| Endometrial carcinoma is one of the most common malignant tumors of the female pelvis and its increased incidence has been apparent in recent years. It has been proved that most of endometrial hyperplasia diseases are reversed, except for some of them capable of carcinogenesis. Up to now, however, the clinical diagnosis and treatment of endometrial hyperplasia have not become routinely. Only depending on the pathological diagnosis according to morphological changes of the endometrium often led to clinical overdiagnosis and overtreatment. As the biochemical changes of cells should precede their histological changes, it is significant to study some biochemical characteristics of the endometrial cells. It is well known that unopposed estrogenic stimulation of the endometrium is one of the main responsible factors of endometrial hyperplasia and carcinoma. Both stromal and epithelial endometrial cells synthesize insulin-like growth factor-I (IGF-I) and express its receptor (IGF-IR) which actively regulate endometrial growth and differentiation by the interaction with steroid hormones. Increased expressions of IGF-I/-IR have been found frequently in many cancers. Nevertheless, little is known about and the effects and changes of them in the progression from normal cells to endometrial hyperplasia and malignancy. Our present study was aimed at evaluating the expression of IGF-I/IR at normal endometrium,endometrial hyperplasia and endometrial adenocarcinomas, and thus exploring new biochemical indicators for differential diagnosis and treatment for endometrial boarderline diseases.The study included 55 patients treated by dilatation & curretage or hysterectomy from May 2002 to November 2003 at the department of Obstetrics and Gynecology in the Second Clinical Hospital of Jilin University, pathologically proved 20 cases of normal endometrium (Normal Group ) and 35 cases of endometrial hyperplasia (Hyperplasia Group ). In addition, there were also 22 patients treated for endometrial adenocarcinoma (Adenocarcinoma Group). The normal group included proliferative and secretory endometrium, respectively 10 cases. The hyperplasia group included simple hyperplasia,complex hyperplasia and atypical hyperplasia (ATH), respectively 13,10 and 12 cases. Clinical stage and histological grade was evaluated in the adenocarcinoma group according to FIGO's standard: 11 cases of First Stage, 6 cases of Second Stage, 5 cases of Third Stage; 13 cases of G1, 5 cases of G2, 4 cases of G3. All of them underwent hysterectomy, bilateral salpigo-oophorectomy and selected pelvic lymphadonectomy. All patients included in our study had not used any hormonal contraceptive medicine or devices three months before operation. Immunohistochemical staining for IGF-I and IGF-IR were performed by SP. The staining intensity was expressed with histological score (H –Score) and analysed with HPIAS-1000 color imaging analysis system. SPSS statistical software was used for statistical analysis. The significance of differences between individual groups was assessed with t-test ,LSD test and so on.In the present study, we have detected IGF-I H-Score of normal endometrium in the proliferative phase was much higher than in the secretory phase (P<0.05), thus strengthening the view that IGF-I acts as an estromedin ,involving in the endometrial proliferation. On the other hand, IGF-IR H-Score was not significantly different between proliferative and secretory phase (P>0.05), suggesting its local expression may not be regulated by estrogen.In our study, IGF-I H-Score of atypical hyperplasia (ATH) was significantly low relative to complex hyperplasia (6.3±1.1 versus 9.6±1.7,P<0.05), nevertheless, IGF-IR H-Score of ATH was significantly high compared with simple hyperplasia (8.0±1.3 versus 5.8±1.6, P<0.01). Pathologically, the radical differentiation between ATH and other hyperplasia lies in the atypicity of glandular epithelial cells. These results suggest that a correlation between IGF-I and endometrial benign hyperplasia as a kind of mito...
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