An immunohistochemical study of metroplastic surgical specimens from patients with a septate uterus

Abstract

Purpose

To elucidate the etiology of recurrent pregnancy loss in patients with congenital uterine anomalies, an immunohistochemical technique was used to quantitatively evaluate the vascular arrangement of septate uteri with respect to vascular density and morphology.

Methods

Nine specimens obtained from patients who had undergone metroplastic surgery for the treatment of a septate uterus and 10 control specimens from patients who had undergone a hysterectomy because of cervical carcinoma were used in this study. Formalin-fixed paraffin-embedded uterine specimens were then immunostained for CD34, which is specifically expressed in vascular endothelial cells.

Results

The mean blood vessel count (mean ± SD) for the myometrium was 149.7 ± 22.7/field in the septate uteri and 162.2 ± 36.4/field in the control uteri; these values were not significantly different. However, the total vessel cross-sectional areas, as evaluated quantitatively using the KS400 image analysis system, were 10350.4 ± 1024.3 μm²/field for the septate uteri and 12002.9 ± 2232.3 μm²/field for the control uteri; these values were significantly different (p < 0.05). The vessel morphology expressed by vessel irregularity and deformity showed a characteristic change in the septate uterus.

Conclusions

A significant difference in the distribution of the blood vessels existed between the septate and control uteri, presumably impairing blood flow in the myometrium and the adverse pregnancy outcome.

References Abnormalities of the reproductive tract. In: Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Gilstrap III LC, Wenstrom KD, editors. Williams Obstetrics, 22nd ed. New York: McGraw-Hill; 2005. Makino T, Hara T, Oka T, Toyoshima K, Sugi T, Iwasaki K, Umeuchi M, Iizuka R. Survey of 1120 Japanese women with a history of recurrent spontaneous abortions. Eur J Obstet Gynecol Reprod Biol, 1992, 44, 123–130 10.1016/0028-2243(92)90057-6 Raga F, Bauset C, Remohi J, Bonilla-Musoles F, Simon C, Pellicer A. Reproductive impact of congenital Müllerian anomalies. Hum Reprod, 1997, 12, 2277–2281 10.1093/humrep/12.10.2277 Treffers PE Huisyis HJ Lind T. Uterine cause of early pregnancy failure: a critical evaluation. Early pregnancy failure, 1990 Edinburgh Churchill Livingstone 114–147 Mizuno K, Koike K, Ando K. Significance of Jones–Jones operation on double uterus: vascularity and dating of endometrium in uterine septum. Jpn J Fertil Steril, 1978, 29, 9 Blum M. Comparative study of serum CAP activity during pregnancy in malformed and normal uterus. J Perinat Med, 1978, 6, 165–168 10.1515/jpme.1978.6.3.165 Keller DW, Wiest WG, Askin FB. Pseudocorpus luteum insufficiency: a local defect of progesterone action on endometrial stroma. J Clin Endocrinol Metab, 1979, 48, 127–132 10.1210/jcem-48-1-127 Simon C, Martinez L, Pardo F, Tortajada M, Pellicer A. Mullerian defects in women with normal reproductive outcome. Fertil Steril, 1991, 56, 1192–1193 Makino T, Umeuchi M, Nakada K, Nozawa S, Iizuka R. Incidence of congenital uterine anomalies in repeated reproductive wastage and prognosis for pregnancy after metroplasty. Int J Fertil, 1992, 37, 167–170 Laak JAWM, Westphal JR, Schalkwijk LJM, Pahlplatz MMM, Ruiter DJ, waal RMW, Wilde PCM. An improved procedure to quantify tumor vascularity using true color image analysis: comparison with the manual hot spot procedure in a human melanoma xenograft model. J Pathol, 1998, 184, 136–143 10.1002/(SICI)1096-9896(199802)184:2<136::AID-PATH970>3.0.CO;2-9 Buttum VC Jr, Gibbons WE. Müllerian anomalies: a proposed classification (an analysis of 144 cases). Fertil Steril, 1979, 32, 40–46 McShane PM, Reilly RJ, Schiff I. Pregnancy outcome following Tompkins metroplasty. Fertil Steril, 1983, 40, 190–194 The American Fertility Society classification of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, Mullerian anomalies and intrauterine adhesions. Fertil Steril. 1988;49:944–55. Auderbert AJ, Cittadini E, Cognat M. Habitual abortion and uterine malformations. Acta Eur Fertil, 1983, 14, 273–278 Moutos DM, Damewood MD, Schlaff WD, Rock JA. A comparison of the reproductive outcome between women with a unicornuate uterus and women with a didelphic uterus. Fertil Steril, 1992, 58, 88–93 Burchell RC, Creed F, Rasoulpour M, Whitcomb M. Vascular anatomy of the human uterus and pregnancy wastage. Br J Obstet Gynaecol, 1978, 85, 698–706 10.1111/j.1471-0528.1978.tb14950.x Fina L, Molgaad HV, Robertson D, Bradley NJ, Monaghan P, Delia D, Sutherland DR, Baker MA, Greaves MF. Expression of the CD34 gene in vascular endothelial cells. Blood, 1990, 75, 2417–2426 Tanigawa N, Amaya H, Matsumura M, Shimomatsuya T, Horiuchi T, Muraoka R, Iki M. Extent of tumor vascularization correlates with prognosis and hematogenous metastasis in gastric carcinomas. Cancer Res, 1996, 56, 2671–2676 Buttram VC Jr. Müllerian anomalies and their management. Fertil Steril, 1983, 40, 159–163 Fedele L, Dorta M, Brisoshi D, Giudici MN, Candiani GB. Pregnancies in septate uteri: outcome in relation to site of uterine implantation as determined by sonography. Am J Roentgenol, 1989, 152, 781–784 Lavergne N, Aristizabal J, Zarka V, Erny R, Hedon B. Uterine anomalies and in vitro fertilization: what are the results?. Eur J Obstet Gynecol Reprod Biol, 1996, 68, 29–34 10.1016/0301-2115(96)02459-1 Dabirashrafi H, Bahadori M, Mohammad K, Alavi M, Moghadami-Tabrizi N, Zandinejad K, Ghafavi V. Septate uterus: new idea on the histologic features of the septum in this abnormal uterus. Am J Obstet Gynecol, 1996, 172, 105–107 10.1016/0002-9378(95)90093-4 Rock JA, Murphy AA. Anatomic abnormalities. Clin Obstet Gynecol, 1986, 29, 886–911 10.1097/00003081-198612000-00015 Golan A, Langer R, Neuman M, Wexler S, Segev E, David MP. Obstetric outcome in women with congenital uterine malformations. J Reprod Med, 1992, 37, 233–236 Homer HA, Li TC, Cooke ID. The septate uterus: a review of management and reproductive outcome. Fertil Steril, 2000, 73, 1–14 10.1016/S0015-0282(99)00480-X Nakada K, Makino T, Tabuchi T, Iizuka R. Analysis of congenital uterine anomalies in habitual abortions and evaluation of metroplasty. Jpn J Fertil Steril, 1989, 34, 842–848 Jones HW Jr, Jones GE. Double uterus as an etiological factor in repeated abortion: indication for surgical repair. Am J Obstet Gynecol, 1953, 65, 325–339 Tompkins P. Comments on the bicornuate uterus and twinning. Surg Clin North Am, 1962, 42, 1049–1062 Ayhan A, Yucel I, Tuncer ZS, Kisnisci HA. Reproductive performance after conventional metroplasty: an evaluation of 102 cases. Fertil Steril, 1992, 57, 1194–1196 Makino T. Effective treatment for recurrent pregnancy loss. Reprod Immunol Biol, 2010, 25, 1–13 10.3192/jsirib.25.1