Morphological structure of the placenta in women with history of endometrial hyperplasia

DOI: 10.47026/2413-4864-2025-3-20-29

UDC: 618.14-006.5
BBC: 57.161.1:28.706+57.162.16

Podgornyaya M.S., Balter R.B., Ivanova T.V., Tselkovich L.S., Ilchenko O.A., Bogdasarov A.Yu.

Morphological structure of the placenta in women with history of endometrial hyperplasia

Keywords: placenta, endometrial hyperplasia, histology, microbiota, hyperestrogenemia, receptors, estrogen, progesterone, infertility

Alteration of steroid receptor expression (estrogen and progesterone receptors) is a common pathogenic link in the development of both pregnancy complications and endometrial hyperplasia. These disorders are initiated by hyperestrogenemia and can be exacerbated by chronic endometritis. Therefore, studying the placental status in women with a history of endometrial hyperplasia is crucial for determining the likelihood of recurrence. The aim of the study was to conduct a comprehensive morphological examination of placental tissue in patients with a history of endometrial hyperplasia to identify characteristic structural features. Material and methods. A retrospective analysis of the histological and microbiological parameters of the placental tissue was performed. The total sample consisted of 139 pregnant women, who were divided into two groups. The main group (n = 64) included patients with a documented history of endometrial hyperplasia. Within the main group, there were two subgroups: 52 women with endometrial hyperplasia without atypia and 12 women with atypical endometrial hyperplasia. The diagnosis of endometrial hyperplasia was verified at the stage of pregnancy planning in accordance with the WHO binary classification (2014). All patients in the main group had reproductive disorders at the stage of pregravidary preparation and received hormonal therapy to achieve a current pregnancy. The control group (n = 75) consisted of women with a physiological course of pregnancy who did not have a history of endometrial hyperplastic processes. Statistical analysis of the obtained results was carried out using the MedCalc software package (version 15.2). Results. The study revealed significant differences in pathological changes in the placenta between the groups. In the main group, there was a combined lesion that included vascular pathology in the maternal part of the placenta, accompanied by a chronic inflammatory process. In the control group, the pathological changes were mainly limited to signs of inflammation. The structure of the identified pathology in the main group was characterized by the following most common disorders: decidual vasculopathy, segmental vascular damage in the stem villi, and central ischemic infarctions. Inflammatory changes, such as chorioamnionitis, funiculitis, villitis, intervillousitis, and lymphoplasmocytic deciduit, were diagnosed in almost 50% of the patients in the main group. Signs of morphofunctional immaturity of the placental tissue were observed in 12.5±4.2% of women in the same cohort. Microbiological analysis demonstrated the highest degree of contamination of the placenta with opportunistic pathogens, which were dominated by E. coli, Staphylococcus aureus, Streptococcus agalactiae and Atopobium. Conclusions. In patients with a history of endometrial hyperplasia, the formation of the fetoplacental complex is associated with chorionic pathology, which in turn leads to dysfunction of its vascular component. These disorders manifest clinically as complications such as the formation of a retrochorionic hematoma, the threat of miscarriage, and uterine bleeding. In view of the identified patterns, it seems reasonable to conduct a mandatory histological and bacteriological examination of placental tissue in women with a history of various forms of endometrial pathology. The data obtained during such an examination are essential for developing a set of preventive measures aimed at preventing placenta-related gestational complications during preconception and early gestation.

References

Gabidullina R.I., Smirnova G.A., Nukhbala F.R. et al. Giperplasticheskie protsessy endometriya: sovremennaya taktika vedeniya patsientok [Endometrial hyperplastic processes: modern approaches to diagnosis and treatment]. Consilium Medicum, 2019, vol. 21, no. 6, pp. 53–58. DOI: 10.26442/20795696.2019.6.190472.
Kutsenko I.I., Khorol’skaya E.A., Safronova Yu.S. Optimizatsiya podgotovki k beremennosti patsientok s giperplasticheskimi protsessami endometriya [Optimization of preparation for pregnancy the patients with hyperplasia endometria]. Vestnik Rossiiskogo universiteta druzhby narodov. Ser. Meditsina, 2011, no. S5, pp. 254–260.
Sukhanov A.A., Dikke G.B., Kukarskaya I.I., Pesotskaya A.V. Morfologicheskie osobennosti endometriya v pregravidarnom periode, khoriona i platsenty pri beremennosti, nastupivshei v rezul’tate ekstrakorporal’nogo oplodotvoreniya, u patsientok s khronicheskim endometritom (vtorichnye rezul’taty randomizirovannogo kontroliruemogo ispytaniya “TYuL”PAN 2“) [Morphological characteristics of the endometrium in the preconception period, chorion and placenta during pregnancy resulting from in vitro fertilization in patients with chronic endometritis (secondary analysis of the results of the TULIP 2 randomized controlled trial)]. Akusherstvo i ginekologiya, 2024, no. 5, pp. 113–118. DOI: 10.18565/aig.2024.122.
Rudikova A.A., Tsiklauri M.R. Morfologicheskie osobennosti endometriya u zhenshchin s razlichnym tipom narushenii reproduktivnoi funktsii [Morphological features of the endometrium in women with various types of reproductive dysfunction]. Molodoi uchenyi, 2021, no. 48(390), pp. 483–487.
Kotel’nikova N.A., Balter R.B., Tselkovich L.S. et al. Faktory riska razvitiya giperplasticheskikh protsessov v reproduktivnom vozraste. Osobennosti klinicheskoi kartiny zabolevaniya [Risk factors for the development of hyperplastic processes in the reproductive age. Features of the clinical picture of the disease]. Sovremennaya nauka: aktual’nye problemy teorii i praktiki. Ser. Estestvennye i tekhnicheskie nauki, 2025, no. 1, pp. 207–214. DOI: 10.37882/2223-2966.2025.01.22.
Protasova A.E., Adamyan L.V., Sobivchak M.S., Tsypurdeeva A.A. Endometrial’naya giperplaziya: sovremennye kontseptsii etiopatogeneza [Endometrial hyperplasia: modern concepts of etiopathogenesis]. Russian Journal of Human Reproduction, 2023, vol. 29, no. 4, pp. 75–80. DOI: 10.17116/repro20232904175.
Chen J., Cheng Y., Fu V. et al. The PPOS protocol effectively improves IVF out comes without increasing the recurrence rate in patients with early end ometrioid end ometrial can ceranda typical endometrial hyperplasia after fertility-preserving treatment. Front Med (Lausanne), 2021, vol. 8, pp. 581–927. DOI: 3389/fmed.2021.581927.
Chen J., Dongyan C.J., Jiaxin Y. et al. Management of patients with recurrent endometrial cancer or atypical endometrial hyperplasia after primary fertility therapy. Frontiers in oncology, 2021, no. 11, р. 10. DOI: 10.3389/fonc.2022.812346.
Chen K.L., Madak-Erdogan Z. Estrogen and microbiota crosstalk: should we pay attention? Trends in endocrinology and metabolism, 2016, vol. 27(11), pp. 752–755. DOI: 1016/j.tem.2016.08.001.
Cho H.W., Ouh Y.T., Lee K.M. et al. Long-term effect of pregnancy-related factors on the development of endometrial neoplasia: a nationwide retrospective cohort study. PLoS One, 2019, 14(3), e0214600. DOI: 10.1371/journal.pone.0214600.
Dellino М., Cerbone M., Laganà A.S. et al. Improving methods of treatment and molecular diagnosis of endometrial cancer – new tools for endometrial preservation? International Journal of Molecular Sciences, 2023, vol. 24(11), 9780. DOI: 3390/ijms24119780.
Fujimoto A., Ichinose M., Harada M. et al.Results of infertility treatment in patients who underwent assisted reproductive technology after conservative therapy of endometrial cancer. Assist Reprod Genet., 2014, vol. 31(9), pp. 1189–1194. DOI: 10.1007/s10815-014-0297-x.
Huang J., Xie Q., Lin X. et al.Neonatal outcomes and congenital malformations in children born after dydrogesterone application in progestin-primed ovarian stimulation protocol for IVF: a retrospective cohort study. Drug Des Devel Ther., 2019, vol. 13, pp. 2553–2563. DOI: 10.2147/DDDT.S210228.
Lan K.C., Cheng H.H., Tsai N.C. et al. Levels of sex steroid hormones and their receptors in women with preeclampsia. Biol. Endocrinol., 2020, vol. 18(1), pp. 1–7. DOI: 10.1186/s12958-020-0569-5.
Maeda T., Nishimura M., Sogawa E. et al.Pathological examination of the placenta leading to the diagnosis of endometrial carcinoma: a clinical case. Mol Clin Oncol., 2022, vol. 16(1), 24. DOI: 3892/mco.2021.2457.
Main C., Chen X., Zhao M. et al. Understanding how pregnancy protects against ovarian and endometrial cancer development: fetal antigens may be involved. Endocrinology, 2022, 163(11), 141. DOI: 10.1210/endocr/bqac141.
Pu H., Wen X., Luo D., Guo Z. Regulation of progesterone receptor expression in endometriosis, endometrial cancer, and breast cancer by estrogen, polymorphisms, transcription factors, epigenetic alterations, and ubiquitin-proteasome system. Steroid. Biochem. Mol. Biol., 2023, vol. 227, pp. 106–199. DOI: 10.1016/j.jsbmb.2022.106199.
Shiomi M., Matsuzaki S., Kobayashi E. et al.Endometrial carcinoma in pregnant women: a clinical case and a literature view. BMC Pregnancy and Childbirth, 2019, vol. 19(1), 425. DOI: 11186/s12884-019-2489-y.
Wu V., Wang W., Zou V. Recurrent endometrial atypical hyperplasia diagnosed by pathological examination of the placenta from a live birth: a case report. BMCP regnancy and childbirth, 2023, vol.23, 691. DOI: 10.1186/s12884-023-05972-0.
Yu M., Wang Y., Yuan Z. Fertility-sparing treatment in young patients with grade 2 presumed stage IA endometrioid end ometrial adenocarcinoma. Front Oncol., 2020, vol. 10, 1473. DOI: 3389/fonc.2020.01437.
Yu T., Wu D., Cao Yu, Zhai J. The relationship between the menstrual favorable in patients with polycystic ovaryFront Endocrinal (Lausanne), 2021, vol. 12, pp. 740–747. DOI: 10.3389/fendo.2021.740377.

Article link

Podgornyaya M.S., Balter R.B., Ivanova T.V., Tselkovich L.S., Ilchenko O.A., Bogdasarov A.Yu. Morphological structure of the placenta in women with history of endometrial hyperplasia [Electronic resource] // Acta medica Eurasica. – 2025. – №3. P. 20-29. – URL: https://acta-medica-eurasica.ru/en/single/2025/3/3/. DOI: 10.47026/2413-4864-2025-3-20-29.

Single article

Podgornyaya M.S., Balter R.B., Ivanova T.V., Tselkovich L.S., Ilchenko O.A., Bogdasarov A.Yu.