Progesterone binding by human endometrial tissue during the proliferative and secretory phases of the menstrual cycle and by hyperplastic and carcinomatous endometrium

ECC-1 human endometrial cells as a model system to study dioxin disruption of steroid hormone function

ECC-1, an established epithelial cell line derived from an adenocarcinoma of human endometrial lining, was examined for growth optimization, steroid hormone receptor- and Ah receptor content, and dioxin modulation of estrogen receptor function. Proliferation of ECC-1 cells was accelerated by growth on a lethally irradiated feeder layer of murine 3T3 fibroblasts. Immunoblot analysis demonstrated the presence of Ah receptor an intracellular protein that binds and regulates the toxic action of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). The Ah receptor was functional in these cells as assessed by concentration and kinetic patterns of CYP1A1-mediated 7-ethoxycoumarin O-deethylase (ECOD) induction. The half-maximal effective concentration (EC50) for TCDD was 0.2 nM, and maximal activity appeared after 24-h exposure. A limited structure-activity examination of ECOD activity provided additional evidence for Ah receptor involvement. Competitive binding assays were performed to examine kinetic parameters for estrogen, progesterone, and glucocorticoid receptors. Binding parameters of dissociation constant (Kd) and number of binding sites (Bmax) derived from Scatchard analysis were: estrogen, Kd = 0.67 nM; Bmax = 321 fmol/mg cytosolic protein; progesterone, Kd = 1.31 nM; Bmax = 258 fmol/mg cytosolic protein; dexamethasone, Kd = 1.75 nM, Bmax = 128 fmol/mg cytosolic protein. Exposure of ECC-1 cells to TCDD reduced the estrogen receptor level by 40% without affecting the Kd value, and reduced estrogen receptor-mediated transcription by 50% assessed by transient transfection of an estrogen-responsive reporter plasmid. These data suggest that the ECC-1 cell line is a useful model system for examining the action of dioxin in human endometrial tissue. Both the estrogen receptor and Ah receptor have been implicated in diseases of the endometrium, and examining their interactions may elucidate mechanisms of uterine disease etiology, as well as potential targets for disease prevention.

Steroid receptors and proliferative activity in non-neoplastic and neoplastic endometria

In the glands of cyclic endometria, proliferative activity (PA), as revealed by expression of the Ki-67 antigen, is highest in the proliferative phase (P) and early secretory phase (S1). The PA decreases in the middle secretory phase (S2). In the stroma the PA is low during the whole cycle. In P and S1, the oestrogen receptor (ER) and the progesterone receptor (PR) are strongly expressed in glands and stroma. The number of positive cells and the staining intensity decreases in S2, particularly in the glands. In atrophic endometria, fibro-glandular polyps and in endometria with arrested secretion the PA is low in both glands and stroma. ER and PR can be detected in glands and stroma. The PA in atypical hyperplasias is only slightly higher than in cyclic endometria and endometria with simple hyperplasia. The ER and PR levels are comparable to those in proliferative endometria. The PA of endometrial adenocarcinomas is positively and the ER and PR negatively correlated with the degree of de-differentiation. No ER-negative carcinoma displays the PR. Immunohistologically, non-neoplastic receptor positive tissue can be seen in many ER- and PR-negative carcinomas. These structures may falsify the biochemical receptor analysis.

An immunohistochemical study of steroid binding by endometrial glandular epithelial cells throughout the menstrual cycle

An immunohistochemical technique was used to demonstrate oestrogen and progesterone binding by endometrial glandular epithelial cells at various stages of the menstrual cycle. A cross-section of steroid binding sites, including low affinity, concentration dependent Type II and III binding sites, were demonstrated but only in cells which contain the classical high affinity receptor. The technique demonstrated both free binding sites and receptor-hormone complexes within the cytoplasm but was poorly effective in demonstrating nuclear complexes. Oestrogen binding sites were shown to reach a peak during the late proliferative and early secretory phases of the cycle: oestrogen binding capacity remained high during the mid and late secretory phases. Progesterone binding capacity rose progressively throughout the proliferative and early secretory phase.

Correlation of female sex steroid hormone receptors with histologic and ultrastructural differentiation in adenocarcinoma of the endometrium

A series of 43 patients with endometrial adenocarcinoma were evaluated in order to investigate the relationships of the estrogen receptor (ER) and the progesterone receptor (PR) with the histologic and nuclear grades and the ultrastructural differentiation of these tumors. Twenty-six neoplasms were positive (greater than or equal to 10 fmole/mg protein) for both receptors, 1 was positive for the ER only, 9 were ER-PR+, and 7 were ER-PR-. Twenty carcinomas were histologic Grade I, 12 Grade II, and 11 Grade III. Distribution of nuclear grade was 11 Grade I, 18 Grade II, and 14 Grade III. Both histologic and nuclear grades were found to be significantly related to the presence or absence of both the ER and the PR. Several cytoplasmic structures (cilia, primary lysosomes, intracytoplasmic lumens) were highly specific but of low sensitivity for predicting the receptor status of these tumors. To a limited extent, ultrastructural markers were associated with histologic differentiation.

Correlation between cytoplasmic steroid receptors and tumour differentiation and invasion in endometrial carcinoma

The incidence and levels of cytoplasmic steroid receptors were studied in 155 endometrial carcinomas: oestrogen receptors (ER) were measured in all samples, progesterone receptors (PR) in 148 and androgen receptors (AR) in 118. Well-differentiated adenocarcinomas were significantly more likely to contain ER, PR and AR than were poorly-differentiated tumours, and mean values of ER and PR content were significantly higher in well-differentiated adenocarcinomas than in less-differentiated tumours. Receptor profiles in adenosquamous carcinomas and clear-cell carcinomas were similar to those in adenocarcinomas. Deeply invasive tumours were significantly less likely to be ER, PR or AR positive and, even when positive, such tumours had significantly lower mean levels of ER and PR. Poorly-differentiated tumours were significantly more likely to be ER-negative PR-positive than well-differentiated adenocarcinomas and adenosquamous carcinomas.

Serum hormones and their receptors in women with normal and inadequate corpus luteum function

The purpose of this study was to attempt to characterize women with a luteal phase defect (LPD) by cytosol estrogen and progesterone (P) levels and peroxidase activity in endometrial biopsy samples. These values were correlated with circulating serum estradiol, P, testosterone, and dehydroepiandrosterone sulfate measurements. Similar data were obtained from women during the proliferative phase of the cycle. Midluteal phase P values were significantly greater in women with normal luteal function than in those with LPD; however, some overlap of values existed. Furthermore, because no significant differences between this group and normal women were seen, we were unable to characterize women with LPD by estrogen or P receptor levels or endometrial peroxidase activity.

An ultrastructural comparison of grade I and II endometrial adenocarcinoma considering estrogen and progesterone receptor status

Eighteen (18) previously untreated patients with grade I (9) and II (9) endometrial adenocarcinoma provided endometrial samples for biochemical analysis of estrogen and progesterone receptors. The same samples were evaluated by histology and ultrastructure. Progesterone receptor negative samples (PR less than 1000 fmole/g tissue) showed more ultrastructural characteristics of malignancy and a wider range of changes than the progesterone positive specimens (PR greater than 1000 fmole/g tissue). These findings appeared to be independent of estrogen receptor status. No significant ultrastructural changes were seen when grades I and II were compared.

Long-term effect of megestrol acetate in the treatment of endometrial hyperplasia

Fifty-two postmenopausal women who were poor surgical risks and had histologically proved adenomatous hyperplasia, atypical hyperplasia, or adenocarcinoma in situ of the endometrium were treated with megestrol acetate, 40 mg per day, continuously for 9 to 104 months (mean, 42 months). More than 90% of these women had complete remissions of the hyperplasia. Three women with carcinoma in situ were followed up for 57, 65, and 104 months, without recurrence of the disease. Four women required hysterectomy; none had invasive adenocarcinoma. No adverse side effects of the drug were observed. Thus, we conclude that the continuous use of megestrol acetate is an effective, safe, alternative form of therapy for endometrial hyperplasia in postmenopausal women.

Cytosol estrogen and progesterone receptor levels measured in normal and pathological tissue of endometrium, endocervical mucosa and cervical vaginal portion

The aim of this study was to compare cytosol estrogen (ER) and progesterone (PgR) receptor levels measured in normal and pathological tissue specimens (n = 395) of endometrium (ED), endocervical mucosa (EM) and cervical vaginal portion (VP) from 108 patients (age 27-79). The highest ER levels were found in ED which decreased to 25% in VP. The PgR decline was more pronounced in VP since the majority of samples were PgR-negative. In addition pathological tissue from ED exhibited marked differences in steroid receptor levels: The highest ER and PgR concentrations were detected in the proliferative phase, whereas the secretory phase exhibited significantly reduced ER and PgR levels. The lowest ER and PgR amounts were measured in atrophic and quiescent tissues; in proliferative tissue ER and PgR levels were comparable to hyperplastic tissue. Cervical ER and PgR concentrations were significantly lower as compared with ED (25-30%), and no cyclic variations were detectable. Also ER and PgR levels were different between EM and VP. 96% of ER were positive in the cervix, whereas 73% were PgR-negative in VP. Furthermore an inverse correlation between ER and progesterone was found in ED and a positive correlation between estradiol and PgR. These results suggest that the cytosol ER and PgR levels vary markedly in the uterine corpus and may explain in part the different response to endocrine therapy.

Measurement of progesterone receptor in human renal cell carcinoma and normal renal tissue

Progesterone receptor was measured in eight samples of renal cell carcinoma, nine samples of normal renal tissue, and one sample of melanoma tissue. Progesterone receptor was identified in all samples, with the exception of one renal cell carcinoma. Three patients, all with receptor-positive tumors, were treated with medroxyprogesterone acetate for metastatic disease. In one of these patients there was a partial objective response to treatment. Further research regarding progesterone receptor in renal cell carcinoma is indicated.

Endolymphatic stromal myosis. Surgical and hormonal treatment of extensive abdominal recurrence 20 years after hysterectomy

This report describes the clinicopathologic features of a 49-year-old woman who was reoperated on for bulky abdominal metastases 20 years after hysterectomy for endometrial stromal myosis (ESM). The levels of estrogen (ER) and progesterone (PR) receptors measured in the resected tumorous tissue amounted to 48.3 and 71.4 femtomoles (fmol)/mg cytosol protein, respectively. After medroxyprogesterone acetate (Depo-Provera; Upjohn) treatment of 16 months duration, the unresected pelvic tumor mass compressing the bladder and the left ureter had decreased in volume and hydroureteronephrosis had regressed. The efficacy of the therapy was monitored by computed tomography. Two years and nine months after surgery, the evolution of the tumor seems well-controlled by continuous progestin therapy and the patient is living without symptoms.

Endometrial hyperplasia and carcinoma. Are ultrastructural, biochemical and immunocytochemical studies useful in distinguishing between them?

Endometrial hyperplasia and carcinoma represent different points in a disease continuum which may be difficult to distinguish using standard histologic criteria. The role of ancillary biochemical, ultrastructural and immunocytochemical techniques in understanding the normal physiologic responses to hormonal stimuli is briefly considered in order to serve as a basis for an analysis of abnormal proliferative states. Not surprisingly, the ultrastructural and biochemical features of hyperplastic and carcinomatous endometria demonstrate a progressive continuum of abnormalities. The role of the immunohistologic detection of CEA, HCG, Casein, and other markers in distinguishing between the various endometrial diseases is discussed. The endometrium represents one of the more spectacular of endocrine target organs in which marked morphologic and ultrastructural changes occur throughout a women's lifetime. Such changes include those accompanying the menarche and the menopause as well as the extensive remodelling which occurs during the reproductive years. During the latter period, the endometrium cyclically proliferates, undergoes secretory differentiation, regresses, degenerates and regenerates. These regularly occurring changes are distinctive and have been described in histological detail, (Noyes et al., 1950, Noyes, 1973, Dallenbach-Hellweg, 1974), as well as ultrastructurally (Cavazos and Lucas, 1973, Ferenczy and Richart, 1974, Ferenczy, 1977). Morphological studies, coupled with advances in knowledge of steroid biochemistry, have confirmed that the cyclic morphological alterations are under the regulatory role of estrogens and progesterone.

Estradiol and progesterone receptors in estrogen-primed endometrium

Estradiol and progesterone receptor levels were measured in endometrial samples obtained from patients who were on different dosages of estradiol therapy and from women in the late proliferative phase of a normal menstrual cycle. Samples of blood were collected at the time of biopsy, and the levels of estradiol, estrone, progesterone, follicle stimulating hormone, and luteinizing hormone were measured in the serum. The patients were divided into five groups. The first group (controls) consisted of patients in their late proliferative phase. The patients in groups two, three, and five were receiving estradiol in various doses by pellet therapy, along with a cyclic progestogen each month. The women in the fourth group also had implantation of estradiol pellets but failed to take the progestogen as advised. In our series, the levels of cytoplasmic estradiol and progesterone receptors were markedly elevated in the no progestogen group compared to the controls. There was no significant difference in the levels of the receptors in the groups which took the progestogen as advised.