A Study of angiogenesis in human endometrial denocarcinoma, and premalignant endometrial lesions: A comparative clinic pathological study
AbstractBackground: The development of new blood vessels is essential to embryonic growth and throughout life for physiological repair processes. Tumors cannot enlarge beyond 1-2 mm in diameter or thickness unless they are vascularized. Angiogenesis is an essential step in growth of primary tumor and for distant metastasis. MVD (Microvessel Density) is one of the important measurement to asses angiogenesis. Aim: The aims of this study are to asses the micro vessel density (MVD) of endometrium using two markers which are (CD31 and CD34),to investigate the relationship between the degree of angiogenesis and clinicopathological variants, to determine its usefulness in histopathological practice, and to compare between the two markers. Materials and methods: This retrospective study includes formalin fixed, paraffin embedded tissue sections from patients underwent different gynecological diagnostic and therapeutic procedures. These samples were taken from the hospitals in the period between August 2005 and January 2007. forty nine cases were studied; 10 were normal functional endometrium; 21 hyperplasia, and 18 were diagnosed as endometrial carcinoma. Five slides for each case was done, one slide was stained with Hematoxylin and eosin (H&E), and re-examined to confirm the diagnosis, and the other four were stained immunohistochemically for monoclonal antibodies CD31 and CD34 (two slides for each one). Results: This study showed that MVD was correlated with benign and malignant endometrial lesions. The mean MVD for normal functional endometrium cases was as follows: 53.9 using CD34 stain, and 47.5 using CD31 stain for secretory endometrium, and 32.2 using CD34 and 30.1 using CD31 for the proliferative type. The mean MVD for hyperplastic endometrium was found to be: 63.2,45.8 (by CD34, and CD31 respectively) for cystic; 75.1 and 69.7(by CD34, and CD31 respectively) for adenomatous, and 78.4,73.2 (by CD34, and CD31 respectively) for atypical endometrial hyperplasia. Regarding the malignant cases, the mean MVD was: 87.43, 70.22 for well differentiated adenocarcinoma; for moderately differentiated cases they were 102.6, 88.35; and 114.8, 102.7 for poorly differentiated cases (by CD34, and CD31 respectively). The results of mean MVD using CD34 is significantly higher than that obtained by using CD31 for both benign and malignant cases (the p values are 0.0412, and 0.0327 respectively). This study showed that MVD is significantly correlated with the benign and malignant endometrial lesions, but no significant statistical correlation between age and the MVD of the malignant cases. Conclusion: MVD is an important parameter to asses angiogenesis in functional, hyperplasic and malignant endometrium, and it was found to be higher in malignant cases than benign ones. Significantly higher results obtain for CD34 in comparison with CD31for both benign and malignant cases.
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