Đặc điểm mô bệnh học viêm nội mạc tử cung mạn tính ở bệnh nhân thất bại làm tổ liên tiếp tại Bệnh viện Đa khoa Tâm Anh giai đoạn 2023–2024

Recurrent Implantation Failure (RIF) presents a significant challenge in assisted reproductive technology, particularly in in-vitro fertilization (IVF) cycles. Chronic endometritis (CE) has emerged as a crucial yet often overlooked factor contributing to RIF, characterized by persistent plasma cell infiltration disrupting endometrial receptivity. Despite its recognized importance, the definitive diagnosis and effective treatment of CE remain contentious due to a lack of consensus on specific histopathological criteria and limited regional data, especially in Vietnam. This study aims to address this gap by describing the histopathological characteristics and CD138 immunohistochemical expression in endometrial biopsy samples from patients experiencing RIF and suspected of having CE, thereby improving diagnostic accuracy and guiding clinical management.

Gynecologists, reproductive endocrinologists, pathologists, and researchers involved in infertility treatment and assisted reproductive technologies.

This cross-sectional descriptive study investigated the histopathological features of chronic endometritis (CE) and the expression of CD138 in endometrial biopsies from 91 women with recurrent implantation failure (RIF) undergoing treatment at Tam Anh General Hospital between 2023 and 2024. The methodology involved hysteroscopy-guided biopsies, followed by Hematoxylin-Eosin (HE) staining and CD138 immunohistochemical analysis. The findings revealed a high prevalence of histological abnormalities in 96.7% of HE-stained samples, with combined lesions constituting 45.1% and stromal alteration being the most common isolated lesion (28.6%). Crucially, all abnormal HE samples exhibited CD138-positive plasma cells, with 86.8% showing more than 5 plasma cells and 71.4% exceeding 10, indicating severe inflammation. A strong statistically significant correlation was observed between plasma cell density and histological lesions. Following a single course of antibiotic treatment, 33.3% of patients showed no abnormalities on hysteroscopy, and the proportion of patients with >10 plasma cells significantly decreased from 71.4% to 40%. These results underscore that combining hysteroscopy with detailed histopathological analysis, particularly CD138 immunostaining, substantially enhances the diagnostic accuracy for chronic endometritis in RIF patients. This integrated approach is not only vital for initial screening but also serves as an effective tool for monitoring treatment response, paving the way for more individualized and effective treatment regimens in managing recurrent implantation failure.