http://www.revistadechimie.ro REV.CHIM.(Bucharest)♦70♦ No. 8 ♦2019 2860 Endometriosis of the Abdominal Wall - Clinical, Histopathological and Immunohistochemical Aspects ANCA MARIA ISTRATE OFITERU 1,2,3 , SABINA BERCEANU 1 , STEFAN PAITICI 4 , GABRIELA CAMELIA ROSU 2,3 , LARISA IOVAN 1,2,3 , NICOLETA LOREDANA VOICU 1,2 , DANIEL PIRICI 2, 5 , LAURENTIU MOGOANTA 2,3 , RADU VLADAREANU 6 , CLAUDIA MEHEDINTU 6 *, ELVIRA BRATILA 6 , OVIDIU BRATU 6 , COSTIN BERCEANU 1 * 1 University of Medicine and Pharmacy of Craiova, Department of Obstetrics and Gynecology, 2 Petru Rares, 200349, Craiova, Romania 2 University of Medicine and Pharmacy of Craiova Research Center for Microscopic Morphology and Immunology, 2 PetruRares Str., 200349, Rom ania 3 University of Medicine and Pharmacy of Craiova, Department of Histology, 2 PetruRares Str., 200349, Romania 4 University of Medicine and Pharmacy of Craiova, Department of General Surgery, 2 PetruRares Str., 200349, Craiova, Romania 5 University of Medicine and Pharmacy of Craiova, Department of Metodology, 2 PetruRares Str., 200349, Craiova, Romania 6 Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., 050474, Bucharest, Romania Endometriosis is a benign gynecological pathology that mostly affects the organs of the pelvis,but also organs located at a distance maybe affected. Tissue immunohistochemically identified as ectopic endometrium may undergo certain structural and functional changes that may lead to preneoplastic alterations (hyperplasia, dysplasia) in normal cellswhich can evolve to neoplasia. Clinical, genetic, metabolic conditions and local factors may influence degenerationof a benign pathology into a malignant pathology. Endometriosis of the abdominal wall is more frequently encountered, as the number of casarean section has increased. Endometriomas surrounding tissue has a direct impact on the structure of the cells that form the mass. By remodeling cellular morphology, corroborated with the hormonal factors action and the inflammatory response ( via lymphocyte cell secretion), the cell cycle is altered and antiapoptotic activity may be promoted. Immune system via lymphocyte cell secretion, the pressure exerted on the tumor area by surrounding tissueswith its size change, conditioned by the fluctuation of hormonal factors, act directly on the cellular structure and can increase anti-apoptotic action and decrease cell cycle regulation. The presence of endometriomas is identified by the positivity of immunohistochemical reactions for estrogen receptors (ER), progesteron receptors (PR), Cytokeratin 7 (CK7) for endometrial tissue. Negative reaction at Cytokeratin 20 (CK20) shows that the studied area is not a metastasis of a digestive tumor. The presence of abundant inflammatory, peritumoral cells markedwith anti-CD68 / Tryptase for macrophages / mast cells demonstrates the involvement of the inflammatory system in the structural and functional modification of endometrial cells.The pronounced cell division was demonstrated by intense reaction with the anti-Ki67 antibody.The signigicant anti-apoptotic action of the endometrial tissue is shown by the positivity of anti-B cell Lymphoma 2 (BCL2) / anti-Phosphatase and tensin homolog (PTEN) / anti-p53 antibodies. Keywords: endometriosis, progesterone receptor, estrogen receptor, Bcl-2, PTEN Ectopic endometrial implantscan be present in the pelvic organs: ovaries, uterine ligaments, rectovaginal septum, peritoneum and extra pelvic structures like kidneys, lymph nodes, pleura, lungs, brain and abdominal wall [1, 2]. Patients experience period-related pain.Tumor’s size was significantly bigger before menstruation. This increaseamplifies the symptoms.In the time between menstruations, these patients were asymptomatic and they did not report any vaginal bleeding. In areas of focus, the presence of a large number of ER and PR was demonstrated, in addition toan increasing hormone secretion, causing an abnormal activity of steroidogenesis [3, 4]. The aims of this study were: to identifythe presence of ectopic endometrial tissue, to evaluate the inflammatory reaction around it and to observe the preneoplastic (hyperplasic) transformation of the areas of interest. Experimental part This retrospective study included a total of 20 patients, who were admitted in the Obstetrics-Gynecology II Clinic of the Craiova County Emergency Clinical Hospital, between 2010-2018.The endometriosis diagnosis was based on thepatients’ history (all of them had underwent c-section), their intense symptoms and the presence of endometriomas in their ultrasound examination. The final diagnosis was established after the excision and the biopsy of the endometriomas was performed and the histopathological results were available. All the patients included in the study signed the acceptance form (approved by the Ethics Commission of the University of Medicine and Pharmacy of Craiova) for inclusion in the study after having been provided in writing and verbally with all necessary information. The subjects were divided into two groups: one group formed of 10 patients diagnosed with post-cesarean section abdominal wall endometriosis without preneoplastic alterations and another one composed of 10 patients affected byatypical endometriosis - hyperplasic glands. Patients’ age ranged from 18 to 57 years old and the premalignant condition was diagnosed on older subjects, compared to the benign endometriosis(Chart 1). Following excision surgery, the tissue was fixed in 10% formalin solution and embedded in paraffin wax as it follows: after fixation, the tissue was washed in tap water for one hour to remove the fixation solution.Then the tissue was immersed into successive alcohol baths 70, 90, 96%, for one hour each and it was left overnight in absolute * email: claudiamehedintu@yahoo.com, Phone: + 40722312976 All authors have contributed equally to this paper. dr_berceanu@yahoo.com, Phone: + 40722728180