Cramer S F, Patel A
Department of Pathology, Rochester General Hospital, University of Rochester School of Medicine, NY 14621.
Hum Pathol. 1992 Jun;23(6):635-8. doi: 10.1016/0046-8177(92)90318-w.
Although uterine leiomyomas are a major public health problem, very little is known about their etiology or histogenesis. To seek clues as to why the myometrium so frequently gives rise to these tumors, we attempted to determine if the regional distribution of leiomyomas was uniform. It appears that the proportion of leiomyomas in the premenopausal (0.8%) and postmenopausal (3.7%) cervix may be substantially less than the proportion of smooth muscle in the premenopausal (7.3%) and postmenopausal (17%) cervix. These data suggest that the smooth muscle cells of the corpus uteri may be at higher risk for neoplastic transformation than those of the cervix. Within the corpus there appeared to be a relative excess of fundic leiomyomas (premenopausal, 89%; postmenopausal, 86%) as compared with fundic smooth muscle (premenopausal, 79%; postmenopausal, 61%). No such excess was apparent in the isthmus or cornu. Immunohistochemical studies of estrogen and progesterone receptors in premenopausal and postmenopausal myometrium were uniformly positive, with no regional differences to suggest a hormonal basis for regional susceptibility to leiomyomas. It may be fruitful to search for precursor lesions and other factors predisposing to neoplastic development in fundic myometrium.
尽管子宫平滑肌瘤是一个重大的公共卫生问题，但对其病因或组织发生却知之甚少。为了探寻子宫肌层为何如此频繁地产生这些肿瘤的线索，我们试图确定平滑肌瘤的区域分布是否均匀。似乎绝经前（0.8%）和绝经后（3.7%）宫颈中的平滑肌瘤比例可能远低于绝经前（7.3%）和绝经后（17%）宫颈中的平滑肌比例。这些数据表明，子宫体的平滑肌细胞可能比宫颈的平滑肌细胞发生肿瘤转化的风险更高。在子宫体内，与宫底平滑肌（绝经前，79%；绝经后，61%）相比，宫底平滑肌瘤似乎相对过多（绝经前，89%；绝经后，86%）。在峡部或子宫角则没有这种过多的情况。对绝经前和绝经后子宫肌层中雌激素和孕激素受体的免疫组织化学研究均呈阳性，没有区域差异表明存在激素基础导致对平滑肌瘤的区域易感性。在宫底肌层中寻找前体病变和其他易导致肿瘤发生的因素可能会有成果。
