Bcl-2, BAX, and apoptosis in endometrial hyperplasia after high dose gestagen therapy

Vereide, Anne Beate; Kaino, Turid; Sager, Georg; Ørbo, Anne

doi:10.1016/j.ygyno.2005.02.030

Cited by 51 publications

(11 citation statements)

References 25 publications

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“…Vereide AB showed that proteins in the apoptotic cascade are regulated by gestagen; stromal Bcl-2 expression is a potential biomarker which can separate responders of gestagen treatment from non-responders after oral administration [38]. Part of the molecular mechanisms of progestin therapy for endometrial hyperplasia is through the upregulation of Fas/FasL expression [27].…”

Section: Overviewmentioning

confidence: 99%

Predictive diagnosis of endometrial hyperplasia and personalized therapeutic strategy in women of fertile age

et al. 2013

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IntroductionEndometrial hyperplasia has a high risk for malignant transformation and relapses; existing mini-invasive treatments may lead to irrevocable endometrium destruction. The aims were to analyze receptor systems in endometrial hyperplasia, to evaluate the capabilities of ultrasonography, sonoelastography for diagnosis and treatment control, and to develop treatment algorithm.Materials and methodsWe included 313 women (20–45 years), assessed into the following: group 1 (n = 112) with glandular cystic hyperplasia, group 2 (n = 98) endometrial polyps, and group 3 (n = 103) atypical hyperplasia; and 82 controls who have undergone hysteroscopy before in vitro fertilization in tubal origin infertility were also included. Patients underwent clinical examination, transvaginal ultrasound, immunohistochemical study, and hormonal therapy/hysteroresectoscopy.ResultsIn patients with glandular hyperplasia, we registered increase of endometrium estrogen receptors (75.6% in the epithelium and 30.9% in the stroma; in controls, 43.3% and 29.6%, respectively); in polyps, there was a significant estrogen receptor increase in the stroma (48.2% vs 29.6% in controls), and in atypical hyperplasia, progesterone receptors significantly increased in the stroma. Ki-67 increased (40% to 50%) in the epithelium without changes in the stroma. Ultrasound has a sensitivity of 96% and a specificity of 85% for early detection of endometrial pathology and prediction outcome of intervention, and sonoelastography has a sensitivity of 91% and a specificity of 83% for polyp diagnosis. Personalized treatment was effective in 88.8%, relapse was diagnosed in 11.2% after 6 months, and conservative treatment of atypical hyperplasia was effective in 45%: in 25.8%, ablative hysteroresectoscopy was performed, while in 22.6% with comorbidities, hystero/oophorectomies were performed.ConclusionsThe evaluation of receptor status with ultrasound data in patients with endometrial hyperplasia allows for a clear definition of the treatment policy, avoidance of relapse, treatment optimization, and observation of such patients.

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Section: Overviewmentioning

confidence: 99%

Predictive diagnosis of endometrial hyperplasia and personalized therapeutic strategy in women of fertile age

et al. 2013

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“…Some authors state that patients could benefit from cyclic progestin therapy rather than continuous treatment [32,33]. Progestin acts directly by the induction of endometrial epithelial apoptosis and indirectly upon withdrawal by physical shedding of tumor tissue.…”

Section: Controversial Topicsmentioning

confidence: 99%

Controversies of the Hormonal Conservative Treatment of Endometrial Cancer

Minig

Franchi

Bernabe

et al. 2013

Gynecol Obstet Invest

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Background: Hysterectomy plus salpingo-oophorectomy represents the standard treatment for patients with well-differentiated endometrial cancer (EC) limited to the endometrium. It is estimated that over 5% of EC are diagnosed in nulliparous women aged 35-44 years. In addition, EC can affect obese women with diabetes, hypertension and other comorbidities increasing the surgical risk. Methods: This article reviews the English literature in PubMed regarding hormonal treatment of EC. Results: Use of hormonal therapies has resulted in complete remission in 60-70%; many of these women were able to achieve full-term pregnancies, and in case of contraindication to surgery, resection could be avoided. Several topics, however, such as patient selection, interobserver histologic evaluation, the type/duration of hormonal treatment, modality of evaluation before treatment and surveillance after treatment, which are still subject to controversy, are therefore discussed in this paper. Conclusion: Uterus-sparing treatment of well-differentiated EC limited to the endometrium is feasible and has acceptable efficacy in women with increased surgical risk or those who wish to preserve their fertility. Although the methods applied to determine disease extent beyond the endometrium are still unsatisfactory, patient selection is a crucial factor determining the outcome of treatment. However, women must be fully informed about the possibility of treatment failure and the necessity of a close follow-up after therapy.

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“…It can be expected that LNG-IUS used for contraception protects primarily from endometrial cancer as do nonhormonal IUDs, although the mechanism differs between these IUSs (Aikat & Chadda 1980, Nilsson et al 1982, Johannisson 1987, Castellsague et al 1993, Raudaskoski et al 1998, Phillips et al 2003, Vereide et al 2005. Regarding the possible mechanisms of protection, there are important differences between nonhormonal IUDs and the (until now only available) hormonal LNG-IUS: although local intrauterine changes are suggested to be the main effect for contraception with both systems within a few days after insertion, only local endometrial effects without relevant systemic side effects (e.g.…”

Section: Mechanisms Using Nonhormonal and Hormonal Iudsmentioning

confidence: 99%

Hormonal contraception and risk of endometrial cancer: a systematic review

Mueck¹,

Seeger²,

Rabe³

2010

Endocrine-Related Cancer

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More than 15 case-control studies and at least four large cohort studies demonstrated a decrease in the risk of endometrial cancer of about 50% for ever use of combined oral contraceptives (COCs). In most of these studies, this protective effect persisted for more than 10-15-20 years after cessation of the COC. An increasing protective effect with longer duration of COC use has been found in most studies. The beneficial effect was independent of the composition of COC, i.e. dosage and type of progestogen, combined with ethinyl estradiol 30-50 mg/day. COCs with higher progestogen potency seem to be somewhat more effective. Nonhormonal uterine devices have also been found to be strongly protective; however, data on oral or injectable progestogen-only preparations (POPs) including the levonorgestrel-releasing intrauterine system (LNG-IUS) are still rare, but also suggest similar protective action. COCs, POPs, as well as LNG-IUS can effectively reduce endometrial hyperplasia but should only be used in exceptional cases in patients with or after endometrial cancer. In contrast to nonhormonal IUS, systemic side effects cannot be excluded with LNG-IUS, but they are certainly rare, as the main effect has decreased the endometrial estrogen response because of the high endometrial tissue levels of LNG.

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Bcl-2, BAX, and apoptosis in endometrial hyperplasia after high dose gestagen therapy

Cited by 51 publications

References 25 publications

Predictive diagnosis of endometrial hyperplasia and personalized therapeutic strategy in women of fertile age

Predictive diagnosis of endometrial hyperplasia and personalized therapeutic strategy in women of fertile age

Controversies of the Hormonal Conservative Treatment of Endometrial Cancer

Hormonal contraception and risk of endometrial cancer: a systematic review

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