Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Japan.
Department of Gynecology, Saiseikai Nagasaki Hospital, 2-5-1, Katafuchi, Nagasaki 850-0000, Japan.
Reprod Biomed Online. 2019 Apr;38(4):634-646. doi: 10.1016/j.rbmo.2018.12.015. Epub 2018 Dec 21.
Is there any difference in ovarian steroid receptor expression and pattern of fibrosis in focal and diffuse adenomyosis and response to hormonal treatment?
Prospective controlled study where biopsy samples were prospectively collected after surgery from 30 women with focal adenomyosis, 21 women with diffuse adenomyosis and 20 women with uterine myoma. Some of these women underwent 3-6 months of treatment with gonadotrophin-releasing hormone agonist (GnRHa) before surgery. Tissue expression of oestrogen receptor (ER) and progesterone receptor (PR) was analysed by immunohistochemistry. Distribution of tissue fibrosis was examined by Masson's trichrome staining with computer-based image analysis of fibrosis in tissues derived from women with and without adenomyosis.
There was no difference in ER/PR expression in gland cells/stromal cells of adenomyotic lesions on the ipsilateral side of focal adenomyosis and the anterior/posterior walls of diffuse adenomyosis. Compared to myoma tissues, a relatively decreased expression of ovarian steroid receptors was observed in both focal and diffuse adenomyosis. Image analysis of tissue fibrosis indicated more fibrosis in both focal and diffuse adenomyosis compared to fibrosis in the myometrium derived from women with uterine myoma. The pattern of fibrosis was no different in tissues derived from GnRHa-treated and -untreated women with focal and diffuse adenomyosis.
No difference was found in the expression of ER/PR and entity of fibrosis between women with focal and diffuse adenomyosis regardless of GnRHa treatment. A lower expression of ER/PR compared to myoma tissue potentially clarifies the biological rationale of non-response to hormonal therapies for adenomyosis.
局灶型和弥漫型子宫腺肌病的卵巢甾体激素受体表达和纤维化模式是否存在差异，以及对激素治疗的反应是否存在差异？
这是一项前瞻性对照研究，在手术前，前瞻性地从 30 名局灶型子宫腺肌病患者、21 名弥漫型子宫腺肌病患者和 20 名子宫肌瘤患者中采集活检样本。其中一些患者在手术前接受了 3-6 个月的促性腺激素释放激素激动剂（GnRHa）治疗。通过免疫组织化学分析，研究了雌激素受体（ER）和孕激素受体（PR）在组织中的表达。通过 Masson 三色染色法检测组织纤维化的分布，并通过计算机图像分析对来自有腺肌病和无腺肌病患者的组织中的纤维化进行分析。
在局灶型子宫腺肌病的同侧和弥漫型子宫腺肌病的前壁/后壁的腺肌瘤病变的腺上皮细胞/间质细胞中，ER/PR 表达无差异。与子宫肌瘤组织相比，局灶型和弥漫型子宫腺肌病组织中卵巢甾体激素受体的表达相对降低。组织纤维化的图像分析表明，与子宫肌瘤患者的子宫肌层来源的组织相比，局灶型和弥漫型子宫腺肌病中存在更多的纤维化。GnRHa 治疗和未治疗的局灶型和弥漫型子宫腺肌病患者的组织纤维化模式无差异。
无论是否接受 GnRHa 治疗，局灶型和弥漫型子宫腺肌病患者的 ER/PR 表达和纤维化程度均无差异。与子宫肌瘤组织相比，ER/PR 表达降低可能阐明了子宫腺肌病对激素治疗反应不佳的生物学基础。
