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Detection of Estrogen and Progesterone Receptors in Endometrial Polyps and Its Diagnosis

Author: LiXiuMei
Tutor: XuWei
School: Jilin University
Course: Clinical
Keywords: endometrial polyp diagnosis progesterone receptor estrogen receptor
CLC: R737.33
Type: Master's thesis
Year: 2006
Downloads: 146
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Abstract

Endometrial polyp(EP) is one of the most common cause of abnormalvaginal bleeding and infertility, it often happened in women beyond35 years old, its prevalence rises by age ,the foreign study showsthat the incidence of endometrial polyp is about 3% in the womenyounger than 35 years old, and 23% older 35 years old, the incidenceof postmenopausal women is about 31%, and it is most common in womenaged 50years old, fewer beyond 70 years old. The symptom of EP inpremenopause women is irregular menses, polyhypermenorrhea,prolonged menstruation;in postmenopause women it manifestsirregular vaginal bleeding or vaginal drainage. It often has noabnormal findings in gynecological examination and is regarded asdysfunctional uterine bleeding wrongly, it often shows no responseto routine hemostasis, treatment of hormone and D&C. it often resultsin hysterectomy before the use of hysteroscopy. The diagnosis of EPis increased greatly with the clinical use of hysteroscopy, becausethe hysteroscope can view the cavity of uterus directly, thehysteroscopy shows its special superiority in the diagnosis of tinyEP.The endometrial polyp is the second common cause of abnormaluterine bleeding,and it is only fewer than endometrial hyperplasia.Its pathogenesis is poorly understood, someone thinks that it isrelated to inflammation, regards it as the hyperplasia of endometriumresponse to repeated mechanical stimulus or biological inflam factor;someone thinks that EP is the benign tumor of endometrium, othersdoubts if it is the same to polyp of rectum and thinks it as the signalof carcinoma. But most scholars think that it is related to turbulenceof incretion, especially to the reaction of estrogen and progesterone,think that EP is the result of local excess endometrial hyperplasiareacted to hormone and trauma. Therefore someone brings forward theview that the distribution of ER and PR in endometrium is unbalancedprobabily. ER and PR are all steroid hormonal receptors, belong tothe members of nucleic receptor. Nucleic receptor is a kind of genethat controls transcription, it can conjoint to DNA responsecomponent. They act important control effect in the life process ofreproduce, growth and metabolize. ER is an important protein ofestrogen signal path. Estrogen and progesterone act on their targetcells through respective receptors. The active degree is related tothe amount of the receptors in the target cells.At present, there are many studies about the expression of ERin carcinoma of endometrium, carcinoma mammae and tumor of alimentarytract. And it had been proved that the expression of ER hadconsanguineous relation to the happen, differentiation, prognosisand incretion treatment of tumor.There are many studies about thepathogenesis of EP abroad, but in our country there are few studiesabout the pathogenesis of EP, the study of zhaohui ouyang proved thatEP was related to fatness, but there is no study of relationshipbetween ER PR and EP in our country.Therefore, this study is to detect the presence of estrogen (ER)and progesterone (PR) receptors in endometrial polyps and adjacentendometrium in postmenopausal women. These patients had been diagnosedbenign endometrial polyp by hysteroscopy, and had been submitted tooperative hysteroscopy. The aim is to discuss the diagnosis of EPand chase down the cause of EP, moreover, we provide theoretical basisto the diagnosis and treatment of EP.Twenty -three consecutively enrolled postmenopausal patientswere submitted to operative hysteroscopy. These patients haddiagnosed benign endometrial polyp. The age range of patients was51 to 72 years (median, 60±2.38 y)。The presence of ER and PR wasdetermined in endometrial samples and polyps by immunohistochemicalmethod and the slides were evaluated using a semiquantitativeanalysis. All the patients had not been taking medication withhormonal effects for at least 6 months.The results of my research show:(1)the endometrium of postmenopause women canbe proliferative phase or atrophic endometrium, but seldom presentssecretory phase under the action of continuous low estrogen.(2) Thereis a little expression of ER and PR in normal endometrium, but inthe non-polyp part of postmenopause women, the expression level ofER and PR is low, this maybe related to the low level of estrogenin the blood, because the expression of ER and PR is changing withthe change of hormonal quantity, estrogens act through specificreceptors located in the nuclei of epithelial and stromal cells ofthe endometrium. estrogens stimulate the synthesis of thesereceptors and the progesterone inhibits their synthesis. (3)Thereis an unbalanced distribution of ER and PR in endometrial polyps andendometrium, whether in gland or in stromal cells of postmenopausalwomen, the expression of ER and PR in polyp part is higher than inthe non-polyp part, especially the expression of ER in gland. Thisresult is accordant to the result of Sant’Ana de Almeida EC’s study.Hormone act through specific receptors located in the nuclei ofepithelial and stromal cells of the endometrium. The high expressionof local part makes it grow obviously under the low hormonal levelin the body, finally, it results in endometrial polyp.Our data suggests that the higher proportion of positive cellsfor ER and PR in EP as compared to endometrium supports an implicationof these receptors in the pathogenesis of polyps in postmenopausalwomen;the hysteroscopy presents a crucial role in the diagnosis ofthe endometrial polyps;we suggest the preventive means and highrisky factors, at the same time, we imagine the drug treatment ofendometrial polyp.

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