Cornillie F J, Brosens I A, Vasquez G, Riphagen I
Int J Gynecol Pathol. 1986;5(2):95-109.
In 20 infertile patients, the laparoscopic, histologic, and ultrastructural characteristics of endometriotic implants were studied before and after a 2-month course of therapy using 1.25 mg of the antiprogesterone steroid ethylnorgestrienone daily. Before treatment, well-differentiated endometriotic foci were seen only in implants with a rich microvascular supply. It is postulated that the degree of microvascular development may determine the differentiation of ectopic endometrium. After therapy, well-differentiated endometriotic tissues were recovered in only one patient. In all other patients, the foci remained undifferentiated, while in 11 patients striking epithelial involutionary changes were seen, such as nuclear pyknosis, extrusion of nuclear remnants, enhanced lysosomal autophagy, abortive secretion, and focal epithelial erosion. These histologic and ultrastructural changes reflect a progesterone withdrawal effect in endometriotic implants. It is thus concluded that ethylnorgestrienone induces inactivity in most endometriotic implants, while marked involution is observed in many foci. However, this subcellular involution does not result in a change of the extent of the disease according to the American Fertility Society classification system. Preliminary data concerning the pregnancy rate reveal that five patients conceived during a mean follow-up period of 6 months.
在20例不孕患者中，研究了使用每日1.25毫克抗孕激素类固醇炔诺孕酮治疗2个月疗程前后子宫内膜异位植入物的腹腔镜、组织学和超微结构特征。治疗前，仅在微血管供应丰富的植入物中可见分化良好的子宫内膜异位病灶。据推测，微血管发育程度可能决定异位子宫内膜的分化。治疗后，仅1例患者恢复了分化良好的子宫内膜异位组织。在所有其他患者中，病灶仍未分化，而在11例患者中观察到明显的上皮退化性变化，如核固缩、核残余物挤出、溶酶体自噬增强、分泌异常和局灶性上皮糜烂。这些组织学和超微结构变化反映了子宫内膜异位植入物中的孕激素撤退效应。因此得出结论，炔诺孕酮可使大多数子宫内膜异位植入物失活，同时在许多病灶中观察到明显退化。然而，根据美国生育协会分类系统，这种亚细胞退化并未导致疾病范围的改变。关于妊娠率的初步数据显示，5例患者在平均6个月的随访期内受孕。
