Department of Obstetrics and Gynecology, Yokohama Municipal Citizen's Hospital, 1-1 Mitsuzawanishimachi, Kanagawa-ku, Yokohama, 221-0855, Japan.
Department of Pathology, Yokohama Municipal Citizen's Hospital, Yokohama, Japan.
BMC Womens Health. 2022 Aug 16;22(1):346. doi: 10.1186/s12905-022-01924-6.
The growth of uterine leiomyomas is dependent on the levels of sex steroid hormones, and they usually shrink after menopause. However, there are cases in which leiomyomas continue to grow and/or surgery is required after menopause. In addition to estrogen, progesterone has recently been implicated in leiomyoma enlargement, but its relevance to postmenopausal leiomyoma remains unknown. Therefore, we investigated whether hormone receptor expression is associated with postmenopausal leiomyoma enlargement and characterized pathological findings of postmenopausal leiomyoma, which have not been clarified yet.
Nine cases that required total hysterectomy for leiomyomas after menopause were examined. Surgeries were conducted because of pelvic pressure, pelvic pain, suspected malignancy, or growing leiomyoma. Six cases of leiomyomas being incidentally found during total hysterectomy for postmenopausal uterine prolapse, and six patients who underwent hysterectomy for leiomyomas before menopause, were examined as controls. We evaluated the expression of estrogen receptor, progesterone receptor B, and progesterone receptor AB by immunohistochemical staining among the cases. We also analyzed the pathological findings of leiomyomas.
In postmenopausal leiomyomas, the expression of progesterone receptor was higher than that in the adjacent myometrium. Compared with premenopausal leiomyomas, the expression of progesterone receptor decreased. Postmenopausal leiomyomas that required surgery did not show elevated sex steroid hormone receptor expression, compared with the leiomyomas that did not require surgery. The degeneration frequency of leiomyomas was 92% in the group that underwent surgery for postmenopausal leiomyomas, 65% in the group that underwent surgery for reasons other than the presence of leiomyomas after menopause, and 47% in the group operated for leiomyomas before menopause.
These results suggest that sex steroid hormones are unlikely to be associated with the growth of leiomyomas after menopause. Since leiomyoma degeneration with increased extracellular matrix is likely to occur in postmenopausal women, the degeneration of leiomyomas may be the main mechanism for the growth of postmenopausal leiomyomas.
子宫肌瘤的生长依赖于性激素水平，绝经后通常会缩小。然而，有些情况下子宫肌瘤会继续生长，或者绝经后需要手术。除了雌激素，孕激素最近也被认为与子宫肌瘤增大有关，但与绝经后子宫肌瘤的关系尚不清楚。因此，我们研究了激素受体表达是否与绝经后子宫肌瘤增大有关，并对尚未阐明的绝经后子宫肌瘤的病理特征进行了描述。
检查了 9 例因绝经后子宫肌瘤而接受全子宫切除术的病例。手术是由于盆腔压迫、盆腔疼痛、怀疑恶性肿瘤或生长的子宫肌瘤而进行的。另外，还检查了 6 例在因绝经后子宫脱垂而进行全子宫切除术时偶然发现的子宫肌瘤病例，以及 6 例在绝经前因子宫肌瘤而接受子宫切除术的病例作为对照。我们通过免疫组织化学染色评估了病例中雌激素受体、孕激素受体 B 和孕激素受体 AB 的表达。我们还分析了子宫肌瘤的病理特征。
在绝经后子宫肌瘤中，孕激素受体的表达高于邻近的子宫肌层。与绝经前子宫肌瘤相比，孕激素受体的表达减少。与不需要手术的绝经后子宫肌瘤相比，需要手术的子宫肌瘤的性激素受体表达并没有升高。行手术治疗的绝经后子宫肌瘤的退变频率为 92%，因绝经后其他原因行手术治疗的子宫肌瘤为 65%，因绝经前子宫肌瘤而行手术治疗的为 47%。
这些结果表明，性激素不太可能与绝经后子宫肌瘤的生长有关。由于绝经后女性子宫肌瘤的细胞外基质增加导致的退变很可能发生，因此子宫肌瘤的退变可能是绝经后子宫肌瘤生长的主要机制。
