RESUMEN
Massive perivillous fibrin deposition (MFD) is a rare condition characterized by heavy accumulation of fibrin in intervillous or perivillous spaces encasing villi throughout the placenta. This condition may cause varying degrees of placental insufficiency, leading to a significantly increased risk of intrauterine growth retardation, intrauterine death, and pre-term delivery. However, the objective criteria for the diagnosis of MFD have not been clearly established. We report a case of MFD associated with intrauterine growth retardation and preterm premature rupture of membranes.
RESUMEN
OBJECTIVE: This study was aimed to investigate the role of matrix metalloproteinase-2 (MMP-2) and inhibitor of metalloproteinase-2 (TIMP-2) for pathogenesis of endometriosis and adeonomyosis by the comparison of their expressions with those of ER (nuclear estrogen receptor) and PR (nuclear progesterone receptor) according to menstrual cycle. METHODS: Twenty seven cases of endometriosis, twenty four cases of adenomyosis,and twenty four cases of normal endometrium were classified by menstrual cycle (proliferative phase, early to mid secretory phase, and late secretory phase to menstrual period) and immunohistochemical study for ER, PR, MMP-2 (72 kD, gelatinase A), and TIMP-2 and Western immunoblotting for MMP-2 and TIMP-2 were performed. RESULTS: The results revealed increased expressions of MMP-2 and TIMP-2 in the epithelial cells of endometriosis throughout cycle compared with uterine endometrium. Expression of MMP-2 and TIMP-2 was weak in adenomyosis. In the epithelium of endometriosis, MMP-2 and ERrevealed a statistical significance each other (p<0.01). Expression of MMP-2 and TIMP-2 in both epithelium and stromal cells of endometriosis of stage 4 was higher than that of stage 1-3 and the expression of MMP-2 in epithelium and stage were statistically significance (p<0.05). PR expression tended to being reduced in both epithelial and stromal cells of endometriosis compared with normal uterine endometrium, except for late secretory phase. Expression of estrogen and progesterone receptors was weak in adenomyosis. By Western immunoblotting study, MMP-2 expression in endometriosis was higher than normal reproductive endometrium. CONCLUSION: The results suggest that the increased expression of MMP-2 associated with the ER expression in epithelium of endometriosis compared with normal endometrium is closely related with the pathogenesis and progression of the endometriosis. Adenomyosis may be associated with different mechanism such as invagination of basal layer of endometrium.