Immunohistochemical Study Of Angiogenic Factors VEGF, BFGF, TNF-α And PCNA In Endometrium And Endometriosis

Objective: According to current theory, endometriosis is initiated during retrograde menstruation when menstrual fragments flow out of the fimbriated end of the fallopian tubes and become established on the ovarian surface or other sites in the peritoneal cavity. Angiogenesis is important in the pathophysiology of endometriosis, a condition characterized by implantation of ectopic endometrium in the peritoneal cavity. Studies have shown that angiogenesis factors may play an important role in development of endometriosis. Vascular endothelial growth factor (VEGF) is a potent angiogenic factor involved in physiological and pathological angiogenesis, and elevated levels of VEGF are found in peritoneal fluid of patients with endometriosis. bFGF and TNF-a might also be related toangiogenesis of ectopic endometrium. Our aim was to investigate the angiogenic activity of the eutopic and ectopic endometrium throughout the menstrual cycle (menstrual, proliferative and secretory) and to examine whether the activity of the eutopic endometrium is useful to predict greater activity of the eutopic and ectopic endometrium.Method: Biopsies from 32 cases with ectopic endometrium and the corresponding eutopic endometrium and 33 cases with normal endometrium were collected. Immunohistochemical staining was performed using VEGF, bFGF, PCNA, and TNF-a antibody, and histological score was used to semi-quantify the results.The immunoreactions of vascular endothelial growth factor (VEGF), base fibroblast growth factor (bFGF), tumor necrosis factor alpha (TNF-a), and proliferating cell nuclear antigen (PCNA) in eutopic and ectopic endometrium were examined. Results: Results showed that VEGF showed cyclic variation in eutopic and eutopic endometrium, and the immunoexpressions of VEGF were significantly higher in the eutopic endometrium of patients with endometriosis than in that of normal endometrium. There was no cyclic change is observed in ectopic and eutopic endometrium of bFGF, but immunoexpressions ofbFGF were significantly higher in the eutopic endometrium of patients with endometriosis than in that of normal endometrium. PCNA and TNF-a showed a cyclic change, but there were no different between eutopic endometrium of endometriosis and in that of normal endometrium. We observed a significant correlation between the immunoexpressions of VEGF and bFGF, VEGF and TNF-a in eutopic and ectopic endometrium. Conclusion: Our studies demonstrates that the pathogenesis and activity of endometriosis possibly depend of internal angiogenesis, and VEGF and bFGF may paly an important role in pathogenesis of endometriosis.