G.O. CLEVELAND^1,2, I.V. KLYUCHAROV^1,3, R.A. DZAMUKOV^1,3, V.N. TSYBULKINA^1,3

¹Kazan State Medical University, 49 Butlerov Str., Kazan, Russian Federation, 420012

²Students’ City Polyclinic №4, 95 Orenburgskiy Trakt, Kazan, Russian Federation, 420059

³Republican Clinical Hospital of MH of RT, 138 Orenburgskiy Trakt, Kazan, Russian Federation, 420064 

Cleveland G.O. ― postgraduate student of the Department of Obstetrics and Gynecology №1, obstetrician-gynecologist, tel. +7-904-764-09-87, e-mail: akridared@yahoo.com

Klyucharov I.V. ― Cand. Med. Sc., Associate Professor of the Department of Obstetrics and Gynecology №1, obstetrician-gynecologist, tel. +7-917-282-44-74, e-mail: gynecolog@pisem.net

Dzamukov R.A. ― Cand. Med. Sc., doctor of the Department of Pathological Anatomy, tel. +7-917-278-87-34, e-mail: drodion@yandex.ru

Tsybulkina V.N. ― D. Med. Sc., Professor, Head of the Department of Allergology and Immunology, tel. +7-917-268-18-08, e-mail: vera.tsybulkina@mail.ru

This article describes the currently existing methods of chronic endometritis diagnosis. Particular attention is paid to the morphological study of endometrial samples and hysteroscopy because they are the most informative methods for diagnosis of this disease at the moment. The results of studies investigating the value of various diagnostic methods are given, diagnostic criteria, indicating chronic endometritis, detected by each of these methods, are described. The differences in diagnostic criteria for chronic endometritis are reviewed. Controversial points regarding the morphological study of the endometrium, the different methods of taking endometrial samples, controversies in histological staining of the samples are shown. The differences in evaluation criteria of endometrial inflammation such as the number of plasma cells and other inflammatory cells are discussed.

Key words: chronic endometritis, histological analysis, immunohistochemistry, diagnosis.

REFERENCES

1. Sukhikh G.T., Shurshalina A.V. Khronicheskiy endometrit: rukovodstvo [Chronic endometritis: A Guide]. Moscow: Geotar Media, 2010. 64 p.
2. Kitaya K., Yasuo T., Tada Y., et al. Current understanding of chronic endometritis. Diagnostic histopathology, 2013, vol. 19, no. 7, pp. 231-237.
3. Shurshalina A.V. Khronicheskiy endometrit u zhenshchin s patologiey reproduktivnoy funktsii: avtoref dis. … dokt. med. nauk [Chronic endometritis in women with abnormal reproductive function. Synopsis of dis. Dr med. sciences]. Moscow, 2007. 25 p.
4. Aplin J.D., Fazleabas A.T., Glasser S.R., Guidice L.C. The endometrium. Molecular, cellular, and clinical perspectives. Second edition. Informa healthcare, 2010. 882 p.
5. Smith M., Hagerty K.A., Skipper B., et al. Chronic endometritis: a combined histopatologic and clinical review of cases from 2002 to 2007. Int. J. Gynecol. Pathol, 2010, vol. 29, no. 1, pp. 44-50.
6. Nucci M., Oliva E. Gynecologic pathology. Elsevier Churchill Livingstone, 2009. 710 p.
7. Crum C.P., Lee K.R. Diagnostic Gynaecologic and Obstetric Pathology. First edition. Philadelphia, PA: Elsevier Saunders, 2006. Pp. 441-491.
8. Kitaya K., Yasuo T. Aberrant expression of selectin E, CXCL1 and CXCL13 in chronic endometritis. Mod. Pathol, 2010, vol. 23, pp. 1136-1146.
9. Mutter G.L., Prat J. Pathology of the Female Reproductive Tract. Third Edition. UK: Churchill Livingstone, 2014. Pp. 326-348.
10. Johnston-MacAnanny E.B., Hartnett J., Engmann L.L. et al. Chronic endometritis is a frequent finding in women with recurrent implantation failure after in vitro fertilization. Fertil. Steril, 2010, vol. 93, pp. 437-441.
11. Kitaya K., Yasuo T. Immunohistochemistrical and clinicopathological characterization of chronic endometritis. American Journal of Reproductive Immunology, 2011, vol. 66, pp. 410-415
12. Pitsos M., Skurnick J., Heller D. Association of pathologic diagnoses with clinical findings in chronic endometritis. J. Reprod. Med, 2009, vol. 54 (6), pp. 373-377.
13. Cicinelli E., De Ziegler D., Nicoletti R. et al. Chronic endometritis: correlation among hysteroscopic, histologic, and bacteriologic findings in a prospective trial with 2190 consecutive office hysteroscopies. Fertil. Steril, 2008, vol. 89, no. 3, pp. 677-684.
14. Allan P.L., Baxter G.M., Weston M.J. Clinical Ultrasound. Third Edition. Elsevier limited, 2011. Chapter 36. P. 709.
15. Guo G.L., Chen S.Y., Zhang W., et al. Diagnosis value of hysteroscopy for chronic endometritis. Clin. Exp. Obstet. Gynecol, 2013, vol. 40, no. 2, pp. 250-252.
16. Cicinelli E., Tinelli R., Lepera A., et al. Correspondence between hysteroscopic and histologic findings in women with chronic endometritis. Acta Obstet. Gynecol. Scand, 2010, vol. 89, no. 8, pp. 1061-1065.
17. Polisseni F., Bambirra E.A., Camargos A.F. Detection of chronic endometritis by diagnostic hysteroscopy in asymptomatic infertile patients. Gynecol. Obstet. Invest, 2003, vol. 55, no. 4, pp. 205-210.
18. Cravello L., Porcu G., D’Ercole C., et al. Identification and treatment of endometritis. Contracept. Fertil. Sex, 1997, vol. 25 (7-8), pp. 585-586.
19. Dotto J.E., Lerna B., Dotto J.R. et al. Classification of micro-hysteroscopic images and their correlation with histologic findings. J. Am. Assoc. Gynecol. Laparosc, 2003, vol. 10, pp. 233-246.
20. Kumar A. Varied Appearances of Chronic Endometritis at Hysteroscopy. Journal of Minimally Invasive Gynecology, 2012, vol. 19, iss. 6, suppl, pp. S111-S112.
21. Cicinelli E., Resta L., Nicoletti R., et al. Endometrial micropolyps at fluid hysteroscopy suggest the existence of chronic endometritis. Hum. Reprod, 2005, vol. 20, pp. 1386-1389.
22. Küçük T., Safali M. “Chromohysteroscopy” for evaluation of endometrium in recurrent in vitro fertilization failure. J. Assist. Reprod. Genet, 2008, vol. 25, iss. 2-3, pp. 79-82.
23. Tawfik O., Venuti S., Brown S. et al. Immunohistochemical characterization of leukocytic subpopulations in chronic endometritis. Infectious Diseases in Obstetrics and Gynecology, 1996, vol. 4, iss. 5, pp. 287-293.
24. Greenwood S.M., Moran J.J. Chronic endometritis: morphologic and clinical observations. Obstet. Gynecol, 1981, vol. 58, iss. 2, pp. 176-184.
25. Achilles S.L., Amortegui A.J., Wiesenfeld H.C. Endometrial plasma cells: do they indicate subclinical pelvic inflammatory disease? Sex. Transm. Dis, 2005, vol. 32, no. 3, pp. 185-188.
26. Robboy S.J. Robboy’s Pathology of the Female Reproductive Tract. Elsevier Health Sciences, 2009. Ch. 14. Endometritis, metaplasias, polyps, and miscellaneous changes. Pp. 344-347.
27. Adegboyega P.A., Pei Y., McLarty J. Relationship between eosinophils and chronic endometritis. Hum Pathol, 2010, vol. 41, no. 1, pp. 33-37.
28. Gilmore H., Fleischhacker D., Hecht J.L. Diagnosis of chronic endometritis in biopsies with stromal breakdown. Human Pathology, 2007, vol. 38, no. 4, pp. 581-584.
29. Vicetti Miguel R.D., Chivukula M., Krishnamurti U. et al. Limitations of the criteria used to diagnose histologic endometritis in epidemiologic pelvic inflammatory disease research. Pathol. Res. Pract, 2011, vol. 207, no. 11, pp. 680-685.
30. Inki P. Expression of syndecan-1 in female reproductive tract tissues and cultured keratinocytes. Mol. Hum. Reprod, 1997, vol. 3, no. 4, pp. 299-305.
31. Centers for Disease Control and Prevention, Workowski K.A., Berman S.M. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep, 2006, vol. 55, no. RR-11, pp. 1-94.
32. Kiviat N.B., Wølner-Hanssen P., Eschenbach D.A. Endometrial histopathology in patients with culture proved- upper genital tract infection and laparoscopically diagnosed acute salpingitis. Am. J. Surg. Pathol, 1990, vol. 14, no. 2, pp. 167-175.
33. Ness R.B., Soper D.E., Holley R.L. et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial. Am. J. Obstet. Gynecol, 2002, vol. 186, no. 5, pp. 929-937.
34. Paukku M., Puolakkaien M., Paavonen T. et al. Plasma cell endometritis is associated with Chlamydia trachomatis infection. Am. J. Clin. Pathol, 1999, vol. 112, no. 2, pp. 211-215.