Ekspresi Reseptor Estrogen Dan Reseptor Progesteron Pada Pasien Dengan Leiomioma Uteri
DOI:
https://doi.org/10.36408/mhjcm.v8i1.498Keywords:
Leiomioma uteri, miometrium, reseptor estrogen, reseptor progesteronAbstract
Latar belakang: Leiomioma uteri merupakan tumor jinak dengan prevalensi yang cukup tinggi dan perkembangannya sangat dipengaruhi oleh hormon steroid. Sementara itu masih terdapat pertentangan pada penelitian mengenai ekspresi reseptor estrogen (ER) dan reseptor progesteron (PR) pada leiomioma uteri, serta belum dipahami tentang etiologi dan patogenesis leiomioma uteri. Objektif: Penelitian ini bertujuan untuk mengetahui ekspresi ER dan PR pada leiomioma uteri. Metoda: Penelitian ini merupakan analitik observasional dengan rancangan case control design, dilakukan di Laboratorium Patologi anatomi RSUP Dr. Kariadi, Semarang. Populasi penelitian adalah blok histopatologi dengan diagnosa leiomioma uteri pada tahun 2017. Pengambilan sampel dilakukan secara acak sederhana, setelah memenuhi kriteria inklusi. Hasil: Berdasarkan karakteristik usia pada kelompok leiomioma uteri, yang terbanyak adalah kelompok usia > 40 tahun. Dari segi karakteristik Indeks Massa Tubuh (IMT), pada kelompok Leiomioma uteri IMT yang paling banyak pada normoweight, tetapi terdapat kecendrungan kasus Leiomioma uteri meningkat pada IMT yang lebih tinggi, dengan jumlah kumulatif pada IMT overweight dan obese adalah sebanyak 6 kasus (40%). Karakteristik paritas pada kelompok Leiomioma uteri yang terbanyak adalah nullipara yaitu 7 kasus (46,7%). Seluruh kelompok leiomioma uteri mengeskpresikan ER dengan rerata skor 7,20 ± 0,78 dan PR dengan rerata skor 7,47 ± 0,74. pengujian dengan uji korelasi spearman’s terhadap ekspresi ER dan PR dihubungkan dengan karakteristik, didapatkan hasil yang tidak signifikan juga. Sehingga tidak bermakna hubungan antara ekspresi ER dan PR terhadap karakteristik dan multiparitas. Pembahasan: Pada pengujian Mann-whitney terdapat perbedaan yang bermakna pada ekspresi ER antara jaringan leiomioma uteri dan miometrium normal (p = 0,045). Dan terdapat perbedaan yang bermakna pada ekspresi PR antara jaringan Leiomioma uteri dan miometrium normal (p = 0.022).
Kata kunci: Leiomioma uteri, miometrium, reseptor estrogen, reseptor progesteron
ABSTRACT
Background: Leiomyoma is a benign tumor with a fairly high prevalence and its development is strongly influenced by steroid hormones. While it is still related to research on estrogen receptors and progesterone receptors in uterine leiomyomas, and has not been understood about the etiology and pathogenesis of uterine leiomyomas. Objective: This study aims to determine the expression of estrogen receptors and progesterone receptors in uterine leiomyomas. Method: This study is an observational analytic with a case control design, carried out at the Anatomical Pathology Laboratory Dr. General Hospital. Kariadi, Semarang. The study population was histopathological block with diagnosis of uterine leiomyoma and myometrium in 2017. Sampling was done in a simple randomized manner, after fulfilling the inclusion criteria. Results: Based on the age characteristics in the uterine leiomyoma group, the most were the age group> 40 years. In terms of characteristics of the Body Mass Index (BMI), in the uterine Leiomioma group the most BMI was normoweight, but there was a tendency for cases of uterine Leiomyoma to increase in higher BMI, with a cumulative number of overweight and obese BMI of 6 cases (40%) . The most characteristic parity in the uterine Leiomioma group was nullipara which was 7 cases (46.7%). All uterine leiomyoma groups expressed estrogen receptors with a mean score of 7.20 ± 0.78 and progesterone receptors with a mean score of 7.47 ± 0.74. testing with the spearman correlation test on the expression of ER and PR is related to the characteristics, which results are not significant as well. So there is no meaningful relationship between ER and PR expression on characteristics and multiparity. Discussion: In the Mann-Whitney test there were significant differences in the expression of estrogen receptors between uterine leiomyoma and normal myometrium (p = 0.045). And there are significant differences in the expression of progesterone receptors between uterine leiomyoma and normal myometrium (p = 0.022).
Keywords: Uterine leiomyoma, myometrium, estrogen receptor, progesterone receptor
Downloads
References
2. Bulun SE. Uterine Fibroids, mechanisms of disease. N engl j med 2013; 369(14): 1344-55 https://www.ncbi.nlm.nih.gov/pubmed/24088094
3. Chethana M, Kumar H, Munikrishna. Endometrial changes in uterine leiomyomas. Kempegowda Institute of Medical Sciences. J Cin. Biomed Scientifica.2013:72-9. https://pdfs.semanticscholar.org/dbc7/7becbc738ae1df4c16ce52f8a477a70f8db0.pdf
4. Speroff L, Fritz MA. Clinical gynecologic endocrinology and infertility. edisi VII. Lippincott Williams & Wilkins. North Carolina. 2005:136-40;561-62.
5. Medikare V, Kandukuri LR, Ananthapur V, Deenadayal M, Nallari P. The Genetic Bases of Uterine Fibroids; A Review. J Reprod Infertil. 2011;12(3):181-91 https://www.ncbi.nlm.nih.gov/pubmed/23926501
6. Lilyani DV. Hubungan faktor risiko dan kejadian mioma uteri di Rumah Sakit Umum Daerah Tugurejo Semarang. Jurnal Kedokteran Muhammadiyah. 2012;1(1):14-9.
7. Pratiwi L, Suparman E, Wagey F. Hubungan Usia Reproduksi Dengan Kejadian Mioma Uteri Di RSUP. Prof. Dr. R.D. Kandou Manado. Jurnal e-CliniC (eCl). 2013;1(1):26-30.
8. Ikbal MN. Prevalensi Anemia Pada Penderita Mioma Uteri di RSUP H. Adam Malik Medan Tahun 2010. Karya Tulis Ilmiah. Fakultas Kedokteran Universitas Sumatera Utara. 2011
9. Ciarmela P, Islam S, Reis FM, Gray PC, Bloise E, et al.Growth factors and myometrium: biological effects in uterine fibroid and possible clinical implications. Human Reproduction Update, 2011; 17(6): 772–90 https://www.ncbi.nlm.nih.gov/pubmed/21788281
10. Wango EO, Tabifor HN, Muchiri LW, Kigondu CS, Makawiti DW. Progesterone, Estradiol And Their Respective Receptors In Leiomyoma And Adjacent Normal Myometria of Black Kenyan Women. African Journal of HealthSciences.2002;3-4(9):123-28. (https://www.researchgate.net/journal/)
11. Englund K, Blanck A, Gustavsson I, Lundkvist U, Sjoblom P, et al. Sex Steroid Receptors in Human Myometrium and Fibroids: Changes during the Menstrual Cycle and Gonadotropin-Releasing Hormone Treatment. J Clin EndocrinolMetab.1998;83:4092–96. (https://www.ncbi.nlm.nih.gov/pubmed/9814497)
12. Hillard PJA et al. Benign diseases of the female reproductive tract. In Berek & Novak's Gynecology, 14e. Lippincott Williams Williams. California 2007:467-71. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984644/)
13. Whitaker L. Abnormal uterine bleeding. Best Pract Res Clin Obstet Gynaecol. 2016 Jul; 34: 54–65.doi: 10.1016/j.bpobgyn.2015.11.012
14. Flake GP, Andersen J, Dixon D. Etiology and Pathogenesis of Uterine Leiomyomas: A Review. Environ Health Perspect. 2003; 111(8):1037–54 https://www.ncbi.nlm.nih.gov/pubmed/12826476
15. Edward DRV. Association of Age at Menarch with Increasing Number of Fibroids in a Cohort of Women Who Underwent Standardized Ultrasound Assessment. Oxford University Press; 2013. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3727338/)
16. Sankaran S, Manyonda IT. Medical management of fibroids. Best Practice & Research Clinical Obstetrics and Gynaecology. 2008;4(22):655–76 https://www.ncbi.nlm.nih.gov/pubmed/18468953
17. Davis PC. Sonohysterographic Findings of Endometrial and Subendometrial Conditions.2002;22(4). https://pubs.rsna.org/doi/full/10.1148/radiographics.22.4.g02jl21803
18. Faerstein E. Risk factors for uterine leiomyoma : A Practice – based case control study. I. African – American Heritage, Reproductive History, Body Size, and Smoking. American journal of Epidemiology. Oxford University Press. 2001;153(1).1-10. https://academic.oup.com/aje/article/153/1/1/107780
19. Grings AO. Protein Expression of Estrogen Receptors ? and ? and Aromatase in Myometrium and Uterine Leiomyoma. Gynecologic and Obstetric Investigation.2012;73:113-7. https://www.ncbi.nlm.nih.gov/pubmed/22377971
20. Hermon TL, Moore AB, Yu L, Kissling GE, Castora FJ, et al. Estrogen receptor alpha (ER-?) phospho-serine-118 is highly expressed in human uterine leiomyomas compared to mathed myometrium. Virchow Arch. 2008;453:557-69.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2693272/
21. Yi Ye. J Assist Reproductive Genetics. CYP1A1 and CYP1B1 genetic polymorphisms and uterine leiomyoma risk in Chinese women. Springer Science. 2008;25. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2582125/
22. Maruo T, Ohara N, Wang J, Matsuo H. Sex steroidal regulation of uterine leiomyoma growth and apoptosis. Human Reproduction Update, 2004;3(10):207-20. https://academic.oup.com/humupd/article/10/3/207/682120
23. Leica. Eestrogen Receptor Clone 6F11 Ready-To-Use Primary Antibody for Bond. 2019.
24. Benassayag C, Leroy MJ, Rigourd V, Robert B, Honore JC, et al. Estrogen receptors (ERalpha/ERbeta) in normal and pathological growth of the human myometrium: pregnancy and leiomyoma. Am J Physiol, 1999;276:E1112–E18. https://www.ncbi.nlm.nih.gov/pubmed/10362625
25. Gowri M, Mala G, Murthy S, Nayak V. Clinicopathological study of uterine leiomyomas in hysterectomy specimens. Journal of Evolution of Medical and Dental\Sciences2013;2(46):9002-09. https://jemds.com/data_pdf/1_vedavathy%20nayak.doc
26. Ofori EK, Asante M, Antwi WK, Coleman J, Brakohiapa EK, et al. Relationship Between Obesity And Leiomyomas Among Ghanaian Women. Journal of Medical and Applied Biosciences. 2012;4:14-25. https://www.uhas.edu.gh/downloads/JOURNAL%20PUB-%2020.pdf
27. Olotu, EJ, Osunwoke EA, Ugboma HA, Odu, KN. Age prevalence of uterine fibroids in south-southern Nigeria: A retrospective study. Scientific Research andEssay.2008;3(9):457-59. http://www.academicjournals.org/app/webroot/article/article1380368069_Olotu%20et%20al.pdf
28. Zimmermann A, Bernuit D, Gerlinger C, Schaefers M, Geppert K. Prevalence, symptoms and management of uterine fibroids: an international internet-based survey of 21,746 women. BMC Women’s Health. 2012;12(6):1-12. https://www.ncbi.nlm.nih.gov/pubmed/22448610
29. Nisolle M, Gillerot S, Casanas-Roux F, Squifflet J, Berliere M, et al. Immunohistochemical study of the proliferation index, oestrogen receptors and progesterone receptors A and B in leiomyomata and normal myometrium during the menstrual cycle and under gonadotrophin-releasing hormone agonist therapy. Human Reproduction, 1999;14(11):2844-50 https://www.ncbi.nlm.nih.gov/pubmed/10548634
30. He Y, Zeng Q, Dong S, Qin L, Li G, et al. Associations between uterine fibroids and lifestyles including diet, physical activity and stress: a case-control study in China. Asia Pac J Clin Nutr. 2013;22(1):109-17. https://www.ncbi.nlm.nih.gov/pubmed/23353618
31. Chan CF. Risk factors for uterine fibroids among woman undergoing tubal sterilization. American Journal of Epidemiology. 2001;1(153):20-6. https://www.ncbi.nlm.nih.gov/pubmed/11159141
32. Terry KL. Anthropometric Characteristics and Risk of Uterine Leiomyoma. Epidemiology.2007;6(18):758. https://www.ncbi.nlm.nih.gov/pubmed/17917603
33. Parker WH. Etiology, Symptomatology, and Diagnosis of Uterine Myomas. FertilityandSterility.2007;4(87).725. https://www.ncbi.nlm.nih.gov/pubmed/17430732
34. Ibrar A. Frequency of fibroid uterus in multipara women in a tertiary care centre in Rawalpindi. J Ayub Med Coll Abbottabad. 2010;3(22):155-7. https://www.ncbi.nlm.nih.gov/pubmed/22338444
35. Lee EJ, Bajracharya P, Lee DM, Cho KH, Kim KJ, et al. Gene Expression Profiles of Uterine Normal Myometrium and Leiomyoma and Their Estrogen Responsiveness In Vitro. The Korean Journal of Pathology. 2010;44:272-83.
36. Asada H, Yamagata Y, Taketani T, Matsuoka A, Tamura H, et al. Potential link between estrogen receptor-a gene hypomethylation and uterine fibroid formation. Molecular Human Reproduction 2008;14(9):539–45. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3688587/
37. Yin P, Lin Z, Cheng YH, Marsh EE, Utsunomiya H, et al. Progesterone Receptor Regulates Bcl-2 Gene Expression through Direct Binding to Its Promoter Region in Uterine Leiomyoma Cells. The Journal of Clinical Endocrinology & Metabolism. 2007;92(11):4459–66. https://www.ncbi.nlm.nih.gov/pubmed/17785366
38. Wachidah. Hubungan hiperplasia endometrium dengan mioma uteri : Studi kasus pada pasien ginekologi RSUD Prof. Dr. Margono Soekardjo. Mandala of Health. 2011;3(5).
39. Ellmann S, Sticht H, Thiel F, Beckmann MW, Strick R, et al. Estrogen and progesterone receptors: from molecular structures to clinical targets. Cell. Mol.LifeSci.2009;66:2405–26. (https://www.ncbi.nlm.nih.gov/pubmed/19333551)
40. Fortner KB. John Hopkins Manual of Gynecology and Obstetrics. Edisi III. Lippincott Williams and Wilkins. USA. 2007:399-401;421-22.
41. Bakas P, Liapis A, Vlahopoulos S, Giner M, Logotheti S, et al. Estrogen receptor a and b in uterine fibroids: a basis for altered estrogen responsiveness. Fertility and Sterility, 2008;3(2):1-8 https://www.ncbi.nlm.nih.gov/pubmed/18166184
Additional Files
Published
How to Cite
Issue
Section
Citation Check
License
Copyright (c) 2021 Medica Hospitalia : Journal of Clinical Medicine
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Copyrights Notice
Copyrights:
Researchers publishing manuscrips at Medica Hospitalis: Journal of Clinical Medicine agree with regulations as follow:
Copyrights of each article belong to researchers, and it is likewise the patent rights
Researchers admit that Medica Hospitalia: Journal of Clinical Medicine has the right of first publication
Researchers may submit manuscripts separately, manage non exclusive distribution of published manuscripts into other versions (such as: being sent to researchers’ institutional repository, publication in the books, etc), admitting that manuscripts have been firstly published at Medica Hospitalia: Journal of Clinical Medicine
License:
Medica Hospitalia: Journal of Clinical Medicine is disseminated based on provisions of Creative Common Attribution-Share Alike 4.0 Internasional It allows individuals to duplicate and disseminate manuscripts in any formats, to alter, compose and make derivatives of manuscripts for any purpose. You are not allowed to use manuscripts for commercial purposes. You should properly acknowledge, reference links, and state that alterations have been made. You can do so in proper ways, but it does not hint that the licensors support you or your usage.