Perbandingan HOXA10 pada Mioma Uteri dan Adenomiosis

Abstract

Background: Uterine fibroids, which have a prevalence of 70-80% in women over 50, and adenomyosis, which affects 19.5% of women of reproductive age, can reduce the expression of HOXA10 and HOXA11 genes due to hypermethylation, thereby impairing endometrial receptivity. The HOXA10 gene, which plays a role in uterine organogenesis and endometrial differentiation, shows high expression during the mid-secretory phase to support embryo implantation. Disruption of gene expression can cause implantation failure, suboptimal decidualization, and lead to recurrent miscarriage and infertility. Methods: This study used a case-control design at Prof. Chairuddin Panusunan Lubis USU Hospital. The inclusion criteria for this study were: (Case group): Women diagnosed with uterine fibroids or adenomyosis, confirmed by pathology examination; (Control group): Healthy women and women with primary or secondary infertility without uterine fibroids or adenomyosis, who were willing to participate and signed the informed consent. The exclusion criteria were: Patients who had received treatment for uterine fibroids or adenomyosis, patients with concurrent gynecological diseases, patients with a history of hormonal contraceptive use, patients with potential malignancy findings, damaged tissue samples, and patients with endometriosis cysts. HOXA testing was performed by examining endometrial tissue using immunohistochemistry. The collected data were analyzed using SPSS. Results: Most patients with adenomyosis and uterine fibroids were over 40 years old, while the control group was under 40. The most common menarche age in both groups was 12 years, and the parity status was mostly nulliparous. The case group had a higher incidence of obesity, while the control group had normal weight. The most commonly found uterine tumors were adenomyosis (53.3%), followed by intramural and submucosal leiomyomas, with few patients having a family history of uterine tumors, especially in the mother. HOXA-10 expression in the case group was predominantly negative, which was significantly different from the control group, which was predominantly +3 (p<0.0001). In the adenomyosis group, HOXA-10 expression was mostly negative, while in uterine fibroids, it was dominated by +2 (p=0.005). Specifically, all patients with submucosal leiomyomas had negative HOXA-10 expression, while intramural leiomyomas were dominated by +2. Conclusion: The differences in HOXA-10 expression in adenomyosis and leiomyoma indicate that adenomyosis has a worse prognosis for endometrial receptivity compared to uterine fibroids, leading to fertility disturbances.