Masuzawa H, Badokhon N H, Nakayama K, Konishi I, Nikaido T, Fujii S
Department of Obstetrics and Gynecology, School of Medicine, Shinshu University, Matsumoto, Japan.
Cancer. 1994 Oct 15;74(8):2321-8. doi: 10.1002/1097-0142(19941015)74:8<2321::aid-cncr2820740817>3.0.co;2-6.
To determine the biologic difference between normal endometrium and endometrial hyperplasias, the authors assessed the expression of estrogen receptors (ER) and progesterone receptors (PR) in the subjects before and after oral administration of medroxyprogesterone acetate (MPA) (Hysron-H, Kyowa Hakko Kogyo Co., Ltd., Tokyo, Japan).
The authors studied the expression of ER and PR in pathologic conditions of the endometrium such as cystic, adenomatous, and atypical hyperplasias before and after MPA treatment, 600 mg daily, for 8-14 weeks, and compared this expression with that of normal endometrium.
Stromal and epithelial components of the normal endometrium in the proliferative phase were positive for ER and PR. In the secretory phase and after MPA treatment, the epithelial component showed either negative or faint staining for ER and PR, but the stromal component showed positive staining for PR and negative or faint staining for ER. All hyperplasias exhibited ER and PR in the stromal and epithelial components, although the intensity of the staining was variable in atypical hyperplasias. After MPA treatment, in the epithelial component of cystic and adenomatous hyperplasias, down-regulation of PR was prominent, but many cells continued to express ER. The epithelial component usually was surrounded by PR-positive decidual cells. In atypical hyperplasia, many cells continued to express ER and PR in the epithelial component surrounded by both ER and PR positive stromal cells after MPA treatment.
Among the pathologic conditions of the endometrium, cystic and adenomatous hyperplasias have mechanisms of down-regulation of PR but not ER in the glandular component after MPA treatment, whereas in atypical hyperplasia, down-regulation of ER and PR does not occur in the epithelial component. Compared with normal endometrium, the majority of endometrial hyperplasias have an impairment of down-regulation of ER in the epithelial component by MPA treatment, and atypical hyperplasia has an impairment of down-regulation of ER and PR. Endometrial hyperplasias seem to have an abnormality of down-regulatory mechanisms of sex steroid receptors in the epithelial component when treated with exogenous progesterone.
为了确定正常子宫内膜与子宫内膜增生之间的生物学差异，作者评估了口服醋酸甲羟孕酮（MPA）（Hysron-H，日本东京协和发酵工业株式会社）前后受试者体内雌激素受体（ER）和孕激素受体（PR）的表达情况。
作者研究了子宫内膜病理状态（如囊性、腺瘤性和非典型增生）在每日口服600mg MPA、持续8 - 14周治疗前后ER和PR的表达情况，并将其与正常子宫内膜的表达情况进行比较。
增殖期正常子宫内膜的间质和上皮成分ER和PR均呈阳性。在分泌期及MPA治疗后，上皮成分ER和PR呈阴性或弱阳性染色，但间质成分PR呈阳性染色，ER呈阴性或弱阳性染色。所有增生的间质和上皮成分均表达ER和PR，尽管非典型增生中染色强度有所不同。MPA治疗后，囊性和腺瘤性增生的上皮成分中PR下调明显，但许多细胞仍持续表达ER。上皮成分通常被PR阳性的蜕膜细胞包围。在非典型增生中，MPA治疗后，上皮成分中许多细胞在被ER和PR阳性的间质细胞包围时仍持续表达ER和PR。
在子宫内膜的病理状态中，囊性和腺瘤性增生在MPA治疗后腺成分存在PR下调机制而无ER下调机制，而非典型增生上皮成分中ER和PR均未发生下调。与正常子宫内膜相比，大多数子宫内膜增生在MPA治疗后上皮成分中ER下调机制受损，而非典型增生ER和PR下调机制均受损。子宫内膜增生在外源性孕激素治疗时上皮成分中似乎存在性类固醇受体下调机制异常。
