Roncati Luca, Manenti Antonio, Pusiol Teresa, Piscioli Francesco, Barbolini Giuseppe, Maiorana Antonio
*Department of Diagnostic and Clinical Medicine and of Public Health, University of Modena and Reggio Emilia, Modena; †Provincial Health Care Services, Cervical Cancer Screening Center, Santa Maria del Carmine Hospital, Rovereto; and ‡Department of Surgery and Surgical Specialities, University of Modena and Reggio Emilia, Modena, Italy.
Int J Gynecol Cancer. 2016 Oct;26(8):1461-4. doi: 10.1097/IGC.0000000000000779.
Aromatization is the biochemical process in which aromatase catalyzes the conversion of testosterone into estradiol, the fundamental pathway for the synthesis of estrogens. When enhanced, it can lead to hyperestrogenism, a well-known risk factor for gynecological cancers.
The surgical specimens, coming from 2 postmenopausal women with hyperestrogenism on pap smear and bioptic diagnosis of endometrial endometrioid carcinoma, were fixed in 10% neutral buffered formalin, paraffin embedded, and then submitted for routine hematoxylin/eosin staining and immunohistochemical characterization for antiestrogen, antiprogesterone, antitesterone, anti-MLH1, anti-PMS2, anti-MSH2, and anti-MSH6.
The presence of an undescribed triad represented by ovarian functioning Brenner tumor, endometrial carcinoma, and pelvic endometriosis has been ascertained. The immunohistochemical investigation proved a normal expression of the DNA mismatch repair proteins and revealed a bimodal hormonal status in the pathological tissues, that is, the Brenner tumor cells showed a high expression of testosterone, contrariwise endometrioid carcinoma and endometriosis a high estrogen and progesterone immunolabeling.
This synchronous triad underlines the importance of aromatization and hyperestrogenism in the development of gynecological malignancies in which the immunohistochemical detection of an active source of hormone production - to always keep in consideration during synchronous diseases - can guide subsequent antihormone chemotherapy based on aromatase inhibitors.
芳香化作用是一种生化过程，其中芳香化酶催化睾酮转化为雌二醇，这是雌激素合成的基本途径。当该过程增强时，可导致高雌激素血症，这是妇科癌症的一个众所周知的危险因素。
手术标本取自2名绝经后妇女，她们经巴氏涂片检查显示高雌激素血症，并经活检诊断为子宫内膜样癌。标本用10%中性缓冲福尔马林固定，石蜡包埋，然后进行常规苏木精/伊红染色以及抗雌激素、抗孕激素、抗睾酮、抗MLH1、抗PMS2、抗MSH2和抗MSH6的免疫组织化学鉴定。
已确定存在一种由卵巢功能性布伦纳瘤、子宫内膜癌和盆腔子宫内膜异位症组成的未描述的三联征。免疫组织化学研究证明DNA错配修复蛋白表达正常，并揭示了病理组织中的双峰激素状态，即布伦纳瘤细胞显示睾酮高表达，相反，子宫内膜样癌和子宫内膜异位症显示雌激素和孕激素免疫标记高表达。
这种同步三联征强调了芳香化作用和高雌激素血症在妇科恶性肿瘤发生中的重要性，其中激素产生活跃来源的免疫组织化学检测——在同步疾病中始终要考虑到——可以指导后续基于芳香化酶抑制剂的抗激素化疗。
