Study of expression of estrogen and progesterone receptors and blood vessel density in dysfunctional uterine bleeding

Abstract

INTRODUCTION: AUB without any associated cause is referred to as a “Dysfunctional uterine bleeding” (DUB). Proliferation and differentiation of endometrial glands and stroma are regulated by steroid hormones mainly estrogen and progesterone. There is also positive correlation between endometrial angiogenesis and menstrual disorders. Therefore, this study focuses on examining blood vessel density. Therefore, analysis of ER and PR receptors allocation in the glandular and stromal component of endometrium could facilitate medical treatment for cases of DUB thereby avoiding unnecessary surgeries. Also, as the alterations in morphology of blood vessels plays a significant role in pathogenesis of DUB, we hereby analyzed mean vascular density. OBJECTIVES: 1. To study immunohistochemical expression of ER and PR in endometrium of women with DUB. 2. To analyze blood vessel density in cases of DUB. MATERIALS AND METHODS: The present study is hospital based cross – sectional study in a sample size of 82 (60 test group which included females with DUB and 22 control group included normal proliferative or secretory phase). Following the collection of endometrial samples, H and E-stained slides were analyzed for histopathological diagnosis, as well as to assess blood vessel density. Additionally, immunohistochemistry is employed to study the distribution of estrogen receptor (ER) and progesterone receptor (PR) expression RESULTS The current research aimed to analyze the estrogen and progesterone receptors expression in the endometrium, as well as the concentration of blood vessels in specific cases of DUB. Among the 60 subjects, there were 31 neoplastic cases (51.7%) and 29 nonneoplastic lesions (48.3%). Results showed notable increase in ER and PR expression in the glandular and stromal component of endometrium when compared to control groups with maximum average scoring of estrogen receptor expression in Endometrioid endometrial carcinoma NOS (6.20 ± 0.58), followed by Endometrial hyperplasia without atypia (6.40± 0.99) and Disordered endometrium (5.80 ± 0.99). Mean Alred scoring of PR in both glands and stroma showed maximum scoring in Endometrioid endometrial carcinoma NOS (6.50 ±1.15) followed by Hyperplasia without atypia (6.35 ± 1.64) and Disordered maturation (5.80 ± 1.34). Mean blood vessel density in the cases group (58.68 ± 12.57) was highest when compared to control group (65.72 ± 16.09) CONCLUSION The current study was conducted emphasizing the role of ER and PR expression and vascular density in the pathogenesis of Dysfunctional Uterine Bleeding (DUB). Additionally, the study establishes a correlation between increased blood vessel density and DUB, indicating that vascular changes contribute to the pathogenesis. These results suggest that hormonal receptor profiling and blood vessel analysis can serve as valuable diagnostic and prognostic tools.