Biological differences between intrinsic and extrinsic adenomyosis with coexisting deep infiltrating endometriosis
Biological differences between intrinsic and extrinsic adenomyosis with coexisting deep infiltrating endometriosis
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DOI：
10.1016/j.rbmo.2019.03.210
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发表时间：
2019-08-01
影响因子：
4
通讯作者：
Kitawaki, Jo
中科院分区：
文献类型：
--
作者：
Khan, Khaleque N.;Fujishita, Akira;Kitawaki, Jo
研究问题：内源性和外源性子宫腺肌病并存深部浸润性子宫内膜异位症（DIE）是否有生物学差异？设计图：在这项前瞻性对照研究中，手术后从23名患有内源性子宫腺肌病的女性和10名患有外源性子宫腺肌病并同时存在DIE病变的女性中收集活检标本。通过对Ber-EP 4（上皮细胞标志物）和CD 10（基质细胞标志物）的免疫反应进行组织学评价。雌激素和孕激素受体的组织表达通过免疫组织化学分析。结果：外源性子宫腺肌病合并DIE的检出率（9/10 [90.0%]）明显高于内源性子宫腺肌病（3/23 [13.0%]; P < 0.001）。外源性子宫腺肌病的Ber-EP 4染色腺体和CD 10染色间质细胞的模式与共存的DIE病变相似。与此相反，在内源性子宫腺肌病病例中，腺体和间质细胞的模式与子宫内膜相似。与外源性子宫腺肌病不同，内源性子宫腺肌病的腺细胞和间质细胞孕酮受体表达均显著降低（P <0.05）。虽然相对更多的纤维化被认为是在活检样本的外源性子宫腺肌病和共存的DIE比在内源性子宫腺肌病和他们共存的DIE，没有显着差异被发现。结论：外源性子宫腺肌病可被认为是子宫腺肌病外部基于一个密切的组织学和生物学关系的外源性子宫腺肌病和共存的DIE。我们的研究结果可能有助于了解两个新分类的内在和外在子宫腺肌病的可能的生物起源。
Research question: Is there a biological difference between intrinsic and extrinsic adenomyosis with coexisting deep infiltrating endometriosis (DIE)?Design: In this prospective controlled study, biopsy specimens were collected after surgery from 23 women with intrinsic adenomyosis and 10 women with extrinsic adenomyosis with coexisting DIE lesions. Histological evaluation was carried out by immunoreaction to Ber-EP4 (epithelial cell marker) and CD10 (stromal cell marker). Tissue expression of oestrogen and progesterone receptors was analysed by immunohistochemistry. Tissue fibrosis was examined by Masson's trichrome staining with computer-based image analysis of fibrosis in respective samples.Results: The detection rate of coexistent DIE was significantly higher in women with extrinsic adenomyosis (9/10 [90.0%]) than in women with intrinsic adenomyosis (3/23 [13.0%]; P < 0.001). The pattern of Ber-EP4-stained glands and CD10-stained stromal cells of extrinsic adenomyosis was similar to that of coexistent DIE lesions. In contrast, the pattern of gland and stromal cells was similar to the endometrium in the cases with intrinsic adenomyosis. Unlike extrinsic adenomyosis, progesterone receptor expression was significantly decreased in both gland cells (P < 0.05) and stromal cells (P < 0.05) of intrinsic adenomyosis. Although relatively more fibrosis was seen in biopsy samples of extrinsic adenomyosis and coexistent DIE than in intrinsic adenomyosis and their coexistent DIE, no significant difference was found.Conclusions: Extrinsic adenomyosis may be considered as adenomyosis externa based on a close histological and biological relationship between extrinsic adenomyosis and coexistent DIE. Our findings may contribute to the understanding of a possible biological origin of two newly classified intrinsic and extrinsic adenomyosis.