Nakayama K, Masuzawa H, Li S F, Yoshikawa F, Toki T, Nikaido T, Silverberg S G, Fujii S
Department of Obstetrics and Gynecology, Shinshu University, School of Medicine, Matsumoto, Japan.
Int J Gynecol Pathol. 1994 Oct;13(4):348-58. doi: 10.1097/00004347-199410000-00009.
This study was designed to investigate whether or not the pelvic peritoneum exhibits a metaplastic process into müllerian-type epithelium using a marker for epithelial differentiation (Ber-EP4 antigen) and markers that indicate müllerian differentiation (estrogen receptors and progesterone receptors). The peritoneum and/or ovarian surface epithelium adjacent to endometriotic lesions were obtained from 24 patients with endometriosis at operation, and peritoneum and ovarian surface epithelium without any lesions were also obtained from control patients without endometriosis. The specimens were immunohistochemically analyzed using antibodies for epithelial antigen Ber-EP4, estrogen receptor (ER), and progesterone receptor (PR) on frozen sections. Normal peritoneal mesothelium showed negative staining for Ber-EP4, ER, and PR. The mesothelium of the peritoneum adjacent to the endometriotic lesions showed focal positivity for Ber-EP4, ER, and PR. Several cases of ovarian surface epithelium from normal control ovaries and ovaries adjacent to endometriotic lesions also showed focal positivity for Ber-EP4, ER, and PR. Stromal cells accompanying these foci were sporadically positive for ER and/or PR but negative for Ber-EP4. Focal expression of Ber-EP4, ER, and PR in the mesothelium of the peritoneum and the ovarian surface epithelium adjacent to endometriotic lesions suggests that mesothelium possibly acquires characteristics of epithelial as well as müllerian-type nature. These results support an existence of a metaplastic process of the peritoneal mesothelium in the pathogenesis of endometriosis. The more frequent Ber-EP4 positivity in normal ovarian surface epithelium compared to normal peritoneal mesothelium also suggests a fundamental difference in these tissues that may be related to the greater prevalence of epithelial neoplasms arising in ovarian tissue.
本研究旨在利用上皮分化标志物（Ber-EP4抗原）以及指示苗勒氏分化的标志物（雌激素受体和孕激素受体），调查盆腔腹膜是否会发生向苗勒氏型上皮的化生过程。在手术中从24例子宫内膜异位症患者获取与子宫内膜异位病变相邻的腹膜和/或卵巢表面上皮，同时也从无子宫内膜异位症的对照患者获取无任何病变的腹膜和卵巢表面上皮。对冷冻切片使用针对上皮抗原Ber-EP4、雌激素受体（ER）和孕激素受体（PR）的抗体进行免疫组织化学分析。正常腹膜间皮对Ber-EP4、ER和PR呈阴性染色。与子宫内膜异位病变相邻的腹膜间皮对Ber-EP4、ER和PR呈局灶性阳性。来自正常对照卵巢和与子宫内膜异位病变相邻卵巢的几例卵巢表面上皮对Ber-EP4、ER和PR也呈局灶性阳性。伴随这些病灶的基质细胞偶尔对ER和/或PR呈阳性，但对Ber-EP4呈阴性。在与子宫内膜异位病变相邻的腹膜和卵巢表面上皮间皮中Ber-EP4、ER和PR的局灶性表达表明间皮可能获得了上皮以及苗勒氏型的特性。这些结果支持在子宫内膜异位症发病机制中腹膜间皮存在化生过程。与正常腹膜间皮相比，正常卵巢表面上皮中Ber-EP4阳性更为常见，这也表明这些组织存在根本差异，可能与卵巢组织中上皮性肿瘤的更高发病率有关。
