Cesarean Section Scar Endometriomas: Immunohistochemical Staining of Estrogen Receptor-alpha, and CD34

Objective: Cesarean section scar endometriomas (CSSEs) are believed to be the resultof direct inoculation of the subcutaneous tissues or abdominal fascia with endometrialcells during surgery as well as higher immune tolerance during pregnancy. The ectopicendometrium exhibits multiple subtle, but biologically important, molecular abnormalities favoring increased production of estrogen, cytokines, prostaglandins, and metalloproteinases.Patients and Methods: The present study was undertaken to immunohistochemicallystudy the expression of the nuclear estrogen receptors (ERs) alpha and cytoplasmic endothelial cell markers CD34 in 34 cases of CSSEs, 27 cases of ovarian endometriomas(OEs) compared with 18 cases with late proliferative endometrium (PE) as control group Results: The incidence of CSSEs is 0.39% in Mansoura university hospitals, the meantotal score (TS) of ERs-alpha and CD34 assessed by mean vascular density (CD-34 MVD)were significantly increased (p < 0.001) in cases of CSSEs and OEs versus the controlgroup. There was a statistically significant increase in the TS of ERs-alpha (p < 0.001) incases of OEs versus CSSEs. On the other hand, there was no statistically significant difference in CD-34 MVD between cases of CSSEs and OVs. In cases with CSSEs, there wasno significant correlation (r 0.212, p 0.229) between TS of ERs-alpha and CD-34 MVD.No significant correlations were noted between either ERs or CD-34 MVD and age of thepatients, parity, number of prior CSs, duration since the last CS(s) and size of CSSEs.Conclusion: CSSEs are a multifactorial disease, both ERs alpha and CD34 may play arole in the pathogenesis and maintenance of endometriosis. Obstetricians should keep inmind measures to prevent transmission of endometrial cells during CS.