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Hum. Reprod. Advance Access published online on June 28, 2006
Human Reproduction, doi:10.1093/humrep/del220
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© The Author 2006. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received August 11, 2005
Revised April 20, 2006
Accepted May 15, 2006

Article

The normal human myometrium has a vascular spatial gradient absent in small fibroids

E. Aitken 1, A. Khaund 1, S.A. Hamid 2 *, D. Millan 3, and S. Campbell 1

1 Division of Developmental Medicine, University of Glasgow, Glasgow Royal Infirmary, London, UK
2 Division of Developmental Medicine, University of Glasgow, Glasgow Royal Infirmary; Division of Cardiovascular Biology and Inflammation, Royal Veterinary College, Royal College Street, London, UK
3 Department of Pathology, North Glasgow Hospitals Trust, Glasgow, London, UK

* To whom correspondence should be addressed.
S.A. Hamid, E-mail: shamid{at}rvc.ac.uk


  Abstract

BACKGROUND: The human uterine vasculature is highly structured, exhibiting circumferential and radial branching. Previously published angiograms of the arterial network [Farrer-Brown G, Beilby JOW and Rowles PM (1970d) Microvasculature of the uterus: an injection method of study. Obstet Gynecol 35,21-30] describe a system of regular coils. Uterine fibroids lack this structured vasculature. In this study, we make a comparison between the vasculature in normal myometrium and in fibroids using robust stereological methods thus far lacking in the literature. METHODS: Stereological and morphometric analysis of the vascular system was carried out on 15 normal and 27 small fibroid (5-40 mm) uteri taken from women suffering menorrhagia. Projected images of the published angiograms of Farrer-Brown et al. were also re-examined, measuring tortuosity. RESULTS: A decreasing gradient of vascular smooth muscle from outer to inner myometrium was found in normal uteri, with no corresponding gradient in capillary tissue fraction. An association between vascular luminal size, amplitude and frequency of vessel bending was also established. Conversely, fibroids were found to lack structured or muscularized vasculature. CONCLUSIONS: A quantitative gradient within the myometrial vascular system, which is absent in fibroids, has been demonstrated. These structural differences between diseased and healthy tissues are probably because of differing expression of angiogenic growth factors and may explain the distribution of particles seen after uterine artery embolization.

Keywords: fibroids/morphometric analysis/stereology/uterine/vasculature.
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