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Fan J, Liu X, Guo SW. Hypermethylation of Klotho and Peroxisome Proliferator-Activated Receptor γ Concomitant with Overexpression of DNA Methyltransferase 1 in Adenomyosis. Reprod Sci 2024:10.1007/s43032-024-01599-4. [PMID: 38816595 DOI: 10.1007/s43032-024-01599-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/14/2024] [Indexed: 06/01/2024]
Abstract
Cellular senescence is known to be involved in tissue repair, but its role in adenomyosis remains unclear. This study was tasked to evaluate the expression of Klotho, a well-known aging-suppressing protein, as well as PPARγ and DNMT1 in adenomyotic lesions (AD) in comparison with that of control endometrium (CT). We performed immunohistochemistry analysis of markers of cellular senescence p16 and p21, along with Klotho, PPARγ and DNMT1 in CT and AD samples, followed by the quantification of gene expression of Klotho, PPARγ and DNMT1 in epithelial organoids derived from AD and CT samples and methylation-specific PCR to evaluate promoter methylation status. The effect of forced expression and knockdown of DNMT1 on Klotho and PPARγ expression in ectopic endometrial epithelial cells was evaluated. We found that both p16 and p21 immunoreactivity in AD was significantly higher while that of Klotho and PPARγ was significantly lower than CT samples, which was concomitant with elevated immunoexpression of DNMT1. The results were confirmed by transcriptional analysis using epithelial organoids derived from AD and CT samples. In addition, the promoter regions of both Klotho and PPARγ genes were hypermethylated in AD as compared with CT, and treatment with HDAC and DNMT inhibitors reactivated the expression of both Klotho and PPARγ. Forced expression of DNMT1 resulted in downregulation of both Klotho and PPARγ but its knockdown increased their expression. Thus, overexpression of DNMT1 seems to facilitate the promoter hypermethylation of both Klotho and PPARγ in AD, resulting in their reduced expression that is suggestive of the role of senescence in adenomyosis.
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Affiliation(s)
- Jiao Fan
- Department of General Gynecology, Shanghai OB/GYN Hospital, Fudan University, Shanghai, 200011, China
| | - Xishi Liu
- Department of General Gynecology, Shanghai OB/GYN Hospital, Fudan University, Shanghai, 200011, China
| | - Sun-Wei Guo
- Research Institute, Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, China.
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LESIONS OF THE FEMALE REPRODUCTIVE TRACT IN JAPANESE MACAQUE ( MACACA FUSCATA) FROM TWO CAPTIVE COLONIES. J Zoo Wildl Med 2019. [PMID: 29517447 DOI: 10.1638/2016-0171r1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Reproductive lesions have been described in various nonhuman primate species, including rhesus macaques ( Macaca mulatta), cynomolgus macaques ( Macaca fascicularis), baboons ( Papio spp.), squirrel monkeys ( Saimiri sciureus), and chimpanzees ( Pan spp.); however, there are few publications describing reproductive disease and pathology in Japanese macaques ( Macaca fuscata). A retrospective evaluation of postmortem reports for two captive M. fuscata populations housed within zoos from 1982 through 2015 was completed, comparing reproductive diseases diagnosed by gross pathology and histopathology. Disease prevalence, organs affected, and median age at death between the two institutions was also compared. Fifteen female captive M. fuscata, ranging in age from 15 to 29 yr were identified with reproductive tract lesions, including endometriosis, endometritis, leiomyoma, leiomyosarcoma, and adenomyosis. No significant differences were identified in disease prevalence, organs affected, and median age of death between the two institutions. Endometriosis was the most common disease process identified and was found in 10 of the 15 cases (66.7%), followed by leiomyoma (4 of 15; 26.7%). In four cases (26.7%), severe endometriosis and secondary hemorrhage was indicated as the cause of death or the primary reason for humane euthanasia. These findings were compared with a separate population of Japanese macaques managed within a research facility in the United States, with a prevalence of endometriosis of 7.6%. This study discusses possible risk factors and potential treatment options for the management of endometriosis in captive M. fuscata.
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Gruber-Dujardin E, Bleyer M, Mätz-Rensing K. Morphological and immunohistochemical characterization of spontaneous endometriosis in rhesus macaques ( Macaca mulatta). Primate Biol 2017; 4:77-91. [PMID: 32110695 PMCID: PMC7041517 DOI: 10.5194/pb-4-77-2017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/21/2017] [Indexed: 11/11/2022] Open
Abstract
Several cases of spontaneous endometriosis in middle-aged
to old rhesus macaques (Macaca mulatta) from the breeding colony of the
German Primate Center were thoroughly characterized with regards to
anatomical distribution and macroscopic appearance, histological
differentiation and immunohistochemical profile including somatic markers,
hormonal receptors, and proliferation indices. More than half of the
examined animals (five of nine) were directly related to one breeding male,
supporting a strong genetic predisposition. Histologically, four different
types of endometriotic lesions, depending on the degree of ectopic
endometrial gland and stromal differentiation (well differentiated, purely
stromal, mixed differentiation, poorly differentiated), could be constantly
identified within all animals. Immunohistochemistry (IHC) of cytokeratin (CK),
vimentin, smooth muscle actin (SMA), desmin, estrogen (ER), and progesterone
(PR)
receptors as well as of the nuclear proteins Ki67 and p53 revealed varying
staining patterns in the four different types of endometriosis
differentiation and compared to normal endometrium. Purely
stromal, mixed, or poorly differentiated lesions, especially, showed additional
cytokeratin-positive stromal cells, whereas epithelial cells of
endometriosis with mixed or poor differentiation increasingly expressed
mesenchymal markers (vimentin, SMA). Hormonal receptor and Ki67 expression
in well-differentiated endometriotic lesions mostly reflected that of normal
endometrial tissue according to the cyclic phase of the animal, while the
expression gradually diminished with decreasing grade of differentiation.
However, increased nuclear accumulations of p53 antigen could only be
continuously detected in epithelial cells of mixed or poorly differentiated
endometriosis. Altogether, these findings support the pathogenetic theory of
coelomic metaplasia, since the expression profiles of somatic markers in
less differentiated forms closely resembled that of mesothelial cells. Thus,
the four different histological types of endometriosis might display
subsequent grades of differentiation in the course of time, with poorly
differentiated types representing newly formed, immature lesions and
well-differentiated types being older, fully differentiated forms, rather
than being the outcome of dedifferentiation processes.
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Affiliation(s)
| | - Martina Bleyer
- Pathology Unit, German Primate Center, 37077 Göttingen, Germany
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Valentine MJ, Beierschmitt A, DeLay J, Callanan JJ. Uterine angioleiomyoma in an African green monkey (Chlorocebus aethiops sabaeus). J Med Primatol 2016; 46:9-12. [PMID: 27859319 DOI: 10.1111/jmp.12248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND A uterine neoplasm was observed, as an incidental finding, during post-mortem examination of a 26-year-old female multiparous African green monkey (Chlorocebus aethiops sabaeus). The intramural, expansile, 2 to 3 cm well-demarcated, dark-red, nodular neoplasm was located on the anterior uterine body (corpus) wall. METHODS The mass was examined by light microscopy and by immunohistochemistry. RESULTS The mass was confirmed as a cavernous uterine angioleiomyoma (syn. vascular leiomyoma) characterized by abundant intratumoural vasculature lined by Factor VIII-positive endothelial cells and surrounded by smooth muscle actin-positive cell proliferations. CONCLUSION Angioleiomyoma sharing the characteristics of intramural human cavernous uterine angioleiomyoma should be considered in the differential diagnosis of uterine tumours in non-human primates.
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Affiliation(s)
| | - Amy Beierschmitt
- Behavioural Science Foundation, Caribbean Primate Laboratory, Saint Kitts and Nevis
| | - Josepha DeLay
- University of Guelph Ontario Veterinary College, Guelph, ON, Canada
| | - John Joseph Callanan
- Ross University School of Veterinary Medicine, Basseterre, Saint Kitts and Nevis
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Nishimoto-Kakiuchi A, Netsu S, Matsuo S, Hayashi S, Ito T, Okabayashi S, Yasmin L, Yuzawa K, Kondoh O, Kato A, Suzuki M, Konno R, Sankai T. Characteristics of histologically confirmed endometriosis in cynomolgus monkeys. Hum Reprod 2016; 31:2352-9. [PMID: 27591226 PMCID: PMC5027930 DOI: 10.1093/humrep/dew209] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 07/26/2016] [Indexed: 11/24/2022] Open
Abstract
STUDY QUESTION What are the characteristics of spontaneous endometriosis in cynomolgus monkeys? SUMMARY ANSWER Spontaneous endometriosis in cynomolgus monkeys exhibited similar characteristics to the human disease. WHAT IS KNOWN ALREADY One previous report described the prevalence and the basic histopathology of spontaneous endometriosis in cynomolgus monkeys. STUDY DESIGN, SIZE, DURATION Endometriotic lesions that had been histologically confirmed in 8 female cynomolgus monkeys between 5 and 21 years old were subjected to study. PARTICIPANTS/MATERIALS, SETTING, METHODS The monkeys died of, or were sacrificed because of, sickness consequent on endometriosis. Specimens were evaluated histopathologically with haematoxylin and eosin staining, iron staining and immunohistochemistry (CD10, CD31, α-SMA and PGP9.5), and by observing them under a microscope. MAIN RESULTS AND THE ROLE OF CHANCE Endometriotic and stromal cells (CD10-positive) with haemorrhage and inflammation were observed. Smooth muscle metaplasia and nerve fibres were also noted in the endometriotic lesions. Endometriotic lesions in lymph nodes were incidentally found. LIMITATIONS AND REASONS FOR CAUTION Since laparoscopic analysis for monitoring the disease state was not set as a parameter of the current study, time course changes (progression) of the disease were not assessed. WIDER IMPLICATIONS OF THE FINDINGS Further investigation of spontaneous endometriosis in cynomolgus monkeys may contribute to better understanding of the disease pathobiology. STUDY FUNDING/COMPETING INTEREST(S) No external funds were used for this study. A.N.K., S.M., S.H., T.I., O.K., A.K. and M.S. are full-time employees of Chugai Pharmaceutical Co., Ltd. R.K. received lecture fees from Chugai Pharmaceutical Co., Ltd., unrelated to the submitted work. S.N., S. O., L.Y., K.Y. and T.S. have nothing to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- A Nishimoto-Kakiuchi
- Research Division, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura-shi, Kanagawa 247-8530, Japan
| | - S Netsu
- Department of Obstetrics and Gynecology, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiya-ku, Saitama-shi, Saitama 330-8503, Japan
| | - S Matsuo
- Research Division, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura-shi, Kanagawa 247-8530, Japan
| | - S Hayashi
- Research Division, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura-shi, Kanagawa 247-8530, Japan
| | - T Ito
- Research Division, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura-shi, Kanagawa 247-8530, Japan
| | - S Okabayashi
- Tsukuba Primate Research Center, National Institute of Biomedical Innovation, Health and Nutrition, 1-1 Hachimandai, Tsukuba-shi, Ibaraki 305-0843, Japan
| | - L Yasmin
- Tsukuba Primate Research Center, National Institute of Biomedical Innovation, Health and Nutrition, 1-1 Hachimandai, Tsukuba-shi, Ibaraki 305-0843, Japan
| | - K Yuzawa
- Tsukuba Primate Research Center, National Institute of Biomedical Innovation, Health and Nutrition, 1-1 Hachimandai, Tsukuba-shi, Ibaraki 305-0843, Japan
| | - O Kondoh
- Research Division, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura-shi, Kanagawa 247-8530, Japan
| | - A Kato
- Research Division, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura-shi, Kanagawa 247-8530, Japan
| | - M Suzuki
- Research Division, Chugai Pharmaceutical Co., Ltd., 200 Kajiwara, Kamakura-shi, Kanagawa 247-8530, Japan
| | - R Konno
- Department of Obstetrics and Gynecology, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiya-ku, Saitama-shi, Saitama 330-8503, Japan
| | - T Sankai
- Tsukuba Primate Research Center, National Institute of Biomedical Innovation, Health and Nutrition, 1-1 Hachimandai, Tsukuba-shi, Ibaraki 305-0843, Japan
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Vergneau-Grosset C, Summa N, Rodriguez CO, Cenani A, Sheley MF, McCarthy MA, Tanner JC, Phillips KL, Hunt GB, Groff JM. Excision and Subsequent Treatment of a Leiomyoma From the Periventiduct of a Koi (Cyprinus carpio koi). J Exot Pet Med 2016. [DOI: 10.1053/j.jepm.2016.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Uterine adenomyosis in southern three-banded armadillos (Tolypeutes matacus). J Zoo Wildl Med 2014; 44:1018-26. [PMID: 24450063 DOI: 10.1638/2013-0008r.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Uterine adenomyosis was diagnosed in five southern three-banded armadillos (Tolypeutes matacus) from four different zoological collections in North America between 1995 and 2012. Two cases were diagnosed after ovariohysterectomy and histopathologic evaluation of the uteri, and the remaining cases were identified incidentally at the time of postmortem examination. Animals ranged from 5 to 14 yr of age at the time of diagnosis. Of armadillos diagnosed before postmortem examination, clinical signs included weakness, collapse, anemia, and vulvar discharge. Histopathologic evaluation of the uteri revealed well-developed, irregular endometrial glands extending into the myometrium and occasional hemorrhage within these glands. The two cases diagnosed antemortem were successfully treated with ovariohysterectomy. To the authors' knowledge, this condition has not been previously reported in Xenarthra, including armadillos.
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Machado SA, Bahr JM, Hales DB, Braundmeier AG, Quade BJ, Nowak RA. Validation of the aging hen (Gallus gallus domesticus) as an animal model for uterine leiomyomas. Biol Reprod 2012; 87:86. [PMID: 22811571 DOI: 10.1095/biolreprod.112.101188] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Uterine leiomyomas, or fibroids, are the most frequent gynecological tumors in premenopausal women with as many as 65% of women becoming clinically symptomatic. Uterine fibroids are benign myometrial tumors that produce large quantities of extracellular matrix proteins. Despite its high morbidity, the molecular basis underlying the development of uterine leiomyomas is not well understood. Domestic hens of Gallus gallus domesticus develop oviductal leiomyomas similar to those found in humans. We investigated the natural history of chicken leiomyomas, in vivo expression of protein biomarkers, and in vitro expression of ovarian steroid receptors. Based on the analysis of 263 hens, tumor prevalence, tumor number per hen, and tumor size increased as the hens aged. Immunohistochemistry for alpha-smooth muscle actin (SMA) and desmin confirmed the smooth muscle phenotype of the chicken leiomyomas. Intense collagen expression was detected in these oviductal leiomyomas by Mason's trichrome, and the tumors also showed increased expression of TGFB3 and collagen type I mRNAs. Consistent with human leiomyomas, chicken fibroids displayed increased BCL2 and estrogen (E) and progesterone (P) receptor expression. Chicken leiomyomas were dissociated for in vitro culture. Cells from explants were positive for SMA, desmin, and E and P receptors until the fourth passage. These cells also displayed a response similar to human cells when challenged with halofuginone, an antifibrotic agent. Our findings indicate that the chicken is an excellent complementary model for studies involving the pathophysiology of human uterine leiomyomas.
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Affiliation(s)
- Sergio A Machado
- Department of Animal Sciences, University of Illinois, Urbana, USA
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Irizarry Rovira AR, Lynch S, David M, Ramos Vara JA. Gonadoblastoma in the ovaries of a lesser galago (Galago senegalensis braccatus). J Comp Pathol 2012; 147:204-8. [PMID: 22520808 DOI: 10.1016/j.jcpa.2012.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 01/04/2012] [Accepted: 01/09/2012] [Indexed: 01/06/2023]
Abstract
An enlarged right ovary was removed from a 14-year-old lesser galago (Galago senegalensis braccatus). Cytological preparations consisted of a heterogeneous population of neoplastic cells admixed with extracellular hyaline structures and cell-free nuclei. Microscopically, the ovary was replaced with gonadoblastoma and was composed of nests of germinal cells, including large oocyte-like cells, and sex cord-stromal cells arranged in palisading patterns around the germinal cells, the periphery of the nests and around extracellular hyaline material. The animal died 2 years after initial diagnosis. Necropsy examination revealed gonadoblastoma in the left ovary. The germinal cells of the tumour in the right and left ovaries were immunoreactive for calretinin, OCT3/4, PGP 9.5, Ki67 and/or faintly for cytokeratins. Sex cord-stromal cells were immunoreactive for calretinin, OCT3/4, GATA-4, E-cadherin and vimentin. Luteinized sex cord-stromal cells were immunoreactive for inhibin-alpha. The extracellular hyaline material was immunoreactive for laminin. This is the first case of gonadoblastoma in a non-human primate.
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Affiliation(s)
- A R Irizarry Rovira
- Department of Pathology, Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA.
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Wu D, Yue F, Zou C, Chan P, Alex Zhang Y. Analysis of glucose metabolism in cynomolgus monkeys during aging. Biogerontology 2011; 13:147-55. [PMID: 22057901 DOI: 10.1007/s10522-011-9364-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 10/17/2011] [Indexed: 11/28/2022]
Abstract
This study was designed to investigate the effect of aging on the glucose metabolism on cynomolgus (Macaca fascicularis) monkeys. A total of 33 cynomolgus monkeys in three aged groups were monitored for glucose levels, serum parameters in fasting state and somatometric measurements. Intravenous glucose tolerance test (IVGTT) and insulin tolerance test (ITT) were also performed. Aging associated changes lies in the less secretion of insulin and C-peptide during IVGTT in cynomolgus monkeys. It was also found that impaired insulin sensitivity occurred in female monkeys during aging based on HOMA-IR and K(ITT) value. In addition, triglyceride level also rose with the increase of age. Less insulin secretion and impaired insulin sensitivity in female were the characteristic during the aging of cynomolgus monkeys in this study. Body mass index, weight and waist hip rate may be the relevant factors in insulin resistance of cynomolgus monkeys.
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Affiliation(s)
- Di Wu
- Cell Therapy Center, Beijing Institute of Geriatrics, Xuanwu Hospital, Capital University of Medical Science, People's Republic of China
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Videan EN, Satterfield WC, Buchl S, Lammey ML. Diagnosis and prevalence of uterine leiomyomata in female chimpanzees (Pan troglodytes). Am J Primatol 2011; 73:665-70. [PMID: 21442632 DOI: 10.1002/ajp.20947] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 02/23/2011] [Accepted: 02/23/2011] [Indexed: 11/06/2022]
Abstract
Uterine leiomyomata are common, affecting 70-80% of women between 30 and 50 years of age. Leiomyomata have been reported for a variety of primate species, although prevalence rates and treatments have not been widely reported. The prevalence, diagnosis, and treatment of uterine leiomyomata in the Alamogordo Primate Facility and the Keeling Center for Comparative Medicine and Research were examined. Uterine leiomyomata were diagnosed in 28.4% of chimpanzees with an average age at diagnosis of 30.4 ± 8.0 years. Advanced age (>30 years) was related to an increase in leiomyomata and use of hormonal contraception was related to a decrease in leiomyomata. As the captive chimpanzee population ages, the incidence of leiomyomata among female chimpanzees will likely increase. The introduction of progesterone-based contraception for nonbreeding research and zoological chimpanzees may reduce the development of leiomyomata. Finally, all chimpanzee facilities should institute aggressive screening programs and carefully consider treatment plans.
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Affiliation(s)
- E N Videan
- Alamogordo Primate Facility, Holloman AFB, Alamogordo, New Mexico 88330, USA.
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Cline JM, Wood CE, Vidal JD, Tarara RP, Buse E, Weinbauer GF, de Rijk EPCT, van Esch E. Selected Background Findings and Interpretation of Common Lesions in the Female Reproductive System in Macaques. Toxicol Pathol 2008; 36:142s-163s. [PMID: 21475639 DOI: 10.1177/0192623308327117] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The authors describe a selection of normal findings and common naturally occurring lesions in the reproductive system of female macaques, including changes in the ovaries, uterus, cervix, vagina, and mammary glands. Normal features of immature ovaries, uteri, and mammary glands are described. Common non-neoplastic lesions in the ovaries include cortical mineralization, polyovular follicles, cysts, ovarian surface epithelial hyperplasia, and ectopic ovarian tissue. Ovarian neoplasms include granulosa cell tumors, teratomas, and ovarian surface epithelial tumors. Common non-neoplastic uterine findings include loss of features of normal cyclicity, abnormal bleeding, adenomyosis, endometriosis, epithelial plaques, and pregnancy-associated vascular remodeling. Hyperplastic and neoplastic lesions of the uterus include endometrial polyps, leiomyomas, and rarely endometrial hyperplasia and endometrial adenocarcinoma. Vaginitis is common. Cervical lesions include endocervical squamous metaplasia, polyps, and papillomavirus-associated lesions. Lesions in the mammary gland are most often proliferative and range from ductal hyperplasia to invasive carcinoma. Challenges to interpretation include the normal or pathologic absence of menstrual cyclicity and the potential misinterpretation of sporadic lesions, such as epithelial plaques or papillomavirus-associated lesions. Interpretation of normal and pathologic findings is best accomplished with knowledge of the life stage, reproductive history, and hormonal status of the animal.
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Affiliation(s)
- J Mark Cline
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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