The characteristic features of pelvic peritoneal adhesions’ morphology in women of reproductive age Ganna Sulima M.D., Ph.D., Oleksandra Davydova M.D., Ph.D.

Study Objective To examine the morphological structure of the pelvic peritoneal adhesions at fertile women and forecast scientifically the future behavior of formed adhesions after adhesiolysis.

Design The morphological and immunohistochemical study of adhesions are carried out by standard techniques using of monoclonal CD68 antibodies.

Setting Department of Obstetrics, Gynaecology and Perinatology and Department of Pathological Anatomy with Sectional Course, the Crimean State Medical University.

Patients Fifty women (aged yrs) with pelvic peritoneal adhesions.

Interventions Laparoscopic adhesiolysis in conjunction with other laparoscopic procedures.

Measurements and Main Results Morphological examination of the pelvic peritoneal adhesions revealed differences in cellular and fiber composition depending on the genesis. The different activity of CD68 positive macrophages was found, indicating that moderate inflammatory reaction and self-sustaining progress of adhesions.

Figure 1. Postoperative pelvic adhesion is represented by coarse-fibered connective tissue with expelled focal mesothelial cells. Hematoxylin - eosin. Increase in 100 times. Figure. 2. Weak expression of CD68- positive cells in the postoperative pelvic adhesion. Immunohistochemistry. Increase in 400 times. Postoperative adhesions are usually found in previous surgery. Morphologically, their structure is characterized by low cells and the extensive growth of the coarse-fibered connective tissue, poor vascularization and poor expression of CD68 in separate cells (n=6,7±0,99).

Figure 3. Coarse-fibered connective tissue with lymphoplasmocytic cell infiltration. Figure. 4. Weak expression of CD68- positive cells in pelvic inflammatory desease. Immunohistochemistry. Increase in 400 times. Pelvic peritoneal adhesions in women who suffered from chronic pelvic inflammatory diseases contain a moderate or small number of CD68-positive macrophages (n=10,4±2,12), poor lymphoplasmocytic cell infiltration and vascularization; connective tissue had a coarse-fibered structure with areas of smooth muscle accumulation and, rarely, nerve fibers and had a well-developed layer of mesothelial cells.

Figure 5. Severe circulatory disorders of pelvic peritoneal adhesion in case of endometriosis. Hematoxylin - eosin. Increase in 400 times. Figure. 6. Severe diffuse expression of CD68- positive cells in a pelvic peritoneal adhesion in case of endometriosis. Immunohistochemistry. Increase in 400 times. A result of endometriosis, a friable fibrous connective tissue with a relatively small number of mesothelial cells, focal hemorrhages and massive vascularization was morphologically found in the adhesions. Immunohistochemical method found the increased activity and predominance of mature CD68-positive macrophages (n=23,8±1,38).

Discussion Morphological examination of the pelvic peritoneal adhesions revealed differences in cellular and fiber composition depending on the genesis. CD68-positive cells (macrophages) were found in all observations, but their number varied depending on the pathogenesis of adhesions and exceeded significantly at the patients with external endometriosis. These differences may partly explain the unequal dynamics of adhesions process in the formation of adhesions, as well as their different sensitivity to the preventive and curative effects.

Thank you for your attention!!!