Tooru Yamabe

Expression of estrogen and progesterone receptors in endometrium and peritoneal endometriosis: an immunohistochemical and in situ hybridization study

OBJECTIVE To clarify the role of ovarian steroids in the development and progression of endometriosis, estrogen receptors (ERs) and progesterone receptors (PRs) were localized by immunohistochemistry, and ER messenger RNA (mRNA) was detected by in situ hybridization in the uterine endometrium and in normal and altered pelvic peritoneum. DESIGN Retrospective and prospective study. SETTING Nagasaki University School of Medicine, Nagasaki, Japan. PATIENT(S) A retrospective study of 61 formalin-fixed uterine endometria and normal and altered pelvic peritonea from patients suffering from various gynecologic diseases was conducted. In addition, in 22 fresh frozen tissue specimens, ER mRNA expression was evaluated prospectively. MAIN OUTCOME MEASURE(S) In formalin-fixed tissues, ER and PR were localized immunohistochemically. The results of immunohistochemical staining were scored from 0 to 4, depending on the signal intensity and frequency of positive cells. In fresh frozen specimens, ER mRNA expression was assessed by nonradioactive in situ hybridization using thymine-thymine dimerized oligonucleotide probes. RESULTS The highest score of ERs and PRs was observed in the epithelial and stromal cells of the normal uterine endometrium at the early proliferative phase of the menstrual cycle. The ER and PR scores declined throughout the secretory phase. In typical endometriotic lesions, the ER and PR scores were constantly high independent of the menstrual cycle. The expression pattern of ER mRNA was mostly in parallel with that of ERs. In typical endometriosis, ERs and PRs were found in both glandular epithelial cells and their surrounding stromal cells. Expression of ER mRNA was found in typical endometriotic peritonea and in pelvic peritoneum with columnar epithelial cells, but not in normal pelvic peritoneum (mesothelium). Estrogen receptors and PRs were negative in mesothelium, but were positive in the nuclei of fibroblasts in the connective tissue. CONCLUSION(S) We demonstrated the expression of ERs, ER mRNA, and PRs in the columnar cells in pelvic peritonea and typical endometriosis, but not in normal mesothelium. These results suggest that endometriosis may originate from the columnar cells with ERs and PRs in the pelvic peritoneal lining.

A solitary neurilemmoma of the clitoris

Abstract Neurilemmoma of the female genital tract is extremely rare. Presented is the case of a 84-year-old woman with a gradually enlarging clitoral mass. After simple excision, the mass proved to be a neurilemmoma originating from the clitoris histologically.

Influence of ovarian endometrioma on fertility

OBJECTIVE This study examines the influence of ovarian endometrioma on fertility. STUDY DESIGN For 117 infertile women who were diagnosed as having endometriosis by laparoscopy and who underwent danazol therapy, we examined (1) the relationship between ovarian endometrioma and level of bead-phagocytotic macrophages in ascites and the interleukin-1 beta level, (2) the relationship between ovarian endometrioma and pregnancy rate during the 36 months after danazol therapy, and (3) the relationship between ovarian endometrioma and pregnancy rate, considering the severity of the lesion on the bilateral tubes and the pelvic peritoneum. RESULTS (1) The levels of bead-phagocytotic macrophages in patients with or without ovarian endometrioma were 68% and 67%, respectively (not significant). Similarly, no significant difference was seen in the interleukin-1 beta positive rate between the two groups. (2) The pregnancy rates of the former group and the latter group were 36% and 43%, respectively (not significant). (3) The existence or absence of ovarian endometrioma made no significant difference in the pregnancy rate in a group of patients with no lesions in the bilateral tubes or in another group with no lesions and scattered endometriotic implants on the peritoneum. CONCLUSIONS It seems unlikely that ovarian endometrioma itself significantly impedes fertility after danazol therapy.

Sporadic Appearance of Luteal-Phase Defect in Prospective Assessment

We studied the sporadic appearance of luteal-phase defect in the prospective assessment of consecutive cycles. Basal body temperature (BBT) was recorded in 36 women (20-35 years of age) for at least 3 consecutive cycles (total of 194 cycles). These BBT records were analyzed for pattern and luteal-phase length (LPL). Furthermore, the relationship was investigated between the BBT and luteal function in terms of serum hormonal levels and endometrial dating in the luteal phase. The length of the transitional period from the hypothermic to the hyperthermic phase was also studied in relation to luteal function in 59 women (21-33 years of age). The results were as follows: (1) Different BBT patterns and LPLs in consecutive cycles occurred in 36 and 67% of the observed cycles, respectively. (2) Cycles with abnormal steroid levels and endometrial dating were observed sporadically. (3) The length of the transitional period appeared useful for prospective evaluation of luteal function. These findings suggest that the conditions of the luteal function do not appear in every cycle of each woman. Therefore, assessing the function of one cycle seems of little use in predicting the function of the next or future cycles.

Characterization and comparison of two forms of human chorionic gonadotropin from hydatidiform moles with low and high immunoreactivity

Two glycoproteins (LM-hCG and HM-hCG) with gonadotropic activity were purified from the chorionic tissue of patients with hydatidiform mole with low and high urinary human chorionic gonadotropin levels and were compared to each other. The immunologic, biologic, and physicochemical properties of the two preparations were very similar. Also, the quantities of LM-hCG and HM-hCG recovered from molar tissue from the two types of patients were similar. However, the molar tissue from patients who excreted high levels of human chorionic gonadotropin immunoreactivity also contained other molecular forms with apparent human chorionic gonadotropin immunoreactivity tissues from patients who excreted low levels did not. These latter molecular forms may account for the differences in the levels of human chorionic gonadotropin immunoreactivity excreted by the two types of patients.

Immunohistochemical expression of P-glycoprotein in cases of uterine cervical cancer

BackgroundExpression of P-glycoprotein (P-GP), which is the product of the multidrug resistance gene,MDR1, and its relation to the conventional clinicopathological prognostic factors and prognosis in cervical cancer were examined.MethodsThe relationship between immunohistochemical expression of P-GP and accumulative survival rate and the conventional clinicopathological prognostic factors of 119 cases of uterine cervical cancer was examined. In addition, the relation of P-GP expression before and after administration of platinum drugs to total platinum concentration in tumor tissue was examined in 19 cases.ResultsThe expression rate of P-GP was 0% (stage 0), 37.7% (stage I), 49.0% (stage II), 83.3% (stage III), and 100% (stage IV). The P-GP expression rates in the groups with and without parametrial invasion were 65.8% and 29.6%, respectively (P<0.001). The accumulative survival rate in the group positive for P-GP was significantly lower than that in the group negative for P-GP in stage II (P=0.0298). The median relative ratio of intratumor platinum concentration to serum level in group A (P-GP had already been expressed before administration of platinum drug), group B (P-GP was not expressed either before or after administration of platinum drug) and group C (P-GP was expressed after administration of platinum drug) was 1.82, 7.45, and 2.70, respectively.ConclusionThe expression of P-GP in the cases of uterine cervical cancer could be associated with conventional clinicopathologic prognostic factors and the efficacy of radiation therapy and chemotherapy.

Changes seen in vaginal epithelial cell after oophorectomy

Cytohormonal evaluation was made on vaginal smears and smears of urinary sediment taken from 56 premenopausal and 16 postmenopausal castrated women.1) The atrophic type appeared soon after castration in the normally menstruating women. The breakdown after 25 weeks was 37.0% atrophic type, 55.6% intermediate type and 7.4% estrogenic type.2) There were a few cases which later turned out to be of the estrogenic type, although they had initially been of the intermediate type.3) Histological findings of vaginal epithelium 16 weeks after castration gave such a breakdown which was 11.8% estrogenic type, 50.0% intermediate type, and 38.2% atrophic type.4) The foregoing results suggested the existence of some mechanism which assists the vaginal epithelium in proliferating and maturating after castration.5) Also suggested was the existence of a slightestrogen secretory function in the menopausal ovary.6) Serum estradiol was as low as 30-60 pg/ml one week after castration.7) Changes in the smears of urinary sediment kept pace with those of the vaginal smears, and they were found satisfactory as test objects for cytohormonalevaluation.