Expression Of Aromatase, ER, PR In Women With Adenomyosis And Ovarian Endometriosis

BackgroundAdenomyosis and endometriosis are common diseases in reproductive women,which affect between 5 and 10 percents of female people,with destructive influence.Endometriosis,with malignant biological behaviors such as proliferation, invasion,recurrence,metastasis,and so on,which can invade into anywhere of body,do great harm to people's health.Researchers have been interested in the pathogenesis since it was descriped..Some theories have been proposed to explain the pathogenesis of endometriosis:transplantation of endometrial tissue,celomic metaplasia,Induction hypothesis and so on..Most scholars insist that the aggravation of adenomyosis developed is due to basal cell proliferating and migrateing into stroma of myometrium.No single theory,however,can account for the etiopathogenesis. Endometriosis is an estrogen-dependent disorder,which means that ectopic tissue can hardly grow without stimulation of estrogen.We mainly cure this disease through inhibiting or antagonizing the function of estrogen,nevertheless the effct is unsatisfying.As for the reason,some researchers suppose that ectopic tissue may produce estrogen itself.Aromatase plays a key role in the synthesizing of estrogen,and what's more,many cases about successfully healing endometriosis with aromatase inhibitors are reported in other countries.Its effct of adenomyosis has rarely be studied sofar.Therefore,exploring the expression of aromatase in these diseases may help us to know the disease more clearly,in order to develop a new target of the therapy.Objectives1.To observe the expression of aromatase,ER,PR in eutopic endometrium of normal control group,adenomyosis group and ovarian endometriosis group.Find out the differences of the expression of aromatase,ER,PR in eutopic endometrium between normal control group,adenomyosis group and ovarian endometriosis group.2.To observe the expression of aromatase,ER,PR in ectopic situs of denomyosis group and ovarian endometriosis group.Compare them with that of eutopic endometrium,to infer the regulation of reproductive hormones in ectopic site.Materials,methodsPick up patients with ovarian endometriosis(15 cases),adenomyosis(15 cases),adenomyosis complicated with ovarian endometriosis(15 cases) and normal control condition(20 cases) who have accepted operative treatment during January 2003 to September 2007 in Shanghai First Maternity and Infant health Hospital.By immunohistochemical method,we assessed their expression of aromatase,ER,PR in eutopic and ectopic endometrium,in the same way,gave corresponding immunohistochemical score.Results1.The expression of aromatase,ER,PR in eutopic endometrium of normal control group,adenomyosis group and ovarian endometriosis group.(1).There wasn't any expression of aromatase in the eutopic endometrium in the normal control group,while the other two groups expressing aromatase.In addition,expressions of ovarian endometriosis were statistically higher than adenomyosis.(2).ER was expressed in the eutopic endometrium in all of the three groups,there was no significantly distinction between the proliferative phase and the secretive phase.We didn't find differences statistically among the three groups.(3). PR was expressed in the eutopic endometrium in all of the three groups.We found statistically significant increased PR expression in secretive phase compared to proliferative phase.There was no statistically differences between the two phases in other two groups.Compared with the control group,there wasn't significant diatinction in the ovarian endometriosis group during respective menstrual phase and during the proliferative phase in the adenomyosis group,while during the secretive phase,expression decreased.2.The expression of aromatase,ER,PR in ectopic situs of adenomyosis group and ovarian endometriosis group.(1).Aromatase was expressed in every adenomyosis,rarely expressed in ovarian endometriosis,what's more,expression was lower in ovarian endometriosis than in adenomyosis.(2).ER,PR was expressed both in two groups,significantly decreased expression in adenomyosis was observed compared with ovarian endometriosis.(3).Compared with respectively eutopic endometrium,we found significantly increased aromatase,decreased ER,PR expression in endomyosis and decreased aromatase,ER,PR in ovarian endometriosis in ectopic tissue.(4).Results in self contrast are basically consistent with xenogenic contrast:eutopic endometrium of adenomyosis complicated with ovarian endometriosis expressed aromatase, ER,PR,increased aromatase expression,decreased ER,PR expression in the site of adenomyosis,rarely aromatase expression,increased ER,decreased PR expression was detected in the site of ovarian endometriosis compared with its eutopic endometrium.Conclusions:1.There is no expression of aromatase in normal people.The expression of aromatase in eutopic endometrium might be one of the important factors in the pathogenesis of adenomyosis and ovarian endometriosis.2.Ectopic tissue of adenomyosis can synthesize estrogen,which develop effect in the way of paracrine,autocrine,implies that adenomyosis is not only independent of serumal estrogen.3.Rare expression of aromatase and much expression of ER in ectopic endometrium of ovarian endometriosis reflect that this disorder is probably mainly dependent on serumal estrogen.4.Decreased PR ecpression in the ectopic tissue of adenomyosis and ovarian endometriosis might contributes to the pathogenesis of endometriosis and ovarian endometriosis.