Expression Of GnRHR,P450arom, ER And PR In Eutopic And Ectopic Endometrium And The Clinical Significance

Background: Endometriosis is a common and frequently occurring disease. The effect of its treatment is often unsatisfying because the occurrence and progression of ectopic endometrium are far from being completely understood. We conclude that it would be related to various pathegenisis by its various manifestation. Endometriosis is considered as a kind of hormone-dependent disease. Studies have demonstrated that the occurrence and development of endometriosis have hormone dependence. The expression of hormone receptors in ectopic tissues could effect the growth and implantation of endometriosis. The estrogen receptor(ER), progesterone receptor(PR) had been detected in actopic endometrium. Present studies have found that gonadotropin-releasing hormone receptor(GnRHR) express in ectopic endometrial cells and speculated whether GnRH mediated by its receptor may also exert a direct modulatory effect on endometriosis growth by autocrine-paracrine regulators. Aromatase cytothrome P450 (P450arom) is a key enzyme during the estrogen synthesis, the expression of this gene inendometriosis suggest that ectopic endometrium may compose estrogen by paracrine secretion to anticipate the ocurrence and progression of the disease. Studies on the expression of sex hormone receptors in eutopic and ectopic endometrium will make great contribution to detecting the role of hormone in endometriosis mechanism and to treating endometriosis with hormone inhibitor better.Objective: to determine whether GnRHR, P450arom, ER and PR can be expressed in eutopic and ectopic endometrium with different location and to find the relationship among them; to detect the role of GnRHR, P450arom,ER and PR in endometriosis mechanism; to give clinic reference for using GnRHa and aromatase inhibitor better in the endometriosis treatment.Samples and Method: This study included 40 patients who had undergone operation because of endometriosis. All are at the stage of III and IV, according to the r-AFS. Their eutopic endometrium were at the proliferative phase. No hormone was used within 3 months. 83 tissues from different locations were taken from the patients, which were clinically and pathologically confirmed. Tissues from different locations had been formalin-fixed and pareffin-embedded. Normal endometrium were obtained from 20 fertile women who had endometrial curettage before put in IUD. Meanwhile, the proliferative phase of the tissues were confirmed by pathological assay. Groups: Endometriosis group: eutopicendometrium, 25 cases; ovarian endometriosis tissues, 23 cases; vagina-rectum endometriosis tissues, 11 cases; peritoneum endometriosis tissues, 8 case; uterine serosa endometriosis tissues, 16 cases. Control group: normal endometrium, 20 cases. Two-steps immunohistochemically. Staining intensity was assigned with a semiquantitative HSCORE standard. Statistical Analysis: Analysis of variance for measurement data; Chi-square test for enumeration data; SPSS 11.5 for analysis.Results: GnRHR could be expressed with different levels at different locations. Positive reactive substance was localized in the cytoplasm of glandular cells, and had negative reaction in the nucleolus. The tissues had high expression in glandular epithelial cells while having weak or no expression in stromal cells. P450arom expression was similar to GnRHR, which were localized in the cytoplasm, primarily in glandular epithelial cells. ER and PR were expressed to a higher level in the nucleolus in both the glandular and stromal cells.The expression of GnRHR in diseased endometrium showed significantly higher than that in normal endometrium(P<0.001).; Expressions of GnRHR in ovary and vagina-rectum endometriosis were no difference with those in other groups(p>0.05); Expressions of GnRHR in peritoneum and uterine serosa endometriosis were higher than those in normal endometrial tissues(P<0.05).The expression of P450arom in eutopic endometrium weresignificantly higher than that in normal endometrium (P<0.001); Expressions of P450arom in ovary, vagina-rectum...