Silva Elvio G, Ross Jennifer L, Gershenson David M, Deavers Michael T, Malpica Anais
Department of Pathology, The University of Texas-MD Anderson Cancer Center, Houston 77030, USA.
Int J Gynecol Pathol. 2002 Oct;21(4):412-5. doi: 10.1097/00004347-200210000-00012.
Foci of peritoneal fibrosis frequently occur with ovarian neoplasms, especially those of epithelial type, usually in association with foci of metastatic tumor or implants. However, in the absence of the latter, the presence of fibrosis cannot be clearly explained. To find an explanation for this phenomenon, we investigated the development of hormone-dependent peritoneal changes in guinea pigs. Of the 59 guinea pigs studied, 49 received one of the following hormones or hormone analogs: estradiol, diethylstilbestrol (DES), testosterone, estrone, Megace, human chorionic gonadotropin, Norethin, clomiphene, luteinizing hormone, dienestrol, hexestrol, and tamoxifen, over a period ranging from 3 to 9 months. Ten guinea pigs received sterile water (control cases). Multiple peritoneal fibrous plaques 1 to 7 mm in greatest dimension were found in 5 of 7 guinea pigs that received estradiol, 6 of 8 treated with DES, and 2 of 2 that received hexestrol and estrone. The largest lesions (fibrous polyps up to 1.2 cm in greatest dimension) were seen in those that received estrone; however, this hormone was poorly tolerated, as two of the animals that received it died after 1 and 2 months, respectively. Because DES was the best-tolerated hormone, we administered it to five additional guinea pigs for 12 months. All five developed fibrous plaques; three of them also developed peritoneal fibroleiomyomas. We conclude that estrogens can induce the development of fibrous plaques in the peritoneum and when they are administered for a long period of time they also induce the development of smooth muscle nodules. This finding is relevant to understanding the pathogenesis of both fibrous lesions associated with ovarian tumors and peritoneal leiomyomatosis.
腹膜纤维化病灶常与卵巢肿瘤同时出现，尤其是上皮类型的肿瘤，通常与转移性肿瘤病灶或种植灶相关。然而，在没有后者的情况下，纤维化的存在无法得到明确解释。为了找到这种现象的解释，我们研究了豚鼠激素依赖性腹膜变化的发展情况。在研究的59只豚鼠中，49只接受了以下激素或激素类似物之一：雌二醇、己烯雌酚（DES）、睾酮、雌酮、甲地孕酮、人绒毛膜促性腺激素、炔诺酮、克罗米芬、促黄体生成素、二乙雌酚、己烷雌酚和他莫昔芬，给药时间为3至9个月。10只豚鼠接受无菌水（对照病例）。在接受雌二醇的7只豚鼠中有5只、接受DES治疗的8只中有6只以及接受己烷雌酚和雌酮的2只中均发现了最大尺寸为1至7毫米的多个腹膜纤维斑块。接受雌酮的豚鼠出现了最大的病变（最大尺寸达1.2厘米的纤维息肉）；然而，这种激素耐受性较差，接受它的两只动物分别在1个月和2个月后死亡。由于DES是耐受性最好的激素，我们又给另外5只豚鼠给药12个月。所有5只都出现了纤维斑块；其中3只还出现了腹膜纤维平滑肌瘤。我们得出结论，雌激素可诱导腹膜纤维斑块的形成，长期给药时还可诱导平滑肌结节的形成。这一发现与理解卵巢肿瘤相关纤维病变和腹膜平滑肌瘤病的发病机制有关。
