The endometrium undergoes marked morphologic and functional changes in very short
periods of time, and these are controlled by ovarian hormones. These changes of the
endometrium are fundamentally based on biochemical alterations. The endometrium is
composed of surface and glandular epithelium, connective tissue and blood vessels, all of
which participate in the morphologic alteration during the cyclic changes. Thus, to
understand the mechanisms of morphologic alterations and the basis of endometrial
function, histochemical studies concerning the localization of specific chemical and
enzymatic activity are very important (Mckay, et al., 1956; Levine, 1963).
It is the purpose of this report (1) to evaluate histochemical patterns during the
normal cyclic Processes of the endometrium, and (2) to search for the histochemical
differences in various conditions of endometrium compared with normal endometrium.
Material and Methods
Ninety specimens of endoinetrium removed by curette were obtained from patients for
diagnosis of disease, and sterility at the Department of Gynecology, Yonsei University
Medical Center. The histologic criteria of Noyes, et al. (1951) were used to establish the
state of each specimen.
Of the 25 normal specimens, 9 were proliferative, 14 were secretory, and 2 were
menstrual. The 65 abnormal endometriums consisted of 16 with intrauterine pregnancies,
16 with ectopic pregnancies, 25 with hyperplasia, 3 with atypical hyperplasia, 3 with
adenocarcinoma, and 2 with endometrial polyp. A portion of each specimen was
frozen-sectioned and prepared for the activity of alkaline phosphatase by Gomori's
metal-salt method (1939).
The remainder of each specimen was fixed in 10% neutral formalin solution. The
paraffin-embedded sections were stained by hematoxylin and eosin, periodic acid-Schiff
reaction for glycogen and glycoprotein, alcian blue stain for acid mucopoly-saccharides,
and methylgreen pyronin stain for ribonucleic acid.
Result and Summary
1. The PAS positive material, regarded as glycogen, or glycoprotein, underwent cyclic
change in surface as well as in glandular epithelium of the normal endometrium. The
amount of the material was greater in the secretory endometrium than in the
proliferative endometrium and was also large in the endontetrium of intra as well as
ectopic pregnancies. However, in hyperplasia and adenocarcinoma, the PAS positive
material was small in amount as in the proliferative endometrium.
2. The acid mucopolysaccharides which were located chiefly along the brush border of
epithelium and in the stroma, revealed its cyclicity, and increased in the secretory
endometrium.
3. The most interesting observation relates to the uterine change in hyperplasia and
adenocarcinoma of endometrium, where diffuse staining of cytoplasm of the epithelial
cells was observed with the acid mucopolysaccharides method.
4. No significant histochemical differences were found in the endometrium between
intrauterine pregnancy and ectopic pregnancy.
5. Arias-Stella atypias were observed in 62.5% of ectopic pregnancies and in 31.3% of
intrauterine pregnancies. These cells consisted of actively secreting cells, which possibly
was due to apocrine secretion.
6. The large quantity of ribonucleic acid granules, which were observed diffusely in
the cytoplasm of epithetial cells in proliferative and hyperplastic endometrium, was
interpreted as an index of active protein synthesis in these conditions. Those which
were concentrated above or near the nuclei of the epithelial cells seemed to be
concerned with the secretory function in secretory and pregnant endometrium.
7. The cyclicity of the alkaline phosphatase activity was well demonstrated in the cell
membrane of the epithelium, whereas the enzymatic activity in the blood vessels did not
show cyclic change. In the proliferative endometrium the epithelial activity was higher
than in the secretory or pregnant endometrium but in hyperplasia and adenocarcinoma it
varied from gland, or from cell to cell.
8. Estrogen was considered to contribute more to the development of hyperplasia and
adenocarcinoma than progesterone because the histochemical findings of these abnormal
conditions were more or less similar to those of proliferative endometrium, although
irregular findings were also noted in hyperplasia or adenocarcinoma.
9. The staining reactions of the endometrium in the secretory phase of the cycle and
in ectopic pregnancy are quantitatively different because they are both under the
influence of progesterone.
Acknowledgement
This study was partly supported by the Population Council, New York, N.Y.,
U.S.A.(Grant No. M69.184 and M71.0136 to Soon O Chung).
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