(Novak and Woodruff, 1967).

This study was made to investigate the ultrastructural changes of the human

endometrial stromal cells during the menstrual cycle and to determine whether there

are any ultrastructual differences among the pseudodecidual cells of late secretory

phase, the decidual cells of intrauterine pregnancy, and the decidual cells of

ectopic pregnancy.

Materials and Methods

Meterials were curetted endometrial tissues from 59 healthy women who aged 20 to

40 years with the history of normal menstrual cycle and without clinical or

histological evidence of gynecologic disease. The materials were divided into

following groups.

Group Ⅰ: Non-pregnant group………………………………………35 cases

a. Early proliferative phase (Menstrual cycle 4-7th day)… 4 cases

b. Mid-proliferative phase(Menstrual cycle 8-10th day)…… 4 cases

c. Late proliferative phase(Menstrual cycle 11-15th day)… 4 cases

d. Early secretory phase(Menstrual cycle 16-19th day)………7 cases

e. Mid-secretory phase(Menstrual cycle 20-23rd day)…………4 cases

f. Late sectetory phase(Menstrual cycle 24-28th day)……… 6 cases

g. Menstrual phase(Menstrual cycle 1-3rd day)…………………6 cases

Group Ⅱ: Pregnant group………………………………………………24 cases

a. Intrauterine pregnancy 1 month…………………………………5 cases

b. Intrauterine pregnancy 2 months………………………………11 cases

c. Intrauterine pregnancy 3 months……………………………… 4 cases

d. Ectopic (tubal) pregnancy……………………………………… 4 cases

For the light microscopic examination, the one half of the obtained endometrial

tissue was fixed in 10% neutral formalin. Paraffin embedded blocks were cut in 6

micron thickness, and sections were stained by hematoxylin-eosin methods. According

to the criteria of Noyes et al. (1951), the phase of the endometrium was

determined.

For the electron microscopic examination, the other half was cut in about 1 cubic

mm size and fixed in 1% osmium tetraoxide in phosphate buffer pH 7.4 after one to

two days fixation in 4% glutaraldehyde in phosphate buffer pH 7.4 and dehydrated

with graded alcohol. The sections were cut with a glass knife following Epon 812

embedding in 400-500 A thickness and stained with uranyl acetate and lead

hydroxide. Observations were made with the Hitachi HU 11-E model electron

microscope.

Results and Summary

1) The endometrial stromal cell showed, likewise endometrial epithelial cells,

cyclic morphological changes during the menstrual cycle. The undifferentiated

fibroblast-like stromal cell of early proliferative phase progressively matured and

took the form of functionally active cell as progressed towards the secretory and

pregnancy state.

2) The stromal cell during either intrauterine or ectopic pregnancy showed marked

morphological changes, which consisted of distinct cytoplasmic membrane of

increased density, many well developed cytoplasmic processes some of which

containing membranebound granular material, and specialized cell-junction

apparatus, gap-junctions, between the cell surface and cytoplasmic processes and

between the cytoplasmic processes. The stromal cell of late secretory phase did not

have the specialized structures observed in the pregnant decidual cell.

On the basis of the above results it is considered that the decidual tissues

represent a system of communication, uniting decidual cells into a functional

syncytium which might play a part in determining the chemical and physical

environment suitable for the development of a blastocyst and it is also speculated

that gap-junctions bind the cells into a mechanical barrier, protecting the

blastocyst and preventing deeper invasion of the uterus.

It seems to be more reasonable that the decidual cell of ectopic pregnancy will

be called as true decidua as of intrauterine pregnancy and the stromal cell of

non-pregnant late secretory phase will be called as pseudodecidua as has been used.