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1.
J Mol Med (Berl) ; 88(3): 267-78, 2010 Mar.
Article in English | MEDLINE | ID: mdl-19898767

ABSTRACT

Clinical symptoms of endometriosis, such as pain and infertility, can be described as persistent stressors. Such continuous exposure to stress may severely affect the equilibrium and bidirectional communication of the endocrine and immune system, hereby further aggravating the progression of endometriosis. In the present study, we aimed to tease apart mediators that are involved in the stress response as well as in the progression of endometriosis. Women undergoing diagnostic laparoscopy due to infertility were recruited (n = 69). Within this cohort, early stage of endometriosis were diagnosed in n = 30 and advanced stage of endometriosis in n = 8. Levels of progesterone in serum were determined. Frequency of progesterone receptor (PR) expression on CD56(+) and CD8(+) peritoneal lymphocytes was analysed by flow cytometry. The production of tumour necrosis factor (TNF) and interleukin (IL)-10 by peritoneal leukocytes upon stimulation with the potent stress mediator corticotropin-releasing hormone (CRH) and the progesterone derivative dydrogesterone, or both, were evaluated. Furthermore, the production of progesterone-induced blocking factor (PIBF) by peritoneal leukocytes and the expression of PR in endometriotic tissue were investigated. Levels of progesterone in serum were decreased in women with endometriosis and inversely correlated to pain scores. Furthermore, an increased frequency of CD56(+)PR(+) and CD8(+)PR(+) peritoneal lymphocytes was present in advanced endometriosis. The TNF/IL-10 ratio, reflecting cytokine secretion by peritoneal cells, was higher in cells derived from endometriosis patients and could be further heightened by CRH stimulation, whereas stimulation with dydrogesterone abrogated the CRH-mediated inflammation. Finally, the expression of PIBF by peritoneal leukocytes was increased in endometriosis. Low levels of progesterone in the follicular phase could be responsible for the progression of endometriosis and related pain. Peripheral CRH, increasing upon high psychological stress, might contribute to the peritoneal inflammation present in endometriosis. The therapeutic application of progesterone derivatives, CRH blocking agents as well as improvement of stress coping may disrupt the vicious circle between the chronic peritoneal inflammation and high perception of psychological stress in endometriosis.


Subject(s)
Corticotropin-Releasing Hormone/pharmacology , Dydrogesterone/pharmacology , Endometriosis/immunology , Inflammation Mediators/metabolism , Adult , Cells, Cultured , Cohort Studies , Corticotropin-Releasing Hormone/antagonists & inhibitors , Endometriosis/metabolism , Endometriosis/pathology , Female , Humans , Interleukin-10/metabolism , Neurosecretory Systems/metabolism , Peritoneum/cytology , Phenotype , Progesterone/blood , Tumor Necrosis Factor-alpha/metabolism
2.
APMIS ; 115(11): 1302-5, 2007 Nov.
Article in English | MEDLINE | ID: mdl-18092965

ABSTRACT

A 28-year-old patient presented with a 5 cm endometrial stromal tumor situated at the uteroplacental interface, which was diagnosed ultrasonographically at the 28th week of pregnancy. The tumor was asymptomatic and closely attached to the decidua; after a normal term delivery, it was revealed to be embedded within the placenta. Microscopically, the neoplasm had a high mitotic rate and characteristic features of endometrial stromal tumor, such as CD10, progesterone receptor positivity, and an expansile linear, non-infiltrative pushing border. There were also pregnancy-related changes such as decidualization and myxoid change. In conclusion, the lesion was considered a benign endometrial stromal nodule with an unusual morphology and increased proliferation rate due to the hormonal stimuli of pregnancy.


Subject(s)
Endometrial Neoplasms/diagnostic imaging , Gastrointestinal Stromal Tumors/diagnostic imaging , Placenta/pathology , Pregnancy Complications, Neoplastic/diagnostic imaging , Adult , Female , Humans , Infant, Newborn , Placenta/diagnostic imaging , Pregnancy , Pregnancy Trimester, Third , Ultrasonography
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