Kotsabin N. V., Boychuk A. V., Kosharniy V. V.

MORPHOLOGICAL CHARACTERISTICS OF THE ENDOMETRIUM IN PATIENTS WITH CHRONIC ENDOMETRITIS

---

Show/Download

About the author:

Kotsabin N. V., Boychuk A. V., Kosharniy V. V.

Heading:

MORPHOLOGY

Type of article:

Scientific article

Annotation:

Chronic endometritis is a prolonged inflammatory process of the endometrium that often follows an asymptomatic or paucisymptomatic course and may be associated with reproductive dysfunction. Morphological verification of the disease is crucial, as histological examination allows for the assessment of endometrial structural remodeling, while CD138 immunohistochemistry enables the detection of plasma cells. The aim of the study was to conduct a comprehensive histological and immunohistochemical assessment of endometrial morphological changes in patients with chronic endometritis. Endometrial biopsy samples obtained during the proliferative phase of the menstrual cycle were analyzed. Histological examination was performed using hematoxylin and eosin staining. Parameters evaluated included endometrial architecture, gland shape and distribution, the ratio of glandular to stromal components, stromal cellularity, the nature of inflammatory infiltration, the state of spiral arteries, and structural changes in stromal cells. Immunohistochemical analysis using anti-CD138 antibodies was employed to detect plasma cells, and their numbers were quantified across 10 fields of view. Histological analysis revealed complex endometrial remodeling: irregular distribution of glands of varying calibers, altered ratios of glandular to stromal components, uneven stromal cellularity, and focal or diffuse lymphoplasmacytic infiltration. In some biopsy samples, spindle-shaped transformation of stromal cells, incomplete shedding of the functional layer, sclerotic changes in spiral arteries, micropolyps, and polypoid formations were observed. CD138- positive plasma cells were detected in all cases examined; their count ranged from 6 to 28 cells per 10 fields of view. The results indicate that chronic endometritis is accompanied not only by plasmacytic infiltration but also by complex remodeling of the glandular, stromal, and vascular components of the endometrium. Combining histology with CD138 immunohistochemistry enhances the objectivity of the morphological verification of the disease.

Tags:

Bibliography:

1. Kitaya K, Matsubayashi H, Yamaguchi K, Nishiyama R, Takaya Y, Ishikawa T, et al. Chronic endometritis: potential cause of infertility and obstetric and neonatal complications. Am J Reprod Immunol. 2016;75(1):13-22. DOI: https://doi.org/10.1111/aji.12438
2. Kimura F, Takebayashi A, Ishida M, Nakamura A, Kitazawa J, Morimune A, et al. Review: Chronic endometritis and its effect on reproduction. J Obstet Gynaecol Res. 2019;45(5):951-960. DOI: https://doi.org/10.1111/jog.13937
3. Ticconi C, Inversetti A, Marraffa S, Campagnolo L, Arthur J, Zambella E, et al. Chronic endometritis and recurrent reproductive failure: a systematic review and meta-analysis. Front Immunol. 2024;15:1427454. DOI: https://doi.org/10.3389/fimmu.2024.1427454
4. Vitagliano A, Laganà AS, De Ziegler D, Cicinelli R, Santarsiero CM, Buzzaccarini G, et al. Chronic endometritis in infertile women: impact of untreated disease, plasma cell count and antibiotic therapy on IVF outcome—a systematic review and meta-analysis. Diagnostics (Basel). 2022;12(9):2250. DOI: https://doi.org/10.3390/diagnostics12092250
5. Kitaya K, Takeuchi T, Mizuta S, Matsubayashi H, Ishikawa T. Endometritis: new time, new concepts. Fertil Steril. 2018;110(3):344-350. DOI: https://doi.org/10.1016/j.fertnstert.2018.04.012
6. Cicinelli E, Haimovich S, De Ziegler D, Raz N, Ben-Tzur D, Andrisani A, et al. MUM-1 immunohistochemistry has high accuracy and reliability in the diagnosis of chronic endometritis: a multi-centre comparative study with CD-138 immunostaining. J Assist Reprod Genet. 2022;39(1):219-226. DOI: https://doi.org/10.1007/s10815-021-02356-1
7. Huang W, Liu B, He Y, Xie Y, Liang T, Bi Y, et al. Variation of diagnostic criteria in women with chronic endometritis and its effect on reproductive outcomes: a systematic review and meta-analysis. J Reprod Immunol. 2020;140:103146. DOI: https://doi.org/10.1016/j.jri.2020.103146
8. Santoro A, Travaglino A, Inzani F, Angelico G, Raffone A, Maruotti GM, et al. The role of plasma cells as a marker of chronic endometritis: a systematic review and meta-analysis. Biomedicines. 2023;11(6):1714. DOI: https://doi.org/10.3390/biomedicines11061714
9. Bulut H, Yeğinaltay T, Tunç M, Berkkanoğlu M, Töre H, Coetzee K, et al. Chronic endometritis diagnosed using a cut-off of ≥5 CD138 plasma cells significantly affects the reproductive outcomes of frozen embryo transfer: a case-control study. J Turk Ger Gynecol Assoc. 2023;24(3):165-171. DOI: https://doi.org/10.4274/jtgga.galenos.2023.2022-9-20
10. Xiong Z, Zhang W, Liu S, Liu K, Wang J, Qin P, et al. The combination of CD138/MUM1 dual-staining and artificial intelligence for plasma cell counting in the diagnosis of chronic endometritis. Am J Reprod Immunol. 2023;89(3):e13671. DOI: https://doi.org/10.1111/aji.13671
11. Dang J, Xiao X, Li M. Correlation of hysteroscopic findings of chronic endometritis with CD138 immunohistochemistry and their correlation with pregnancy outcomes. J Assist Reprod Genet. 2024;41(9):2477-2483. DOI: https://doi.org/10.1007/s10815-024-03204-8
12. Ilic J, Issa J, Varinot J, Bouaziz J, Massin N, Haddad B, et al. Chronic endometritis diagnosis and fertility outcomes: an old unresolved question. Reprod Fertil. 2025;6(4):e250016. DOI: https://doi.org/10.1530/RAF-25-0016
13. Kong J, Zhao J, Sun X, Sun T, Tang L. The impact of CD138 plasma cell severity on IVF-ET outcomes in women with untreated chronic endometritis: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2026;26(1):527. DOI: https://doi.org/10.1186/s12884-026-09016-1
14. HogenEsch E, Hojjati R, Komorowski A, Maniar K, Pavone ME, Bakkensen J, et al. Chronic endometritis: screening, treatment, and pregnancy outcomes in an academic fertility center. J Assist Reprod Genet. 2023;40(10):2463-2471. DOI: https://doi.org/10.1007/s10815-023-02902-z

Publication of the article:

«Bulletin of problems biology and medicine», 2026 Issue 3, 182, 417-422 pages, index UDC 618.177:611.018.54:616-089.888

DOI:

110.29254/2077-4214-2026-3-182-417-422