Steroid receptors in normal and neoplastic female reproductive tissues

Enlarged uterine corpus volume in women with endometriosis: Assessment using three-dimensional reconstruction of pelvic magnetic resonance images

AIM

To assess and compare the uterine volume and endometrium length between women with and without endometriosis, using pelvic magnetic resonance imaging scans.

METHODS

In this case-control study, a total of 75 nulligravid women (aged 20-45 years) with regular menstrual cycles whose uterus were free of any surgically confirmed lesions were enrolled. The endometriosis group underwent surgery for endometrioma (n = 39), and the control group underwent surgery for non-endometrioma ovarian cysts (n = 36). The primary outcome was uterine corpus volume, which was assessed using three-dimensional reconstructions of preoperative pelvic magnetic resonance imaging scans.

RESULTS

The mean uterine volume was significantly larger in the endometriosis group than in the control group (mean ± standard deviation, 50.9 ± 14.4 cm³ vs 41.7 ± 14.3 cm³ ; P < 0.01). The longitudinal length and transverse diameter of the corpus and the longitudinal length of the endometrium were also significantly greater in the endometriosis group (all, P < 0.01).

CONCLUSIONS

An increase in uterine volume and endometrium length was observed in women with endometriosis.

The presence and role of progesterone receptor in the ovaries of postmenopausal women who have not applied hormone replacement therapy

At present, not much is known about progesterone receptor (PR) expression and localization in postmenopausal women ovaries. In the ovaries of reproductive age women, PR is localized in internal theca and granulosa cells, corpus luteum, ovary surface epithelium (OSE) and in stroma. PR expression depends on the serum concentration of progesterone, estrogen, gonadotropin and androgen. The goal of the conducted studies was to examine PR localization and expression in the ovaries of postmenopausal women who have not applied hormone replacement therapy so far. Also, the correlation was examined between PR expression and localization in the ovaries, steroid and gonadotropin hormone serum concentrations, and influence of the time from the last menstruation. The material came from 50 postmenopausal women who had their ovaries removed due to non-neoplastic diseases. The women were divided into 3 groups (A, B, C) depending on the time from the last menstruation. The follitropin (FSH), luteotropin (LH), estradiol (E2), testosterone (T), androstendione (A) and dehydroepiandrosterone sulphate (DHEAS) concentrations in blood plasma were measured. Monoclonal mouse anti-human PR antibody was used for immunohistochemical detection (examination involved 50 postmenopausal ovaries). Between particular groups, E2 serum concentrations did not differ, but FSH, LH, T, A, DHEAS serum concentrations were significantly different. Immunohistochemical nuclear localization of PR in postmenopausal women ovaries was observed. PR expression was similar in all three groups (A, B, C). PR expression was observed in OSE nuclei and invaginations cysts deriving from the isolation of invaginated epithelium and metaplastic columnar epithelium and in stroma. In the ovaries of postmenopausal women who have not applied hormone replacement therapy so far, PR was detected in all three groups. Its expression did not depend on the time from menopause and was similar in all examined groups. FSH, LH, T, A, DHEAS serum concentrations did not influence PR expression.

Estrogen receptor thymine-adenine dinucleotide repeat polymorphism is associated with susceptibility to leiomyoma

OBJECTIVE

To evaluate the association between leiomyomas and estrogen receptor gene polymorphism.

DESIGN

Prospective study.

SETTING

Department of gynecology and genetics.

PATIENT(S)

Women with (n = 159) or without leiomyomas (n = 131).

MAIN OUTCOME MEASURE(S)

Polymerase chain reaction was used to detect dinucleotide (thymine-adenine [TA]) repeat polymorphisms upstream of the estrogen receptor gene. Genotypes were classified as A through P according to the number of the TA repeats from 12 to 27. Distributions of TA repeat for estrogen receptor in both groups were compared.

RESULT(S)

Genotypes A to E were detected in 10.7%, 18.9%, 15.7%, 16.4%, and 4.4%, respectively, of women with leiomyomas and 4.2%, 9.5%, 20.6%, 19.1%, and 10.3% of women without leiomyomas. Women with genotypes A and B (12 or 13 TA repeats) have a higher risk for leiomyomas, and those with genotype E (16 TA repeats) have a lower risk.

CONCLUSION(S)

Estrogen receptor gene polymorphism probably contributes to the pathogenesis of leiomyoma and may predict the susceptibility to leiomyoma. The 12 and 13 TA repeats are associated with a higher risk of leiomyoma.

Oestrogen and progestin receptors as prognostic indicators in endometrial cancer. A review of the literature

The history of research on oestrogen and progestin receptors in endometrial cancer goes back about 20 years. Summarized data from several clinical studies demonstrate that cytosol oestrogen (ERC) and progestin receptors (PRC) are clinically useful indicators of prognosis. Absence of receptor or its low concentration is indicative of an increased risk of recurrent malignancy. In this respect PRC tends to be more sensitive than ERC. In some studies PRC assay appeared to be more strongly correlated to prognosis than any of the conventional clinico-pathological parameters. In addition, the information obtained by ERC and/or PRC assay is independent of and additional to the classical prognostic indicators. The value of ERC and PRC assay in predicting the sensitivity of endometrial cancer to progestin therapy is of clinical interest. The accumulated data for many clinical trials show that in detecting the non-responders to progestin therapy negative results of ERC and PRC give similar information with an accuracy of about 90%. In identifying responders to progestin therapy, a positive PRC result appeared to give more precise information than a positive ERC, the accuracy being about 75% for PRC. The use of the combination of ERC and PRC determination as a prognostic indicator or predictor of sensitivity to progestin therapy does not significantly increase the information available by PRC measurement alone. Hence, whatever used--a biochemical ligand binding technique or immunohistochemical staining--PRC determination alone seems recommendable for clinical purposes.

Progesterone (P) receptor dynamics in estrogen primed normal human cervix following P injection

Progesterone (P) receptor levels were measured in the cytosol and in the 0.4 M KCl nuclear extract in human cervical tissues with [3H]-R5020 as a ligand and the results compared with those obtained in the myometrium and endometrium of the same uteri. Tissue samples were obtained from 28 women, grouped as follows: group A, 12 premenopausal controls; group B, 7 perimenopausal women who received estrogen 7 to 11 days before operation; and group C, 9 perimenopausal and postmenopausal women who received estrogen as in group B plus P injection 1 to 3 hours before operation. Estrogen administration resulted in a significant rise in total P receptor levels in the cervix, compared with the endometrium and myometrium. P injection after estrogen priming resulted in down-regulation of the P receptor in the cervix to undetectable levels, whereas in the endometrium and myometrium it resulted only in redistribution of the P receptor, with higher nuclear levels and lower cytosol levels. These results indicate the possibility of a different mechanism of regulation of the P receptor in the human cervix, compared with that in the endometrium and myometrium.

Evidence for a possible cytosol estrogen receptor deficiency in endocervical glands of infertile women with poor cervical mucus

Endocervical gland estrogen receptor (ER) deficiency has been proposed as a possible cause for the poor cervical mucus (CM) in some infertile women with cervical factor. Cytosol ERs were measured in endocervical tissue obtained by biopsy within 3 days of ovulation (determined by the endogenous luteinizing hormone [LH] surge) in five infertile women with persistent poor preovulatory CM (group 1) and in endocervical tissue obtained in the late follicular phase in eight ovulatory women with excellent CM (group 2). ER concentrations were measured in Fmol/mg protein by the dextran-coated charcoal separation method (New England Nuclear Kit, Boston, MA). CM score evaluation and measurement of serum estradiol (E2) and progesterone (P) levels were performed concomitantly. Serum E2 levels of 123.4 +/- 29.3 pg/ml (mean +/- standard error of the mean [SEM]) in group 1 were comparable to E2 levels of 123.3 +/- 15.0 pg/ml in group 2. Serum P concentrations of 0.9 +/- 0.27 ng/ml in group 1 were comparable to 0.79 +/- 0.29 in group 2. A CM score of 4.6 +/- 0.69 in group 1 was significantly lower than 11.6 +/- 0.53 in group 2 (P less than 0.01). The cytosol ER was negative in four of five women in group 1, whereas in group 2, ER was positive in six, borderline in one, and negative in one subject. This study suggests that cytosol ER may be deficient in some women with cervical factor.

Correlation of female sex steroid hormone receptors with histologic and ultrastructural differentiation in adenocarcinoma of the endometrium

A series of 43 patients with endometrial adenocarcinoma were evaluated in order to investigate the relationships of the estrogen receptor (ER) and the progesterone receptor (PR) with the histologic and nuclear grades and the ultrastructural differentiation of these tumors. Twenty-six neoplasms were positive (greater than or equal to 10 fmole/mg protein) for both receptors, 1 was positive for the ER only, 9 were ER-PR+, and 7 were ER-PR-. Twenty carcinomas were histologic Grade I, 12 Grade II, and 11 Grade III. Distribution of nuclear grade was 11 Grade I, 18 Grade II, and 14 Grade III. Both histologic and nuclear grades were found to be significantly related to the presence or absence of both the ER and the PR. Several cytoplasmic structures (cilia, primary lysosomes, intracytoplasmic lumens) were highly specific but of low sensitivity for predicting the receptor status of these tumors. To a limited extent, ultrastructural markers were associated with histologic differentiation.