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A Look at Uterine Wound Healing Through a Histopathological Study of Uterine Scars

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Abstract

Background

Few histopathologic studies of uterine wound healing have been published compared with similar healing in other tissues. Our objective was to examine the histopathology resulting from iatrogenic trauma to the myometrium to acquire a better understanding of possible aberrations in uterine wound healing.

Methods

We studied paired injured myometrium and uninvolved myometrium from 7 hysterectomy specimens. All subjects had either abnormal bleeding or chronic pain following an iatrogenic injury to the myometrium. The time between the initial injury and hysterectomy ranged from 2 months to 13 years. Tissue was evaluated with hematoxylin and eosin (H&E) followed by Masson Trichrome staining for collagen, Weigert-Van Gieson elastic staining, and/or Kreyberg staining for fibrin and glycosaminoglycans or MIB-1 (Ki-67) immunhistochemistry for cell proliferation.

Results

Histopathologic examination of the 7 paired tissues revealed evidence of altered healing including myofiber disarray, elastosis, tissue edema, and inflammation. Small fibroids, myometrial hyperplasia, a keloid-like region of scar and adenomyosis were also observed.

Conclusions

Myofiber disarray and elastosis may be markers of aberrancy in wound healing after iatrogenic uterine trauma. Altered myometrial scarring in these cases may have contributed to the clinical outcome necessitating hysterectomies. Myometrial hyperplasia in the region of the scars might also contribute to the clinical presentation as well. Small fibroids found within scars and evidence of a keloid-like structure may also represent alterations in uterine wound healing.

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Authors and Affiliations

  1. University of California-San Diego, San Diego, CA, USA

    Hilary A. Roeder MD

  2. University of Rochester, Rochester General Hospital, Rochester, NY, USA

    Stewart F. Cramer MD

  3. Duke University School of Medicine, Durham, NC, USA

    Phyllis C. Leppert MD, PhD

  4. 242 Sands Building, DUMC 103206, Durham, NC, 27710, USA

    Phyllis C. Leppert MD, PhD

Authors
  1. Hilary A. Roeder MD
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  2. Stewart F. Cramer MD
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  3. Phyllis C. Leppert MD, PhD
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Corresponding author

Correspondence to Phyllis C. Leppert MD, PhD.

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Roeder, H.A., Cramer, S.F. & Leppert, P.C. A Look at Uterine Wound Healing Through a Histopathological Study of Uterine Scars. Reprod. Sci. 19, 463–473 (2012). https://doi.org/10.1177/1933719111426603

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