子宫平滑肌瘤ER、PR、GnRHR、MVD表达及其与MRI表现的相关性
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摘要
目的探讨CUL、OUL和正常子宫肌层中ER、PR、GnRHR、MVD的表达及其与MRI表现之间的相关性。
方法收集本院术前曾行MRI盆腔扫描且术后病理确诊为UL 30例,其中16例为OUL;14例为CUL。收集14例正常子宫肌层作为对照组。对上述病例进行病理切片,采用免疫组化染色二步法检测ER、PR、MVD,采用免疫组化染色S-P法检测GnRHR。所得数据进行合理的统计与分析。
结果1. MRI表现:16例OUL和14例CUL T1WI信号强度均表现为稍低或等信号。两种病理类型UL T2WI信号强度、强化程度的差异均有统计学意义。2. ER、PR的表达:OUL和CUL ER、PR表达的阳性率差异无统计学意义,但两者均显著高于正常子宫肌层的表达。3. GnRHR的表达:正常子宫肌层和OUL中GnRHR表达的阳性率差异无统计学意义,但两者均显著低于CUL。4. MVD的表达:MVD在正常子宫肌层、OUL和CUL中的表达差异均无统计学意义。5. ER、PR、GnRHR、MVD表达与MRI表现的相关性分析:无论OUL还是CUL中GnRHR的表达与MRI强化程度之间存在显著正相关关系。
结论1. OUL T1WI呈等或稍低信号,T2WI呈均匀低信号,增强后以非显著均匀强化为主。CUL T1WI上主要为均匀等信号, T2WI上主要为均匀稍高信号,增强后显著均匀强化。2.核分裂像<5个/10HPF的CUL的生物学特性偏向于良性子宫平滑肌肿瘤。3. GnRHa治疗可能主要通过UL上的GnRHR介导起直接抑瘤作用,利用MRI可筛选出GnRHR表达较高且GnRHa治疗效果较好的CUL。4. UL的生长不依赖于MVD的增高,抗肿瘤血管生成药物对UL的疗效有限。5. MRI增强扫描显著均匀强化的UL,含有GnRHR表达较高,应用GnRHa治疗效果可能较好。
Objective To explore expression of ER, PR, GnRHR, MVD in uterine leiomyoma and the correlation with MRI.
Methods 16 cases of ordinary leiomyomas and 14 cases of cellular leiomyomas were chose, which were examined by MRI and verified by pathology. 14 cases of normal myometrium were chose as the control group. All cases were detected by immunohistochemistry methods with monoclonal antibody against ER, PR, GnRHR and CD34.
Results 1.MRI: All the leiomyomas showed slight hypointensity or isointensity on T1- weighted images. The signal intensity on T2- weighted images and the patterns of enhancement were statistically different between ordinary leiomyomas and cellular leiomyomas. 2.The expression of ER and PR: There was no statistic difference in the positive expression of ER and PR between ordinary leiomyomas and cellular leiomyomas, but both of them were statistically higher than the normal myometrium. 3.The expression of GnRHR: There was no statistic difference in the positive expression of GnRHR between normal myometrium and ordinary leiomyomas, but both of them were statistically lower than cellular leiomyomas. 4.The expression of MVD: The expression of MVD in normal myometrium, ordinary leiomyomas and cellular leiomyomas were not statistically different. 5.The relationship between expression of ER, PR, GnRHR, MVD and MRI: The positive correlation was found between the expression of GnRHR and the pattern of MRI enhancement in ordinary and cellular leiomyomas respectively.
Conclusion 1.Most ordinary leiomyomas show slight hypointensity or isointensity on T1- weighted images, homogenous hypointensity on T2- weigthed images and no homogenously significant enhancement. Most cellular leiomyomas show isointensity on T1- weighted images, hyperintensity on T2- weigthed images, and homogenously significant enhancement. 2. The biological behaviour of cellular leiomyoma without increased karyokinesis activity is similar to the benign smooth muscle tumor. 3. Medical management of uterine leiomyoma by GnRHa may rely upon an directly antiproliferative effect via GnRHR expressed by leiomyoma. MRI helps screen cellular leiomyoma, which expresses more GnRHR and is more responsive to GnRHa. 4. Leiomyoma may not respond to hypoxia or tissue growth by an increase in microvessel density. Antiangiogenic agents would have limited therapeutic value in uterine leiomyoma. 5. Because of more GnRHR, uterine leiomyoma which shows homogenously significant enhancement on MRI may be more responsive to GnRHa.
方法收集本院术前曾行MRI盆腔扫描且术后病理确诊为UL 30例,其中16例为OUL;14例为CUL。收集14例正常子宫肌层作为对照组。对上述病例进行病理切片,采用免疫组化染色二步法检测ER、PR、MVD,采用免疫组化染色S-P法检测GnRHR。所得数据进行合理的统计与分析。
结果1. MRI表现:16例OUL和14例CUL T1WI信号强度均表现为稍低或等信号。两种病理类型UL T2WI信号强度、强化程度的差异均有统计学意义。2. ER、PR的表达:OUL和CUL ER、PR表达的阳性率差异无统计学意义,但两者均显著高于正常子宫肌层的表达。3. GnRHR的表达:正常子宫肌层和OUL中GnRHR表达的阳性率差异无统计学意义,但两者均显著低于CUL。4. MVD的表达:MVD在正常子宫肌层、OUL和CUL中的表达差异均无统计学意义。5. ER、PR、GnRHR、MVD表达与MRI表现的相关性分析:无论OUL还是CUL中GnRHR的表达与MRI强化程度之间存在显著正相关关系。
结论1. OUL T1WI呈等或稍低信号,T2WI呈均匀低信号,增强后以非显著均匀强化为主。CUL T1WI上主要为均匀等信号, T2WI上主要为均匀稍高信号,增强后显著均匀强化。2.核分裂像<5个/10HPF的CUL的生物学特性偏向于良性子宫平滑肌肿瘤。3. GnRHa治疗可能主要通过UL上的GnRHR介导起直接抑瘤作用,利用MRI可筛选出GnRHR表达较高且GnRHa治疗效果较好的CUL。4. UL的生长不依赖于MVD的增高,抗肿瘤血管生成药物对UL的疗效有限。5. MRI增强扫描显著均匀强化的UL,含有GnRHR表达较高,应用GnRHa治疗效果可能较好。
Objective To explore expression of ER, PR, GnRHR, MVD in uterine leiomyoma and the correlation with MRI.
Methods 16 cases of ordinary leiomyomas and 14 cases of cellular leiomyomas were chose, which were examined by MRI and verified by pathology. 14 cases of normal myometrium were chose as the control group. All cases were detected by immunohistochemistry methods with monoclonal antibody against ER, PR, GnRHR and CD34.
Results 1.MRI: All the leiomyomas showed slight hypointensity or isointensity on T1- weighted images. The signal intensity on T2- weighted images and the patterns of enhancement were statistically different between ordinary leiomyomas and cellular leiomyomas. 2.The expression of ER and PR: There was no statistic difference in the positive expression of ER and PR between ordinary leiomyomas and cellular leiomyomas, but both of them were statistically higher than the normal myometrium. 3.The expression of GnRHR: There was no statistic difference in the positive expression of GnRHR between normal myometrium and ordinary leiomyomas, but both of them were statistically lower than cellular leiomyomas. 4.The expression of MVD: The expression of MVD in normal myometrium, ordinary leiomyomas and cellular leiomyomas were not statistically different. 5.The relationship between expression of ER, PR, GnRHR, MVD and MRI: The positive correlation was found between the expression of GnRHR and the pattern of MRI enhancement in ordinary and cellular leiomyomas respectively.
Conclusion 1.Most ordinary leiomyomas show slight hypointensity or isointensity on T1- weighted images, homogenous hypointensity on T2- weigthed images and no homogenously significant enhancement. Most cellular leiomyomas show isointensity on T1- weighted images, hyperintensity on T2- weigthed images, and homogenously significant enhancement. 2. The biological behaviour of cellular leiomyoma without increased karyokinesis activity is similar to the benign smooth muscle tumor. 3. Medical management of uterine leiomyoma by GnRHa may rely upon an directly antiproliferative effect via GnRHR expressed by leiomyoma. MRI helps screen cellular leiomyoma, which expresses more GnRHR and is more responsive to GnRHa. 4. Leiomyoma may not respond to hypoxia or tissue growth by an increase in microvessel density. Antiangiogenic agents would have limited therapeutic value in uterine leiomyoma. 5. Because of more GnRHR, uterine leiomyoma which shows homogenously significant enhancement on MRI may be more responsive to GnRHa.
引文
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3. Chou CS, Beristain AG, MacCalman CD, et al. Cellular localization of gonadotropin-releasing hormone(GnRH) I and GnRH II in first-trimester human placenta and decidua. J Clin Endocrinol Metab, 2004,89:1459~1466.
4. Kang SK, Choi KC, Cheng KW, et al. Role of gonadotropin-releasing hormone as an autocrine growth factor in human ovarian surface epithelium. Endocrinology 2000,141:72~80.
5. Raga F, Casan EM, Kruessel JS, et al. Quantitative gonadotropin-releasing hormone gene expression and immunohistochemical localization in human endometrium throughout the menstrual cycle. Biol Reprod, 1998,59:661~669.
6. Grundker C, Gunthert AR, Millar RP, et al. Expression of gonadotropin-releasing hormone II (GnRH-II) receptor in human endometrial and ovarian cancer cells and effects of GnRH-II on tumor cell proliferation. J Clin Endocrinol Metab 2002;87:1427~1430.
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