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Objection: To study the origin and morphological substrate of pain syndrome in deep infiltrating endometriosis involving the bowel., Subjects and Methods: The investigation was conducted using the intraoperative material (resected portions of the large and small bowels, appendix) obtained from 40 women diagnosed as having deep infiltrating endometriosis involving the bowel, which was accompanied by pain syndrome. Paraffin sections were immunohistochemically examined using the standard protocol. Antibodies to Ki-67, PTEN, ER, PR, ("Dako"), CD34 ("Cell Marque", USA), VEGF, EGF, EGFR, COX-2 ("Abcam"), and MMP 1 and 2 ("Abbiotec") were applied. Dako REAL EnVision Detection System kits ("Dako", Denmark) were used as secondary antibodies., Results: The morphological substrate of pelvic pain syndrome in deep infiltrating endometriosis was established to be factors that acted in situ at the location of endometriotic foci and those caused by the infiltrative perivascular, intravascular, and perineural growth of endometrioid heterotopies., Conclusion: Inflammation and fibrosis in the endometriotic foci contribute to the accumulation of algogenes, which gives rise to somatogenic pain syndrome, and chronic nerve fiber injury as a source of nociceptive stimulation leads to neuropathic pain syndrome.

The results of an annual prophylactic medical examination were studied in 288 women aged 60-87 years. Primary and repeated visits revealed that 92.9% of the patients had endometrial pathology presented with glandular-fibrous polyps that both recurred and occurred de novo. Adenocarcinomas developing 4-14 years after polypectomy were diagnosed in 7.1% of the women. Focal impairments in the differentiation of an epithelial component of endometrial polyps in their recurrences and repeated development were noted in 97.3% of cases. In 88% of the patients, complaints were absent and recurrent endometrial pathology, including one of three adenocarcinomas, were diagnosed by prophylactic medical examination. The false-positive diagnoses of endometrial pathology by ultrasound study were 5.2%. Hysteroscopy in combination with morphology study should be recognized to be the gold standard for diagnosing pathologic endometrial lesions.

The molecular biological features of the eutopic and ectopic endometrium were studied in 46 patients with adenomyosis, 44 with endometrioid cysts in the ovaries, and 34 with disseminated mixed forms of genital endometriosis. Reproductive-aged patients with the eutopic endometrium in a proliferation phase with hyperplastic or inflammatory changes were selected. Ten samples of the endometrium in a phase proliferation, which had been obtained at medicolegal autopsy of women without reproductive disorders, were studied as a control group. Both the glandular and stromal components of the ectopic and eutopic endometrium in different forms of endometriosis were shown to differ from the intact endometrium in their molecular biological features (the expression of Ki-67, Bcl-2, Bax, vascular endothelial growth factor, transforming growth factor-beta1, matrix metalloproteinases 2 and 10, matrix metalloproteinase-2 inhibitor, the enzyme cytochrome P450 aromatase.

An immunoperoxidase test was used to reveal the expression of cytochrome P-450 aromatase in the eutopic and ectopic endometrium of 14 patients with ovarian endometriosis and 26 with adenomyosis, whose age ranged from 21 to 47 years (38+/-2.0 years). Five endometrial samples taken at autopsy from the women who had died from injuries at ages of 32 to 47 years and who had no uterine or ovarian abnormities served as the control. Control observations revealed no aromatase expression by endometrial epithelial and stromal cells. Aromatase expression in the eutopic endometrium was found in patients with ovarian endometriosis and adenomysis in 80 and 58% of cases, respectively; while that in the ectopic endothelium was in all cases in both groups. In external genital endometriosis, the sensitivity and specificity of the test were 75 and 100%, respectively. In the glandular and stromal epithelium of both the ectopic and eutopic endometrium, aromatase expression increased with the higher extent of endometriosis.

A combined cellular transplant for injection has been designed, by using lowly differentiated stromal fat tissue cells obtained from Wistar rats and it preserved biological and physical properties after passing through a small-diameter injection needle (an insulin syringe). A morphological study of the results of its transplantation into paraurethral tissues in 28 female rats showed that the transplant cells, autologous ones in particular, activated the proliferation of local connective tissue cell populations and retained their viability and proliferative and synthetic activities up 20 days or more. At the end of the experiment (on days 27-35), marked focal connective tissue enlargement at the site of injection of both allo- and autografts results in the narrowing of the urethral lumen. The injection implantation of combined allo- and autografts opens up new avenues for the treatment of pathological processes of the reproductive and urinary tracts.