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Ultrastructures of myocytes in uterine
JZ and its alteration in adenomyosis
Beijing Obstetrics and Gynecology Hospital Capital Medical University
Beijing China
Zhang Ying, Duan Hua
Introduction Materials Results Discussion
• JZ : Junctional Zone
— the inner one third myometrium
Anatomy
JZ
OM
Ultrasound Obstet Gynecol 2009; 34: 1–11
JZ
• OM: the outer two third myometrium
Function JZ OM
un-pregnant uterus contraction pregnant uterus contraction
sperm transport
regulate implanation
hemostasis menstruation
Labor
Introduction Materials Results Discussion
Contract
Function
l The contraction of JZ vary in orientation, amplitude and frequency throughout the menstrual
cycle.
Best Practice & Research Clinical Obstetrics and Gynaecology. 2006:523e546.
Introduction Materials Results Discussion
Adenomyosis — JZ related disease
— JZ thickenss≥12mm;
high-signal intensity myometrial foci;
involvement of outer myometrium.
" Imaging:ultrasound, MRI
" Histological diagnosis—gold standard — relied on the identification of endometrial glands within the
myometrium
Introduction Materials Results Discussion
Normal un-pregnant uterus contraction altered
Human Reproduction,1996,11: 1542e1551
Adenomyosis — Disfunc1on of JZ
Introduction Materials Results Discussion
" hyperperistalsis and abnormal peristalsis — may be responsible for the associated clinical symptom such
as dysmenorrhea, metrorrhagia and infer;lity
Ultrastructure of JZ is still unknown
To find the ultrastructral features of JZ
Possible pathogenesis for the abnormal contraction of ADS
Introduction Materials Results Discussion
Objection
Introduction Materials Results Discussion
JZ
OM
Control Adenomyosis
5 Proliferative 5 Secretory 5 Proliferative 5 Secretory
Transmission electron microscope
Introduction Materials Results Discussion
Con
ADS
JZ OM
(× 2500)
" Myocytes arrange:
irregular in JZ
" Collagen fibers are
p rominen t i n t he
extracellular matrix of
JZ
Results 1 ---- JZ vs OM (a)
Introduction Materials Results Discussion
" Both in ADS and Con, myocytes from JZ are smaller than those from OM.
However, in ADS, the difference is significant (P<0.05).
" Both in ADS and Con, the myofilaments /cytoplasm ratio of myocytes from JZ is
significantly less than that from OM (P<0.01) .
Results 1 ---- JZ vs OM (d)
JZ OM P value
Con 4.23±0.66 4.81±0.88 0.141 P>0.05
ADS 3.75±0.53 4.76±0.94 0.015 P<0.05
JZ OM P value
0.67±0.05 0.61±0.04 0.006 P<0.01
0.66±0.04 0.59±0.08 0.021 P<0.05
Myofilaments/cytoplasm ratio Cell mean diameter (µm)
Introduction Materials Results Discussion
(× 10000)
" Rich in organelles.
Abundant with endoplasmic
reticulum (ER), mitochondria
( M T ) a n d G o l g i ( G I ) i n
cytoplasm
" Devoid of contractile
structural components
Results 1 ---- JZ vs OM (b)
Myocytes in JZ
Introduction Materials Results Discussion
Results 1 ---- JZ vs OM (c)
" Rich in contractile structural
components: dense bodies
(white arrows) and the long
dense bands(black arrows)
" Lack in organelles (× 10000)
Myocytes in OM
Introduction Materials Results Discussion
Results 2 ---- JZ between Con and ADS in different phases
" In proliferative phase
ü C e l l s a n d n u c l e i a r e significantly smaller in ADS.
ü Myofilaments/cytoplasm ratio is no significantly different.
" In secretory phase, all p a r a m e t e r s a r e n o t significantly different.
Cell m
ean diam
eter(um)
nuclei mean
diameters (um
)
myofilam
ents/ cytoplasm
ratio
Con ADS
Proliferative phase secretory phase
Con ADS
Introduction Materials Results Discussion
Results 3 ---- JZ between different phases in Con and ADS
" In Control uteri, cells and nuclei mean diameters and the myofilaments/cytoplasm rat io exh ib i t the cyc l ic changes (P<0.05).
" In ADS, all parameters are not significantly different b e t w e e n c y c l e p h a s e s (P>0.05).
Cell m
ean diam
eter(um)
nuclei mean
diameters (um
)
myofilam
ents/ cytoplasm
ratio
Control group
Proliferative secretory
Adenomyosis
Proliferative secretory
Introduction Materials Results Discussion
Myocyte ultrastructure of JZ is different from OM
Introduction Materials Results Discussion
JZ
increased number of organelles
the less contractile components
synthetic phenotype smooth muscle cell
" supposed to secret functional proteins — to participate in non-pregnant uterine function
— to regulate JZ morphogenesis
Introduction Materials Results Discussion
" Exert powerful force during labor
less organelles
OM
Less organelles
Contractile phenotype smooth muscle cell
higher content of myofilaments
Introduction Materials Results Discussion
What is possible mechanism for ADS abberent contraction?
Introduction Materials Results Discussion
Difference between con and ADS (1)
myocyte size
Subtle ultrastructural changes
Smaller cells and nuclei in the proliferative phase
No obvious changes in the myofilaments
" Hyperperistalsis in adnemyosis may be result from the increase cell number
JZ thickening
Introduction Materials Results Discussion
Difference between con and ADS (2)
JZ Rich in estrogen and progesterone receptors
Con Receptors exhibit a cyclic pattern
Ultrastructure exhibit a cyclic pattern
Contraction exhibit a cyclic pattern
ADS Receptors exhibit abberent expression
Ultrastructure exhibit abberent expression
Contraction exhibit abberent expression
play an import role in regulating cyclic contraction
Hum Reprod Update 1998;4:496-502. Hum Reprod 1999;14:190-7.
conclude
Introduction Materials Results Discussion
" The myocytes from JZ and OM have distinctive
ultrastructural features adapted for different functions.
" We observed cyclic ultrastructual changes of JZ in control
group, but the changes appear to be lost in adenomyosis.
The results are consistent with disfunction of JZ in
adenomyosis.
Thank you for your attention