인체 자궁내막의 조직화학적 연구

Abstract

[한글]

Mistochemical Studies on Human Endometrium

Jin Kook Choe

Department of Medical Science

The Graduate School Yonsei University

(Directed by Prof. Dong Sik Kim, M.D. Prof. Yoo Bock Lee, M.D.)

The endometrium undergoes marked morphelogic and functional changes in a vey

short period of time, and these are controlled by overian hormones. These changes

of the endometrium ar fundamentally based on the 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

localisation of specific chemical and enzymatic activity are very important (Mckay,

et al.,1956**a ; 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 from that of normal

endometrium.

Material and Methods

Ninety endometris curetted from normal and abnormal uteri were obtained from the

Department of Obstetrics and Gynecology, Severance Hospital. The histologic

criteria of Noyes, et al. (1951) were used to establishthe state of each specimen.

Of the 25 normal specimens, 9 were proliferative, 14 were secretory, and 2 were

menstrual. And the 65 abnormal endometria consisted of 16 with intrauterine

pregnancies, 16 with extrauterine pregnancien, 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 reachtion for glycogen and glycoprotein, alcian blue stain for acid

mucopolysaccharides, and methylgreen pyronin stain for ribonucleic acid.

Results and Summary

1. The PAS positive material, regarded as glycogen or glycoprotein, underwent the

cyclic changes in surface as well as glandular epithlium of the normal endometrium;

the amount of the material was greater in the sectetory endometrium than in the

proliferative endometrium and was also large in the endometria of intra-as well as

extrauterine pregnancies. But in hyperplasia and adenocarcinoma, the PAS positive

material was small in amount like in the proliferative endometrium.

2. The acid mucopolysaccharides which were located chiefly along the brush border

of epithelium and in the stroma, reealed its cyclicity, and increased in the

secretory endometrium.

3. It was an interesting finding that diffuse intracyto-plasmic location of acid

mucopolysaccharides was observed only in hyperplastic and cancerous endometria.

4. No significant histochemical differences were found in the endometria between

intra-and extrauterine pregnancies.

5. The Arias-Stella atypias were observed in 62.5% of extrauterine pregnancies

and in 31.3% of intrauterine pregnancies, and these cells consisted of actively

secreting cells, that might perform cheifly apocrine secretion.

6. The large queantity of ribonucleic acid granules which were observed diffusely

in the cytoplasm if epithelial cells in the proliferative and hyperplastic

endometria was interpreted

as an index of active protein synthesis in these conditions, and those which

concentrated above or near the nuclei or the epithelial cells seemed to concern the

secretory function in secretory and pregnant endometria.

7. The cyclicity of the alkaline phosphatase activity was well domenstrated in

the cell membrane of the epithelium, whereas the enzymatic activity in the blood

vessels did not show the cyclic change. In the proliferative endometrium the

epithelial activity was higher than in the secretory or pregnant endometrium but

those in hyperplasia and adenocarcinoma were various from gland to gland, or from

cell to cell.

8. The estrogen was considered to contribute more to the development of

hyperplasia and adenocarcinoma than the 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.

[영문]

The endometrium undergoes marked morphelogic and functional changes in a vey short period of time, and these are controlled by overian hormones. These changes of the endometrium ar fundamentally based on the 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 localisation of specific chemical and enzymatic activity are very important (Mckay, et al.,1956**a ; 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 from that of normal endometrium.

Material and Methods

Ninety endometris curetted from normal and abnormal uteri were obtained from the Department of Obstetrics and Gynecology, Severance Hospital. The histologic criteria of Noyes, et al. (1951) were used to establishthe state of each specimen.

Of the 25 normal specimens, 9 were proliferative, 14 were secretory, and 2 were menstrual. And the 65 abnormal endometria consisted of 16 with intrauterine pregnancies, 16 with extrauterine pregnancien, 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 reachtion for glycogen and glycoprotein, alcian blue stain for acid

mucopolysaccharides, and methylgreen pyronin stain for ribonucleic acid.

Results and Summary

1. The PAS positive material, regarded as glycogen or glycoprotein, underwent the cyclic changes in surface as well as glandular epithlium of the normal endometrium; the amount of the material was greater in the sectetory endometrium than in the

proliferative endometrium and was also large in the endometria of intra-as well as extrauterine pregnancies. But in hyperplasia and adenocarcinoma, the PAS positive material was small in amount like in the proliferative endometrium.

2. The acid mucopolysaccharides which were located chiefly along the brush border of epithelium and in the stroma, reealed its cyclicity, and increased in the secretory endometrium.

3. It was an interesting finding that diffuse intracyto-plasmic location of acid mucopolysaccharides was observed only in hyperplastic and cancerous endometria.

4. No significant histochemical differences were found in the endometria between intra-and extrauterine pregnancies.

5. The Arias-Stella atypias were observed in 62.5% of extrauterine pregnancies and in 31.3% of intrauterine pregnancies, and these cells consisted of actively secreting cells, that might perform cheifly apocrine secretion.

6. The large queantity of ribonucleic acid granules which were observed diffusely in the cytoplasm if epithelial cells in the proliferative and hyperplastic endometria was interpreted

as an index of active protein synthesis in these conditions, and those which concentrated above or near the nuclei or the epithelial cells seemed to concern the secretory function in secretory and pregnant endometria.

7. The cyclicity of the alkaline phosphatase activity was well domenstrated in the cell membrane of the epithelium, whereas the enzymatic activity in the blood vessels did not show the cyclic change. In the proliferative endometrium the epithelial activity was higher than in the secretory or pregnant endometrium but

those in hyperplasia and adenocarcinoma were various from gland to gland, or from cell to cell.

8. The estrogen was considered to contribute more to the development of hyperplasia and adenocarcinoma than the 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.