A large ovarian leiomyoma discovered incidentally in a 76-year-old woman: case report

BACKGROUND

Ovarian leiomyoma is very rare type of ovarian tumor. This benign tumor is seen in the pediatric age group to premenopausal women.

CASE

A 76-year-old woman had a huge leiomyoma (19 x 11 x 10 cm) of the right ovary. The preoperative diagnosis was difficult to distinguish from a broad ligament leiomyoma or ovarian cancer.

CONCLUSIONS

Although theses tumors are benign, its extreme rarity led us to report an additional and rather unusual case of ovarian leiomyoma, and to focus some attention on this type of tumor.

Premenstrual syndrome: management and pathophysiology

Premenstrual syndrome (PMS) is triggered by hormonal events ensuing after ovulation. The symptoms can begin in the early, mid, or late luteal phase and are not associated with defined concentrations of any specific gonadal or non-gonadal hormone. Women with PMS experience affective or somatic symptoms that cause severe dysfunction in social or occupational realms. Although evidence for a hormonal abnormality has not been established, the symptoms of the premenopausal disorders are related to the production of progesterone by the ovary. The progesterone metabolites may bind to a neurosteroid-binding site on the membrane of the neurotransmitters. Thus, ovulation suppression is an area of focus for diagnostic and treatment options. Many treatment studies have focused on suppression of ovulation with gonadotropin-releasing hormone analogs (GnRHa), high doses of transdermal estrogen, and bilateral oophorectomy all have positive evidence as treatment options for prevention of PMS. However, because of these limitations and their substantial intensive care, these do not appear to be appropriate methods for conventional treatment of PMS. Serotonergic antidepressants, selective serotonin reuptake inhibitors, are well-established, highly effective, and first-line pharmacologic therapy.

Levonorgestrel-releasing intrauterine device used for dysmenorrhea: five-year literature review

Intrauterine devices (IUDs) provide highly effective, long-term, safe, reversible contraception, and are the most widely used reversible contraceptive method worldwide. The levonorgestrel-releasing IUD (LNG-IUD), originally designed for long-term contraceptives, is now recognized to provide non-contraceptive health benefits. These include severe dysmenorrhea and/or heavy menstrual bleeding associated with uterine myoma, endometriosis, and adenomyosis. This report aims to review the last five-year literature on the efficacy and safety of the LNG-IUD in women with dysmenorrhea. Dysmenorrhea has been reported to decrease in all women. LNG-IUD seems to be superior over copper-releasing IUD for improving dysmenorrhea. The LNG-IUD is beneficial for symptom recurrence and endometriotic cyst recurrence after conservative surgery for patients with severe pain related to endometriosis. There is also evidence to support its role in menstrual problems of severely obese adolescent females. Expulsion, one of the important factors for IUD acceptability, is rare but more common in women with distorted uterine cavity. In the treatment of dysmenorrhea, the LNG-IUD is equal or superior to treat with systemic progestins or oral contraceptives even in adolescent or menopausal women.

An autopsy case of acute aortic dissection during postpartum period

BACKGROUND

Aortic dissection in young women without Marfan disease is related in most instances to pregnancy. This is a potentially catastrophic occurrence.

CASE

An autopsy case of acute aortic dissection type B (Stanford classification), clinically undiagnosed during late puerperium period in a young woman with no discernible risk factors (e.g. family history and signs of connective tissue diseases) is presented. Autopsy with ancillary investigations revealed that knowledge of this albeit relatively rare complication of postpartum may assist the clinician in earlier diagnosis and referral of patients for surgical treatment.

CONCLUSION

This case is presented to raise awareness and review the literature for the critical care of postpartum patients.

Peptide YY producing strumal carcinoid tumor of the ovary

BACKGROUND

Primary ovarian carcinoid tumor is uncommon and represents less than 0.1% of ovarian malignancies. The strumal carcinoid may be complicated by carcinoid syndrome induced by peptide YY (PYY).

CASE REPORT

We describe a 45-year-old woman with a bilateral ovarian tumor diagnosed through periodical gynecological examination. She presented with severe constipation. Right ovarian cyst laparoscopically resected was diagnosed as a strumal carcinoid tumor; the left one was mature cystic teratoma. No metastatic findings were seen macroscopically on the ovarian surface and pelvic peritoneum. Constipation was drastically improved by resecting the tumor. The carcinoid tumor cells were positive for tumor-producing PYY by mRNA analysis.

CONCLUSION

It is important to be aware of this entity in the pathological diagnosis of ovarian tumors, in the presence of any clinical indicator of carcinoid tumor/syndrome, as it carries a markedly better prognosis and clinical outcome in comparison with most other malignant ovarian tumors.

Novel [corrected] medical management of primary bladder endometriosis with dienogest: a case report

BACKGROUND

Because of its low incidence, medical treatment of has not yet been well established although surgical excision is generally considered effective. We report the first case of primary bladder endometriosis successfully managed with a novel progestin dienogest.

CASE

A 39-year-old woman, nulligravida, presented with lower urinary tract symptoms, especially during menstruation. Cystoscopy, with subsequent cold cup biopsy, revealed a solitary submucosal mass (2 x 2 cm) in the bladder on the posterior wall; histopathology revealed the diagnosis of extraperitoneal endometriosis. MRI and laparoscopy confirmed no peritoneal endometriosis implants or adenomyosis. She was treated with oral 2 mg/day dienogest for six months. The measurable lesion exhibited a remarkable reduction in its size, accompanied with immediate relief of the lesion-related symptoms. At one year after medication cessation, she is well and symptom-free.

CONCLUSION

Dienogest may be a novel conservative alternative for bladder endometriosis, in particular for women who wish to avoid surgical intervention.

Estrogen induces the expression of c-fos and c-jun genes in fibroblasts derived from human uterine endometrium

The ratio of membrane/cytosolic protein kinase C (PKC) activity and the levels of c-fos and c-jun expressions in uterine endometrial fibroblasts were increased and reached peak levels with the administration of estradiol, but were partially diminished by the addition of progesterone. The response of c-fos was earlier than that of c-jun. Twelve-0-tetradecanoylphorbol-13-acetate (TPA) increased c-fos and c-jun expressions in endometrial fibroblasts as estradiol did, and pretreatment with 1-(5-isoquinolinesulfonyl)-2-methylpiperazine dihydrochloride (H-7) reduced the estrogen-inducible c-fos and c-jun expressions. Therefore, it is suggested that oncogenes c-fos and c-jun in uterine stromal cells might be induced by estrogen partly via PKC, involving the interplay of the anti-estrogenic effect of progesterone, and there might be a cross talk between estrogen and PKC stimulants for c-fos and c-jun expressions.

Expression of progesterone receptor form A and B mRNAs in uterine leiomyoma

This study was designed to determine the expression pattern of progesterone receptor form A (PR-A) and B (PR-B) mRNAs in uterine leiomyoma. Approximately equal expression of PR-A and PR-B mRNAs was designated as type AB and dominant expression of PR-B mRNA as type B. In all cases of normal uterine myometrium, PR mRNA expression was type AB. Alteration to type B in the superficial part of uterine leiomyoma was observed in approximately 40% of cases. Therefore, the relative overexpression of PR-B mRNA in the surface of uterine leiomyoma might reveal an activated phenotype of progestational proliferation, plausibly related to the growth of uterine leiomyoma.

Progestins suppress estrogen-induced expression of vascular endothelial growth factor (VEGF) subtypes in uterine endometrial cancer cells

Vascular endothelial growth factor (VEGF) contributes to the early advancement of uterine endometrial cancers that conserve hormone dependency via angiogenic activity. This process prompted us to study sex steroidal suppression of VEGF expression in Ishikawa cells (a line of well-differentiated uterine endometrial cancer cells). Estrogen transiently induced VEGF subtype (VEGF165 and VEGF121) secretion from Ishikawa cells. Progestins (progesterone, medroxyprogesterone acetate (MPA) and 17 alpha-hydroxyprogesterone) suppressed the estrogen-induced events. In conclusion, progestins could suppress VEGF-related angiogenic potential, which contributes to tumor growth in the early stage of uterine endometrial cancers that conserve estrogen dependency.

Expression of vascular endothelial growth factor (VEGF) and its mRNA in uterine cervical cancers

To know the potential of growth, invasion and metastasis of uterine cervical cancer associated with neovascularization, localization of vascular endothelial growth factor (VEGF) and microvessel density in tumours were determined by immunohistochemical staining, the levels of VEGF subtypes were determined by Western blot analysis and by a sandwich enzyme immunoassay, and the levels of VEGF subtype mRNAs were determined by reverse transcription polymerase chain reaction (RT-PCR)-Southern blot analysis in uterine cervical cancers. The relation between VEGF subtype expressions and microvessel density, histological types and clinical stages of uterine cervical cancers was analysed. The expression of VEGF was seen dominantly in the cancer cells, and correlated with microvessel density in uterine cervical cancers. Among the four subtypes of VEGF, the populations of VEGF165 and VEGF121 were dominant in normal uterine cervices and uterine cervical cancers. The levels of VEGF and VEGF165 and VEGF121 mRNAs were remarkably higher in some stage II and III/IV adenocarcinomas of the cervix than in other cases, including normal cervices. Therefore, the elevation of VEGF165 and VEGF121 might contribute to the relatively late advancing via angiogenic activity in some adenocarcinomas of the cervix.

Expression of platelet-derived endothelial cell growth factor (PD-ECGF) and its mRNA in uterine cervical cancers

Angiogenesis contributes to the growth and secondary spreading of solid tumours. Platelet-derived endothelial cell growth factor (PD-ECGF) is identified as such an angiogenic factor. In the present study, the prognosis of the patients with high PD-ECGF uterine cervical cancers was worse than those with low PD-ECGF cancers, and PD-ECGF expression correlated with cellular proliferation and with vascular density and venous invasion in uterine cervical cancers. Therefore, PD-ECGF might contribute to the growth of uterine cervical cancers via angiogenesis related to vascular spreading. Furthermore, PD-ECGF and its mRNA had a wide range and were highly expressed in uterine cervical cancers, especially squamous cell carcinoma, regardless of clinical stage. Therefore, PD-ECGF in uterine cervical cancers might play a role of basic angiogenesis in all processes of advancing of uterine cervical cancers. This indicates that 5'-deoxy-5-fluorouridine might be highly effective in squamous cell carcinoma of the cervix, which possesses a high activity of thymidine phosphorylase to convert 5'-deoxy-5-fluorouridine to 5-fluorouracil, and that some angiogenic inhibitors of new capillary formation might be effective in the inhibition of tumour growth and spreading associated with angiogenesis.

Biologic implications of the expression of vascular endothelial growth factor subtypes in ovarian carcinoma

BACKGROUND

Vascular endothelial growth factor (VEGF) has been identified as an important factor for tumor angiogenesis, which is essential for the growth, invasion, and metastasis of solid tumors. This study examines the clinical significance of VEGF subtypes in ovarian carcinoma.

METHODS

Tumor specimens from 128 patients with ovarian carcinoma were evaluated for VEGF and its mRNA expression. The expression of VEGF, especially its subtypes, was determined by Western blot analysis with a sandwich enzyme immunoassay in ovarian carcinomas and reverse transcription-polymerase chain reaction and Southern blot analysis in normal ovaries that served as controls, and the relation between VEGF expression and the histologic types and clinical stages of ovarian carcinomas was analyzed.

RESULTS

Among the four subtypes of VEGF, the populations of VEGF165 and VEGF121 were dominant in normal ovaries and ovarian carcinomas. The levels of VEGF and VEGF165 mRNA in ovarian carcinomas were significantly higher than in normal ovaries (P < 0.05). On the other hand, there was no significant difference in the levels of VEGF and VEGF165 mRNA among ovarian carcinomas classified according to histopathologic type or clinical stage.

CONCLUSIONS

This analysis suggests that VEGF165 may be elevated in all stages of ovarian carcinoma via angiogenic activity, regardless of histopathologic type.

Expressions of vascular endothelial growth factor (VEGF) and its mRNA in uterine endometrial cancers

To know the potential of growth, invasion and metastasis of uterine endometrial cancer associated with neovascularization, the expressions of VEGF and its mRNA, especially their subtypes, in uterine endometrial cancers and normal uterine endometria as controls were determined by Western blot analyses with a sandwich enzyme immunoassay and RT-PCR-Southern blot analysis, respectively, and the relation between their expressions and histological grades, grades of myometrial invasion and clinical stages of uterine endometrial cancers was analyzed. The levels of VEGF (VEGF165 and VEGF121) protein and mRNA were in a wide range and higher in normal uterine endometria than in the malignant counterparts. The levels of VEGF protein were higher in order of histopathological differentiation (normal uterine endometrium > well-differentiated (G1) > moderately differentiated (G2) and poorly differentiated (G3)) and those of VEGF protein and VEGF121 mRNA were lower in order of the advance of clinical stages (normal uterine endometrium > stage I > stage II > stages III and IV). There was, however, no significant difference in their levels among uterine endometrial cancers classified according to grades of myometrial invasion. This suggests that VEGF is downregulated during uterine endometrial cancer progression with dedifferentiation. Namely, VEGF in some endometrial cancers might contribute to the early process of advancing of malignancy via angiogenic activity.

Expression of platelet-derived endothelial cell growth factor (PD-ECGF) and its mRNA in uterine endometrial cancers

To determine the potential of growth, invasion and metastasis of uterine endometrial cancer cells associated with neovascularization, the expressions of platelet-derived endothelial cell growth factor (PD-ECGF) and its mRNA in uterine endometrial cancers and in normal uterine endometria as controls were determined and the relationship between their expressions and histological grades, grades of myometrial invasion and clinical stages of uterine endometrial cancers was analyzed. The levels of PD-ECGF were significantly higher in uterine endometrial cancers of well-differentiated grade (G1) with invasion to < or =1/2 myometrium (B) and of stage 1 than in those of moderately and poorly differentiated grades (G2 and G3, respectively) limited to endometrium (A) and with invasion to >1/2 myometrium (C) and of stages II and III/IV and in normal uterine endometria. There was no significant difference in the levels between uterine endometrial cancers of G2 and G3, A and C, or stages II and III/IV and normal uterine endometria. Therefore, the active availability of PD-ECGF might contribute to the acceleration of angiogenic activity in the early process of invasion of well-differentiated uterine endometrial cancers.

Expression of platelet-derived endothelial cell growth factor and its mRNA in uterine endometrium during the menstrual cycle

Steroid hormones, e.g. progesterone and oestradiol, may be responsible for the production and expression of a variety of angiogenic growth factors present in endometrial tissue. The expression of platelet-derived endothelial cell growth factor (PD-ECGF) in neovascularization after regression of the microvessels in the endometrium was examined. PD-ECGF protein expression in the endometrium during the menstrual cycle was determined by a sandwich enzyme immunoassay. Transcription levels of PD-ECGF were measured by a quantitative reverse transcription-polymerase chain reaction (RT-PCR) Southern blot technique. The data show that levels of PD-ECGF protein and mRNA in uterine endometrium did not alter during the proliferative phase prior to ovulation. During the midcycle phase a sharp transient fall in mRNA levels accompanied by a gradual drop in protein levels was observed. After ovulation transcription of PD-ECGF recovered with a sharp increase in mRNA levels which persisted during the ovulatory phase. PD-ECGF protein levels were temporarily low after ovulation, but increased remarkably through the late secretory phase. PD-ECGF expression in the endometrium seems to be inversely correlated with oestradiol concentrations during the menstrual cycle.

Expression of platelet-derived endothelial cell growth factor (PD-ECGF) and its mRNA in ovarian cancers

The potential of growth, invasion and metastasis of ovarian cancer cells associated with neovascularization, and the expression of platelet-derived endothelial growth factor (PD-ECGF) and its mRNA in ovarian cancers were determined. The relationship between their expression and histopathological types and clinical stages of ovarian cancers was also analyzed. The levels of PD-ECGF and its mRNA were higher in ovarian cancers than in normal ovaries. Furthermore, some endometrioid carcinomas and serous cystadenocarcinomas of the ovary and some ovarian cancers in stages III and IV expressed remarkably high levels of PD-ECGF and its mRNA. Therefore, in some ovarian cancers, PD-ECGF might be related to advanced stages of ovarian cancers associated with neovascularization.

DNA polymorphism in B-domain of the estrogen receptor-alpha among Japanese women

A silent mutation in B-domain of the estrogen receptor-alpha (ER B) change codon 87 (from GCG to GCC) is clinically correlated with frequent spontaneous abortion and familial history of breast cancer among Caucasian patients. However, none of the 167 Japanese female patients and 46 Japanese female healthy volunteers showed ER B variant. Therefore, this DNA polymorphism might involve a genetic racial difference, and appears not to be correlated with frequent spontaneous abortion or familial history of breast cancer at least among Japanese women.

Expressions of E-cadherin and alpha- and beta-catenin mRNAs in uterine endometrial cancers

To know the biological function of the adherens junction associated with histological dedifferentiation, intramuscular invasion, and clinical staging, we studied the expressions of E-cadherin and alpha- and beta-catenin mRNAs in endometrial cancers in comparison with those in normal uterine counterparts. As dedifferentiation, myometrial invasion and staging advanced, the expressions of E-cadherin and beta-catenin mRNAs decreased. This suggests that the function of adhesive molecules in the adherens junction might be disturbed, leading to invasiveness and metastatic potential.

Estrogen and progestin inhibit invasiveness of gynecologic metastatic cancer cells to blood vessel endothelium

The Boyden chamber method showed that the invasiveness to reconstituted blood vessel endothelium of metastatic gynecologic cancer cell lines of the uterine cervix (MS751 and ME-180), endometrium (AN3 CA), and ovary (SK-OV-3 and PA-1) was significantly higher than of primary cancer cell lines of the cervix (HeLa and C-33 A), endometrium (Ishikawa, HEC-1-A and HHUA), and ovary (MCAS and Caov-3), and that the invasiveness was inhibited by estradiol or progestin in the metastatic cells but not in the primary cells. These results suggest that metastatic cancer cells by themselves increase the potential of blood vessel invasion, which can be inhibited by estrogen and progestin administration.

Suppression of E-cadherin and alpha- and beta-catenin mRNA expression in the metastatic lesions of gynecological cancers

To know the biological role of adherens junction, mainly consisting of E-cadherin and alpha- and beta-catenins, associated with invasion and metastasis of ovarian, uterine endometrial and cervical cancers, we studied the expression of E-cadherin and alpha- and beta-catenin mRNAs in the metastatic lesions in comparison with those in the primary tumors. The integral expression of E-cadherin and alpha- and beta-catenin mRNAs in the metastatic lesions in comparison with that of the primary tumors was suppressed in 4 of 5 cases of ovarian cancers, all cases of uterine endometrial cancers, and 4 of 5 cases of uterine cervical cancers. Therefore, the suppressed expression of the main adhesion molecules in the adherence junction might contribute to the cell-to-cell junctional dysfunction, which might lead to the acquisition of invasiveness and metastatic potential of gynecological cancers as one of the rate-limiting steps.

Antiestrogenic compounds inhibit estrogen-induced expression of fibroblast growth factor family (FGF-1, 2, and 4) mRNA in well-differentiated endometrial cancer cells

To clarify the effect of sex steroids on neovascularization in the growth, invasion and metastasis of endometrial cancer, the regulations of acid fibroblast growth factor (FGF-1), basic FGF (FGF-2) and hst-1 (FGF-4) mRNA expressions were studied in well-differentiated endometrial cancer cells under the influence of sex steroids. The levels of FGF-1 and 2 mRNAs in the well-differentiated endometrial cancer (Ishikawa) cells were significantly increased by estradiol. This increase was significantly inhibited by progestins (progesterone, medroxyprogesterone acetate [MPA] and 17 alpha-hydroxyprogesterone) and tamoxifen, but not by tetrahydrocortisol, hydrocortisone and danazol. The expression of FGF-4 mRNA was not altered by sex steroids. Therefore, estrogen might stimulate FGF-2 with FGF-1 secretion of endometrial cancer cells for neovascularization, and antiestrogenic compounds do inhibit estrogen-induced events.

Novel screening technique for dissemination potential of ovarian cancer cells to peritoneum

Invasiveness to the peritoneum reconstituted with a mesothelial cell line and Engelbreth-Holm-Swam extract by metastatic cancer cell lines of the uterine cervix, endometrium, and ovary was always higher than that by primary cell lines. The invasiveness by metastatic ovarian cancer cell lines was significantly stronger than that by the other gynecological primary or metastatic cell lines. In the clinical ovarian cancers studied, cancer cells from the metastatic lesion were more invasive than those from the primary lesion. This suggests that metastatic ovarian cancer cells might inherently possess strong invasiveness to the peritoneum. The assay system used in the present study is useful in investigating the clinical behavior and basic biology of peritoneal dissemination.

Expression of basic fibroblast growth factor and its mRNA in advanced ovarian cancers

To investigate whether growth, invasion and metastasis of ovarian cancer cells is associated with neovascularization, the expression of basic fibroblast growth factor (FGF) and its mRNA in ovarian cancers and normal ovaries as controls were determined by ELISA and reverse transcription-polymerase chain reaction-Southern blot, respectively. The relationships between the expression and the histological grading, clinical backgrounds or clinical staging in ovarian cancers were analyzed. The levels of basic FGF and its mRNA were significantly higher in advanced primary ovarian cancers, regardless of histological types and some clinical backgrounds. Therefore, this status might contribute to the acceleration of growth, invasion, and metastasis with neovascularization in advanced ovarian cancers.

Expression of sex hormone-binding globulin and corticosteroid-binding globulin mRNAs in corpus luteum of human subjects

To understand the biology of sex steroids in human ovarian corpus luteum, the expression of intracellular sex hormone-binding globulin (SHBG) and corticosteroid-binding globulin (CBG) mRNAs as a manifestation of intracellular SHBG and CBG expression was determined. The expression of SHBG and CBG mRNAs was detected in all samples analyzed. Luteal SHBG mRNA level showed no significant change during the endometrial secretory phase of the menstrual cycle. On the other hand, luteal CBG mRNA level was significantly higher (p < 0.05) at the mid-secretory phase than that at the early and late secretory phases of the endometrium. These findings suggest that human ovarian corpus luteum synthesizes SHBG and CBG intracellularly, CBG being plausibly involved in the functional life span of corpus luteum.

Clinical implication of expression of progesterone receptor form A and B mRNAs in secondary spreading of gynecologic cancers

This study was designed to determine the clinical implication of expression of progesterone receptor form A (PR-A) and B (PR-B) mRNAs in secondary spreading of gynecologic cancers. Approximately equal expression of PR-A and PR-B mRNAs was designated as type AB and dominant expression of PR-B mRNA as type B. Alteration from type AB to type B in the metastatic cancers occurred in 3/8 cases of uterine endometrial cancers, 2/8 cases of uterine cervical cancers, and 2/8 cases of ovarian cancers. Other cancers revealed type B regardless of primary or metastatic status. Thus, all metastatic cancers studied revealed type B. These results suggest that transcription of PR-A mRNA may be damaged, which might lead to uncontrolled overexpression of PR-B mRNA in metastatic lesion, and that the type B status could reveal a highly malignant phenotype in these three gynecologic cancers.

Expression of E-cadherin and alpha- and beta-catenin mRNAs in ovarian cancers

To know the biological role of the adherens junction, mainly consisting of E-cadherin and alpha- and beta-catenins, associated with invasion and metastasis of ovarian cancers, we studied the expressions of E-cadherin and alpha- and beta-catenin mRNAs in the cancers in comparison with those in normal counterparts. The integral expression of E-cadherin and alpha- and, beta-catenin mRNAs was suppressed in the metastatic lesions of advanced ovarian cancers, while it was not in the primary tumors. Therefore, the suppressed expression of main adhesion molecules in the adherens junction might contribute to adherens junctional dysfunction, which might lead to the acquirement of invasiveness and metastatic potential by advanced ovarian cancers as one of the rate-limiting steps.

Plausible novel therapeutic strategy of uterine endometrial cancer with reduction of basic fibroblast growth factor secretion by progestin and O-(chloroacetyl-carbamoyl) fumagillol (TNP-470; AGM-1470)

To know the potential of growth, invasion and metastasis of endometrial cancer associated with neovascularization, the effects of sex steroids and O-(chloroacetyl-carbamoyl) fumagillol (TNP-470; AGM-1470) on basic fibroblast growth factor (FGF) expression and secretion and its mRNA expression were investigated in well-differentiated endometrial cancer cell line Ishikawa and in undifferentiated endometrial cancer cell line AN3 CA. Basic FGF expression and secretion and its mRNA expression in Ishikawa cells, but not in AN3 CA cells, were increased by estrogen, while progesterone diminished the estrogen-induced increases. TNP-470 reduced the levels regardless of estrogen treatment in AN3 CA cells. Therefore, basic FGF secretion may be inhibited by progestin in differentiated cells, and by TNP-470 in undifferentiated cells. Since endometrial cancer consists of differentiated and undifferentiated cells as heterogeneity, a combination therapy for endometrial cancer with progestin and TNP470 might be effective.

Antiestrogenic compounds inhibit estrogen-induced expressions of basic fibroblast growth factor and its mRNA in well-differentiated endometrial cancer cells

1. The levels of basic fibroblast growth factor (FGF) expression and secretion and its messenger ribonucleic acid (mRNA) expression in well-differentiated endometrial cancer (Ishikawa) cells were significantly increased by estradiol. 2. This increase was significantly inhibited by tamoxifen, progestins (progesterone, medroxyprogesterone acetate [MPA], and 17 alpha-hydroxyprogesterone), and to some extent danazol, but not by terahydrocortisol and hydrocortisone. 3. Estrogen might stimulate the basic FGF secretion of endometrial cancer cells, at least for neovascularization, and antiestrogenic compounds may inhibit the estrogen-induced event.

Expression of estrogen receptor wild type and exon 5 splicing variant mRNAs in normal and endometriotic endometria during the menstrual cycle

Expression of estrogen receptor exon 5 splicing variant (ER-E5SV) mRNA contributes to dominant positive properties and metastatic potential of gynecological cancers. Therefore, in endometriotic endometria, which conserve implantation and tumor-like spreading potentials, the expression of ER-E5SV and estrogen receptor wild type (ER-WT) mRNA was analyzed, to investigate the biological implications. Estrogen receptor wild type mRNA in normal endometria was downregulated after ovulation, but not in endometriotic endometria. Therefore the wild type cascade in endometriotic endometria might be partly disorganized. The level of ER-E5SV mRNA in endometriotic endometria was lower than that in normal endometria, regardless of the stage in the menstrual cycle. However, there was no significant difference in the ratio of ER-E5SV to ER-WT mRNA in both normal and endometriotic endometria. On the other hand, the level of ER-E5SV mRNA in both normal and endometriotic endometria did not vary during the menstrual cycle. The dominant positive behavior of ER-E5SV might be masked by the functional cascade of ER-WT in normal endometria, but not in endometriotic endometria. This status might result in an incomplete response to endogenous steroids, and contribute to implantation and spreading potentials of endometriosis.

Expression of sex hormone-binding globulin mRNA in uterine cervical cancers

To explore the role of sex hormone-binding globulin (SHBG) in the intracellular steroidal actions in human uterine cervical cancers, the expression of SHBG mRNA as a manifestation of intracellular SHBG expression was investigated using the competitive reverse transcription-polymerase chain reaction-Southern blot analysis. The expression of SHBG mRNA was detected in all cervical endometria and cancers analyzed. The levels of SHBG mRNA in cervical cancers were significantly lower (p < 0.01) than in the normal cervical endometrium. In cervical cancers, the levels of SHBG mRNA in cervical adenocarcinomas were significantly higher (p < 0.01) than in keratinizing and small cell nonkeratinizing squamous cell carcinomas, and tended to be higher than in large cell nonkeratinizing squamous cell carcinomas. There was no difference in expression among the clinical stages of cervical cancers. These data suggest that human uterine cervical cancers, especially adenocarcinomas, might synthesize SHBG intracellularly, and might conserve the activity of SHBG-related steroidal mechanisms to some extent.

Expression of E-cadherin and alpha- and beta-catenin mRNAs in uterine cervical cancers

To show the mRNA expressions of E-cadherin and alpha- and beta-catenin-which mainly compose the adherens junction-associated with invasion and metastasis of uterine cervical cancers, we studied the expression of E-cadherin and alpha- and beta-catenin mRNAs in cancers in comparison with normal counterparts. The integral expression of E-cadherin and alpha- and beta-catenin mRNAs was suppressed in the metastatic lesions of advanced uterine cervical cancers, while it was not in the primary tumors. Therefore, the suppressed expression of main adhesion molecules in the adherens junction might contribute to adherens-junctional dysfunction, which might lead to invasiveness and metastatic potential of advanced uterine cervical cancers as one rate-limiting step.

Expression of basic fibroblast growth factor and its mRNA in advanced uterine cervical cancers

To know the potential of growth, invasion and metastasis of uterine cervical cancer cells associated with neovascularization, the expression of basic fibroblast growth factor (FGF) and its mRNA in uterine cervical cancers and normal uterine cervices as controls were determined by enzyme-linked immunosorbent assay (ELISA) and reverse transcription-polymerase chain reaction-Southern blot (RT-PCR-SB), respectively. Then, the relations between the expression and the histological grading and clinical staging in cervical cancers were analyzed. The levels of basic FGF and its mRNA were significantly higher in advanced primary uterine cervical cancers, regardless of histological type. Therefore, this status might contribute to the acceleration of growth, invasion, and metastasis with neovascularization in advanced uterine cervical cancers.

Ovarian steroids regulate the expression of basic fibroblast growth factor and its mRNA in fibroblasts derived from uterine endometrium

The role of stromal cells in basic fibroblast growth factor (FGF) supply for endometrial neovascularization during the menstrual cycle was investigated. The concentrations of intracellular and secreted FGF, and FGF mRNA expression were determined in fibroblasts derived from uterine endometrium as a substitute for stromal cells. The influence of sex steroids on protein and mRNA expression was investigated. The concentration of FGF and its mRNA expression in the fibroblasts was significantly increased by oestradiol, and these increased concentrations were diminished by progesterone. It is suggested that oestrogen stimulates FGF secretion from the stromal cells, an effect which is inhibited by progesterone. Therefore, endometrial neovascularization might be partially regulated by stromal-derived FGF under the influence of sex steroids, through a paracrine cell-to-cell interaction.

Comparative study on expression of plasminogen activator inhibitor 1 and its mRNA in endometrial cancers and normal endometria

The effects of the endocrine milieu on growth, invasion and metastasis, associated with neovascularization of endometrial cancer, the expression of plasminogen activator inhibitor 1 (PAI-1), and its mRNA in endometrial atypical hyperplasia and cancer, and normal endometria as controls were determined in premenopausal and postmenopausal women. In premenopausal women, the levels of PAI-1 and its mRNA in normal endometria were significantly higher than in endometrial atypical hyperplasia and cancer. On the other hand, in postmenopausal women, the results were reversed. There was no difference in the expression of PAI-1 and its mRNA in the various histological grades and clinical stages in endometrial cancers, while the expression of PAI-1 in other cancers increased during tumor progression. In our previous study, the expression of PAI-1 and its mRNA in well-differentiated endometrial cancer cell lines was dependent upon estrogen and progesterone. This might be partially related to the endocrine milieu, especially in endometrial atypical hyperplasia and well-differentiated endometrial cancer, which seems to be dependent on sex steroids. Therefore, endometrial cancer of any histological grade and clinical stage might maintain PAI-1 expression in both premenopausal and postmenopausal women, which may modulate, at least in part, growth, invasion and metastasis associated with neovascularization of endometrial cancer.

Expression of estrogen receptor exon 5 splicing variant (ER E5SV) mRNA in gynaecological cancers

Estrogen receptor exon 5 splicing variant (ER E5SV) mRNA has been found in tumours and the corresponding normal tissues, being transcriptionally active without ligand binding. Therefore, the expression of ER E5SV mRNA in gynaecological cancers was studied. The presence of ER E5SV mRNA was demonstrated in the normal ovary, uterine endometrium and cervix and their corresponding cancers. The ratio of ER E5SV/ER WT mRNA expression increased in some cases of metastatic tumour, but did not decrease in any case. Relative overexpression of ER E5SV mRNA might contribute to dominant positive properties and metastatic potential. Therefore, detection of ER E5SV mRNA abundance might be a useful indicator of metastatic potency in gynaecological cancers.

Sex steroids regulate the expression of plasminogen activator inhibitor-1 and its mRNA in fibroblasts derived from uterine endometrium

In order to clarify a role of stromal cells in sex steroidal neovascularization, plasminogen activator inhibitor (PAI)-1 [an inhibitor of tissue-type plasminogen activator (tPA) and urokinase-type plasminogen activator (uPA)] and its messenger ribonucleic acid (mRNA) were analysed in fibroblasts derived from uterine endometrium as a model for endometrial stromal cells under the influence of sex steroids. The determinations were carried out by an enzyme-linked immunosorbent assay (ELISA) and reverse transcription-polymerase chain reaction-Southern blotting, respectively. In the fibroblasts, either estradiol or progestogens (progesterone, medroxy progesterone acetate or 17 alpha-hydroxyprogesterone) induced expressions of PAI-1 and its mRNA, and their combination further increased their expression by approximately twofold. PAI-1 from endometrial stromal cells under the influence of sex steroids might contribute to endometrial neovascularization through its effect on endothelial cells in endometrial vessels.

Sex steroids regulate the expression of plasminogen activator inhibitor-1 (PAI-1) and its mRNA in uterine endometrial cancer cell line Ishikawa

To know the effects of sex steroids on the potentials of growth, invasion, and metastasis with neovascularization of endometrial cancer, the expression of plasminogen activator inhibitor (PAI)-1 [an inhibitor of tissue-type plasminogen activator (tPA) and urokinase-type plasminogen activator (uPA)] and its mRNA in well-differentiated uterine endometrial cancer cell line Ishikawa was determined by an enzyme-linked immunosorbent assay and reverse transcription-polymerase chain reaction-Southern blotting (RT-PCR-SB), respectively, under the influence of sex steroids. In Ishikawa cells, either estradiol or progestins (progesterone, medroxyprogesterone acetate, or 17 alpha-hydroxyprogesterone alone) induced the expression of PAI-1 and its mRNA, and those expressions were increased approximately two-fold by both estradiol and progestin administered together. Therefore, sex steroidal induction of PAI-1 might contribute to the inhibition of invasion and metastasis, concomitantly with the inhibition of neovascularization associated with tPA and uPA activities, in well differentiated endometrial cancer.

Expression of E-cadherin, alpha- and beta-catenin mRNAs in ovarian endometriosis

To establish the mechanism of development of ovarian endometriosis from the biological function of the adherens junction, we have investigated the expression of E-cadherin, alpha- and beta-catenin mRNAs in ovarian endometriosis in comparison with that in normal uterine endometrium. The expression of E-cadherin, alpha- and beta-catenin mRNAs in ovarian endometriosis was not altered during the menstrual cycle. On the other hand, the expression in normal uterine endometrium significantly was increased at the secretory phase, and was significantly higher than that in ovarian endometriosis. In conclusion, the expression of E-cadherin, alpha- and beta-catenin mRNAs for adherens junction in ovarian endometriosis appeared to be decreased after ovulation, which might, at least in part, contribute to detachment as the first step of development of endometriotic cells.

Ability of Ovarian Steroids to Regulate the Expression of the Fibroblast Growth Factor Family in Fibroblasts Derived from Uterine Endometrium

Uterine endometrial neovascularization during the menstrual cycle is regulated by a basic fibroblast growth factor (FGF) in the endometrium, consisting of endothelial and stromal cells. Acidic FGF (FGF-1), basic FGF (FGF-2) and hst-1 (FGF-4) proteins also possess angiogenic potency in vivo. Therefore, it is important to improve our understanding of the role of stromal cells in FGF supply for endometrial neovascularization. In this study, we determined FGF-1, -2, and -4 mRNA and FGF-2 by reverse transcription-polymerase chain reaction-Southern blot analysis, and enzyme-linked immunosorbent assay, respectively, in fibroblasts derived from uterine endometria as a substitute for stromal cells. Experimental results indicate that estradiol significanlty increases the levels of intracellular and secreted FGF-2 and its mRNA expression in the FGF family in the fibroblasts. Moreover, progesterone reduces the estradiol-induced increase. Therefore, endometrial neovascularization might be partially regulated by stroma-derived FGF-2 under the influence of sex steroids through a paracrine cell-to-cell interaction. Copyright 1996 S. Karger AG, Basel

Alteration of E-cadherin, alpha- and beta-catenin mRNA expression in human uterine endometrium during the menstrual cycle

To study the biological functions of the adherens junction in uterine endometrium at the reproductive phase, we measured the levels of E-cadherin, alpha- and beta-catenin mRNA in endometrium with or without an intramuscular injection of estradiol dipropionate in patients 5 days before hysterectomy. The levels of E-cadherin, alpha- and beta-catenin mRNA in endometria of the proliferative phase were significantly less than those of the secretory phase. The treatment with estradiol dipropionate significantly reduced the levels of alpha- and beta-catenin mRNA in endometria of the secretory phase, and tended to reduce that of E-cadherin mRNA. In conclusion, the functions of the adherens junction, which regulates the adhesive capacity of endometrial epithelial cells, are considered to be activated after ovulation, and at least in part associated with nidation.

Expression of basic fibroblast growth factor and its mRNA in uterine endometrium during the menstrual cycle

To learn more about reproductive neovascularization after menstrual regression of the microvessels in uterine endometrium, the regulation of basic fibroblast growth factor (FGF) and its mRNA expression in the endometria of the menstrual cycle with or without treatment with estradiol dipropionate were determined by enzyme-linked immunosorbent assay (ELISA), and reverse transcription-polymerase chain reaction-Southern blot (RT-PCR-SB), respectively. The endometrial basic FGF level was increased in advance of proliferation, but decreased at the secretory phase. The expression of basic FGF mRNA in endometria during the proliferative phase did not alter, but it was decreased at the secretory phase. Estradiol dipropionate increased the expression of basic FGF and its mRNA in endometria of the secretory phase. Therefore, the constant high level of basic FGF mRNA might contribute to the synthesis and accumulation of basic FGF up to the late proliferative phase, and the accumulated basic FGF might be rapidly consumed in the secretory phase. Furthermore, basic FGF during the proliferative phase could plausibly contribute to capillary neovascularization, which could be regulated by sex steroids.

Estrogen induces expression of c-fos and c-jun via activation of protein kinase C in an endometrial cancer cell line and fibroblasts derived from human uterine endometrium

Endometrial fibroblasts derived from uterine endometrium as controls and endometrial cancer cell lines (Ishikawa and HHUA cells) were analyzed for the induction manner of c-fos and c-jun transcripts in endometrial cancers, some of which are estrogen-dependent in growth. Estrogen increased c-fos expression and protein kinase C (PKC) activity in fibroblasts and Ishikawa cells, but not in HHUA cells. Progesterone diminished c-fos and c-jun expression and PKC activity induced by estradiol in the fibroblasts, but not in Ishikawa cells, which persistently overexpressed c-fos and c-jun. In these cells, 12-0-tetra-decanoylphorbol-13-acetate (TPA) increased c-fos and c-jun expression as did estradiol. Pretreatment with 1-(5-isoquinolinesulfonyl)-2-methylpiperazine dihydrochloride (H-7) abolished estrogen-inducible over-expression of c-fos and c-jun. The combination of both estradiol and TPA at maximum effective concentration exerted no additive and synergistic effect on induction of c-fos and c-jun expression. In conclusion, persistent activation of PKC might lead to overexpression of c-fos and c-jun in some endometrial cancers with an estrogen predominant milieu, which might be, at least in part, associated with the transformation or growth potential.

Progestins and danazol effect on cell-to-cell adhesion, and E-cadherin and alpha- and beta-catenin mRNA expressions

The first step of invasion and metastasis is the detachment of cancer cells in the primary tumor, which is mainly controlled by the function in the adherens junction, consisting of E-cadherin associated proteins (E-cadherin, alpha- and beta-catenins, vinculin, alpha-actinin, and actin). The cell-to-cell aggregation activity and the expressions of E-cadherin, and alpha- and beta-catenin mRNAs in Ishikawa cells of well-differentiated endometrial cancer were significantly suppressed by estrogen. These suppressions were reversed by progesterone, medroxyprogesterone acetate (MPA) and danazol. Proteins in the adherens junction appeared to be expressed intact and to be functional in Ishikawa cells. Persistent estrogen predominant milieu might contribute to the detachment of well-differentiated endometrial cancer cells, leading to spreading of those cells, while progestins and danazol protect estrogen-induced spreading of those cells.

Estrogen activates migration potential of endometrial cancer cells through basement membrane

The migration potential through a basement membrane in an endometrial cancer cell line, such as Ishikawa, HEC-1-A or HHUA cell, in terms of strength, was enhanced by estradiol, but not modified by progesterone, medroxyprogesterone acetate (MPA), danazol or tamoxifen alone, by which estradiol-enhanced migration potential was inhibited. The order of the level of estrogen receptor was Ishikawa > HEC-1-A > HHUA cells. Therefore, it is suggested that the invasiveness of endometrial cancer cells might be activated by estradiol via estrogen receptors, but inactivated by progesterone, MPA, danazol or tamoxifen as an antiestrogen action, and that endometrial cancer cells could become invasive in the estrogen-predominant milieu, and the antiestrogenic agents could protect it.

Expressions of the fibroblast growth factor family (FGF-1, -2 and -4) mRNA in endometrial cancers

To investigate whether growth, invasion and metastasis of endometrial cancer cells is associated with neovascularization, the expressions of fibroblast growth factor-1 (acidic FGF), -2 (basic FGF) and -4 (hst-1) mRNAs and FGF-2 in endometrial cancers and normal endometria as controls were determined by reverse transcription-polymerase chain reaction-Southern blot and ELISA, respectively, and the relationships between their expressions and histological grades, grades of myometrial invasion or clinical stages of endometrial cancers were analyzed. The levels of FGF-1 mRNA and FGF-2 and its mRNA tended to increase with dedifferentiation (especially grade G3), myometrial invasion (especially grade C) and staging (especially stages III and IV) in endometrial cancers were significantly (p < 0.05) higher than those in normal endometria. However, the levels of FGF-4 mRNA expression were significantly (p < 0.05) lower than those of FGF-1 and -2 mRNAs in both endometrial cancers and normal endometria. Therefore, endometrial cancers might mainly secrete FGF-1 and -2, which leads to neovascularization to provide nutrition, resulting in accelerated growth, invasion and metastasis. Apparently, the increased secretion parallels the progressive malignancy of endometrial cancers.

Overexpressions of c-fos/jun mRNA and their oncoproteins (Fos/Jun) in the mouse uterus treated with three natural estrogens

To further understand hormonal carcinogenesis of natural estrogens (estrone, 17 beta-estradiol (E2) and estriol), we determined the expressions of c-fos/jun mRNA, and their oncoproteins (Fos/Jun) with intracellular localization in the uterus of ovarectomized mice treated with these estrogens. Mid-term chronic, as well as short-term assays were examined. Of three estrogens examined, mid-term chronic E2-treatment significantly increased the expression of c-fos/jun mRNA, and their oncoproteins (Fos/Jun). These were most prominently expressed in glandular cells of E2-treated mouse endometrium. Therefore, mid-term chronic E2-treatment might partially induce glandular cell transformation of uterine endometrium via overexpression of Fos/Jun.

Expression of corticosteroid-binding globulin mRNA in human uterine endometrial cancers

Since it has been demonstrated that corticosteroid-binding globulin (CBG) plays a role in intracellar steroidal actions in target cells, the expression of CBG mRNA as the measure of CBG expression was investigated in human endometrial cancers in order to assess the biological implications of CBG. The level of CBG mRNA was analyzed using competitive reverse transcription-polymerase chain reaction-Southern blot analysis. While the level of CBG mRNA was significantly (P < 0.01) higher in secretory phase endometrium than in early and late proliferative phase endometrium, the level of CBG mRNA tended to decrease with advanced dedifferentiation of endometrial cancers as compared to normal endometrium. These results suggest that dedifferentiation of endometrial cancers induces a reduction in intracellular CBG synthesis.

Estrogen induces c-Ha-ras expression via activation of tyrosine kinase in uterine endometrial fibroblasts and cancer cells

Endometrial fibroblasts derived from uterine endometrium as controls and endometrial cancer cells (Ishikawa and HHUA cells) were used to analyze the manner of induction of c-Ha-ras transcripts in endometrial cancers, some of which are estrogen-dependent in growth. Estrogen increased c-Ha-ras expression and tyrosine kinase (TK) activity in fibroblast and Ishikawa cells, but not in HHUA cells. Progesterone diminished c-Ha-ras expression and tyrosine kinase (TK) activity induced by estradiol in the fibroblasts, but not in Ishikawa cells, which persistently overexpressed c-Ha-ras. In these cells, epidermal growth factor (EGF) increased c-Ha-ras expression as did estradiol. Pretreatment with tyrphostin, an inhibitor of TK, abolished estrogen-inducible overexpression of c-Ha-ras. The combination of both estradiol and EGF at maximum effective concentration exerted no additive or synergistic effect on induction of c-Ha-ras expression. In conclusion, persistent activation of TK might lead to overexpression of c-Ha-ras in some endometrial cancer cells under estrogen predominant milieu, which might be associated with the transformation or growth potential.