MORPHOLOGIC ASSESSMENT OF ENDOMETRIUM OVERLYING SUBMUCOSAL LEIOMYOMAS

The effect of submucosal leiomyomas on endometrial structure in women with symptomatic clinical findings was studied retrospectively, The en dometrial histology from 13 hysterectomies for uterine leiomyomas teas examined using three 2-mm sections of endometrium (one overlying a su bmucosal leiomyoma and two without underlying leiomyomas). Endometrial thickness, gland number and appearance, vessel number and diameter, a nd stromal inflammation were assessed. The thickness of the myometrium between the leiomyoma and the overlying 2-mm section of endometrium a nalyzed was also evaluated. The control group consisted of seven nonmy omatous uteri removed for benign disease. Analysis of the endometrium with underlying submucosal leiomyomas identified two groups using endo metrial gland number as the criterion for this division. Five cases (g roup A) were found to have no endometrial glands, while the remaining eight (group B) had an average gland number of 74.5 per 2-mm section o f endometrium. The mean gland number for the control group was 82.6, s howing no significant difference from group B. Group A hall an average endometrial area (2-mm thickness) of 0.38 mm(2), and group B had an a verage area of 4.47 mm(2), for a significant difference (t = -3.76, P = .007). Comparison of the two groups with the control group (mean are a, 4.71 mm(2)) showed a significant difference in endometrial area onl y with group A (t = -7.64, P < .0005). A significant difference (t = - 2.93, P = .019) was ol?served in the analysis of the thickness of the myometrium between the leiomyoma and overlying endometrium between gro ups A (mean thickness, 0.53 mm) and B (mean thickness, 1.70 mm). No si gnificant patterns were found in the analysis of endometrial phase, ve ssel number and diameter, and stromal inflammation. The results of thi s study indicate that submucosal leiomyomas are associated with struct ural endometrial changes in a subpopulation of women with abnormal cli nical symptomatology who have undergone hysterectomy for uterine leiom yomas. These changes may contribute to the problems seen clinically in women of childbearing age.