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