Cramer S F, Marchetti C, Freedman J, Padela A
Department of Pathology, Rochester General Hospital, University of Rochester School of Medicine, Rochester, NY, USA.
Arch Pathol Lab Med. 2000 Oct;124(10):1448-53. doi: 10.5858/2000-124-1448-ROMCSA.
Although myomas shrink after menopause, the cellular mechanism for this phenomenon has received little attention. It was recently demonstrated that fibrous degeneration is significantly associated with postmenopausal status in both small and large myomas.
The purpose of the present study was to evaluate whether reduction in myoma cell size is also associated with postmenopausal status in small myomas.
Tumor size and patient age have also been related to fibrous degeneration in small (<1 cm) myomas. Therefore, in the present study, 10 pairs of premenopausal and postmenopausal small myomas were matched within 3 years for patient age, within 1 mm for size, and within 1 grade for degree of fibrous degeneration. Most of the women were in their 50s, the decade during which postmenopausal fibrous degeneration in small myomas is most prevalent. Myoma cell size was derived by morphometric evaluation of relative myoma cell area (correcting for percentage of stroma, as measured by point counting) and by direct counting of the number of myoma cells per unit area in trichrome-stained sections.
Small myomas from postmenopausal women had significantly (P <.05) smaller cell sizes than did size-matched myomas from age-matched premenopausal women. Myoma cell sizes and nucleus-cell (N/C) ratios were highly variable, especially in premenopausal myomas.
Reduction in myoma cell size is significantly associated with postmenopausal status in small uterine leiomyomas and may be an important mechanism for postmenopausal shrinkage of myomas. In addition, the high variability of myoma cell size and N/C ratio may further support the somatic mutation theory (ie, the theory that diverse mutations may account not only for variations in the growth potential of uterine myomas, but also for variations in their cellular details).
尽管子宫肌瘤在绝经后会缩小，但这种现象的细胞机制却很少受到关注。最近有研究表明，无论是小肌瘤还是大肌瘤，纤维变性都与绝经后状态显著相关。
本研究的目的是评估小肌瘤中肌瘤细胞大小的减小是否也与绝经后状态相关。
肿瘤大小和患者年龄也与小（<1 cm）肌瘤的纤维变性有关。因此，在本研究中，选取了10对绝经前和绝经后的小肌瘤，患者年龄相差3岁以内，肌瘤大小相差1 mm以内，纤维变性程度相差1级以内。大多数女性处于50多岁，这是小肌瘤绝经后纤维变性最普遍的十年。肌瘤细胞大小通过对相对肌瘤细胞面积进行形态计量评估（校正间质百分比，通过点计数测量）以及通过对三色染色切片中每单位面积的肌瘤细胞数量进行直接计数来确定。
绝经后女性的小肌瘤细胞大小明显（P <.05）小于年龄匹配的绝经前女性的大小匹配肌瘤。肌瘤细胞大小和核质比（N/C）差异很大，尤其是在绝经前肌瘤中。
小子宫平滑肌瘤中肌瘤细胞大小的减小与绝经后状态显著相关，可能是绝经后肌瘤缩小的重要机制。此外，肌瘤细胞大小和N/C比的高度变异性可能进一步支持体细胞突变理论（即不同的突变不仅可能导致子宫肌瘤生长潜力的差异，还可能导致其细胞细节的差异）。
