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  • Title: Endometrial lymphomyeloid cells in abnormal uterine bleeding due to levonorgestrel (Norplant).
    Author: Clark DA, Wang S, Rogers P, Vince G, Affandi B.
    Journal: Hum Reprod; 1996 Jul; 11(7):1438-44. PubMed ID: 8671483.
    Abstract:
    Endometrial lymphomyeloid cell subsets were evaluated in samples from normal women and from women with abnormal uterine bleeding due to subcutaneous levonorgestrel implants (Norplant) or an intrauterine device (IUD). The frequency of CD3(+), CD68(+), CD43(+) and endometrial granulated lymphoid cells was evaluated by immunohistochemical or phloxine-tartrazine staining of formalin-fixed paraffin-embedded samples. In normal women, cyclic variation in lymphomyeloid subsets was seen. In women using Norplant for contraception, the frequency of CD3(+), CD68(+) and CD43(+) cells was dramatically decreased, compatible with endometrial atrophy. When Norplant users with abnormal bleeding were compared to women without bleeding, however, the number of CD68(+) cells was significantly increased and the number of CD3(+) and CD43(+) cells was preserved, contrary to the hypothesis that this group would show a greater degree of atrophy and hence, tissue fragility. A similar pattern was seen in a preliminary study of women with bleeding associated with use of copper-only IUD contraception, and in samples taken from late secretory and menstrual biopsies from normal cycling women. Whether these changes in endometrial lymphomyeloid cells represent a result of bleeding arising from a common mechanism or rather cause the uterine bleeding is discussed. In Australia, Canada, China, Indonesia, and the UK, physicians performed endometrial biopsies on women with infertility caused by tubal blockage or male factor who had not used exogenous hormones or used an IUD in the last 3 months or who had uterine pathology and on healthy fertile women. Researchers aimed to determine the prevalence of different types of endometrial cells in women with no abnormal bleeding and those with abnormal bleeding caused by levonorgestrel contraceptive implants (Norplant) or an IUD. They used immunohisto-chemical or phloxine-tartrazine staining of formalin-fixed paraffin-embedded samples to determine the frequency of CD3+, CD68+, CD43+, and endometrial granulated lymphoid cells. Women with no abnormal bleeding experienced cyclic variation in lymphomyeloid subsets. Norplant users had such significantly lower CD3+, CD68+, and CD43+ cells that the situation corresponded to endometrial atrophy. Norplant users with abnormal bleeding had significantly higher CD68+ cells than Norplant users without abnormal bleeding (399 vs. 254/cu. mm). Their CD3+ and CD43+ cells were not significantly different. Overall, the numbers of lymphomyeloid cells were markedly different than normal women with no abnormal bleeding for all Norplant users and those with abnormal bleeding. These patterns were essentially repeated for users of a copper releasing IUD with abnormal bleeding and during the late secretory and menstrual phases in normal women. These studies demonstrate that researchers can use conventionally processed endometrial samples to study endometrial lymphomyeloid cell populations in uterine bleeding. Further research is needed to examine the role of uterine lymphomyeloid cells and their cytokines in abnormal uterine bleeding as well as the functional activities of these cells.
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