Progesterone-induced smooth muscle—like cells in the subperitoneal nodules produced by estrogen: Experimental approach to leiomyomatosis peritonealis disseminata

doi:10.1016/0002-9378(81)90440-3

American Journal of Obstetrics and Gynecology

Volume 139, Issue 2, 15 January 1981, Pages 164-172

https://doi.org/10.1016/0002-9378(81)90440-3 Get rights and content

Abstract

In order to examine the pathogenesis and histogenesis of leiomyomatosis peritonealis disseminata (LPD), guinea pigs were treated with various doses of estradiol benzoate (E) (40, 80, 100, and 200 μg/day, three times a week, by intramuscular injection). After treatment for 3 months, each dose of E produced lesions simulating the disseminated pattern of LPD. Ultrastructurally, the nodules were considered to be composed of cells resembling those of fibroblast. In guinea pigs, pretreatment with estradiol benzoate (100 μg/day, three times a week intramuscularly for 3 months followed by combination treatment with E and progesterone (P) (0.5 and 1.0 mg/day, once a week, intramuscularly) for 1 to 3 months produced nodules similar to those with estrogen alone. Ultrastructurally, these nodules were composed of cells resembling smooth muscle and decidual cells. According to these results, we conjectured that estrogen differentiates and proliferates cells with the features of fibroblast-like cells from the subcoelomic totipotential mesenchyme, and these cells are differentiated into smooth muscle—like cells and decidua-like cells under the influence of both estrogen and progesterone, resulting in the production of multiple subperitoneal nodules.

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Ginsenoside Rh2 suppresses growth of uterine leiomyoma in vitro and in vivo and may regulate ERα/c-Src/p38 MAPK activity
2015, Journal of Functional Foods
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Each animal was weighed once per week and fed standard rat chow. The models of ULs were established according to Fujii et al. (1981) and Zhu et al. (2007) with some modifications. Forty-eight female SD rats were randomly divided into six groups.
Panax ginseng is widely used as a functional food in Asia because of its bioactivities. Here, we report that ginsenoside Rh2, an extract of red Panax ginseng, suppressed growth of uterine leiomyomas (ULs) in a rat model and decreased serum hormone levels in a dose-dependent manner. Rh2 also inhibited the growth of cultured human UL cells in vitro. After Rh2 treatment, cells showed morphological changes that were consistent with apoptosis. Using ELISA, real-time RT-PCR, and Western blot methods, we found that Rh2 significantly reduced the activity of oestrogen receptor alpha (ERα) and c-Src, increased p38 MAPK activity, and reversed ERα activity mediated by PP2 and SB203580, specific inhibitors of c-Src and p38 MAPK, respectively, in UL cells. These findings provide a novel mechanism for the anti-proliferative efficacy of Rh2 that likely involves regulating ERα/Src/p38 MAPK activity.
Ectopic decidua: Variability of presentation in pregnancy and differential diagnoses
2012, Gynecologie Obstetrique et Fertilite
La déciduose ectopique est un phénomène fréquent pendant la grossesse correspondant à la présence de tissu décidual hors de l’endomètre. La physiopathologie de ces lésions n’est pas encore totalement élucidée. Le phénomène est bénin le plus souvent, d’évolution favorable dans le post-partum et sans suivi nécessaire. Sa grande variété de présentation clinique rend le diagnostic difficile : de la granulation péritonéale localisée ou diffuse à la volumineuse masse pelvienne. L’imagerie est peu spécifique. La découverte de telles lésions doit amener à la réalisation de biopsies systématiques pour un examen anatomopathologique et éliminer d’autres étiologies telles que des lésions de carcinose ou de tuberculose. L’examen immunohistochimique vient compléter l’analyse pour éliminer le mésothéliome de forme déciduoïde, son principal diagnostic différentiel au pronostic catastrophique.
The ectopic decidua is a common occurrence during pregnancy, corresponding to the presence of decidual tissue outside the endometrium. The pathophysiology of these lesions is not yet fully elucidated. The phenomenon is most often benign, with a favourable outcome in the post-partum and without follow-up. Because of the wide range of clinical presentations, from localized peritoneal granulation to large pelvic mass, the clinical diagnosis of ectopic decidua is difficult. Furthermore, imaging is not specific. The discovery of such lesions should lead to the realization of systematic biopsies for histological examination and rule out other causes such as lesions of tuberculosis or carcinomatosis. Immunohistochemical studies are helpful in differentiating deciduosis from malignant deciduoid mesothelioma, its main differential diagnosis with a catastrophic prognosis.
Leiomyomatosis peritonealis disseminata: An unusual form of presentation
2011, Progresos de Obstetricia y Ginecologia
El hallazgo casual de lesiones ocupantes de espacio de considerables proporciones no es infrecuente en la práctica clínica ginecológica. Suele tratarse de lesiones de crecimiento lento, que producen poca o ninguna sintomatología en las pacientes, muchas veces en forma de episodios sintomáticos vagos y poco específicos que pueden haber sido motivo de consulta médica durante años sin sospechar su origen. Presentamos el caso de una leiomiomatosis peritoneal diseminada diagnosticada en una paciente que acudió remitida a nuestra consulta para valorar el posible origen ginecológico de un dolor hipogástrico intermitente de larga evolución.
An incidental finding of pelvic masses of considerable proportions is not uncommon in clinical gynecological practice. These lesions tend to grow slowly and produce no or few symptoms, often consisting of vague and nonspecific episodes that may have lead to medical consultations for years without their cause being suspected. We present a case of leiomyomatosis peritonealis disseminata diagnosed in a patient who attended our clinic for assessment of a possible gynecological origin of longstanding, intermittent, low abdominal pain.
Metastasizing Leiomyomatosis peritonealis disseminata (LPD) in association with an ovarian endometrioma: A case report
2010, European Journal of Radiology Extra
Citation Excerpt :
Spontaneous regression of LPD in those cases associated with pregnancy or an estrogen producing tumor, after estrogen levels have normalized supports this fact. Extra-genital leiomyomas have been experimentally induced in guinea pigs by exposing them to estrogen and progesterone [8]. Hales et al. have demonstrated the regression of tumor nodules of LPD secondary to gonadotropin-releasing hormone agonists acting as hypoestrogenic agents [9].
Leiomyomatosis peritonealis disseminata (LPD) is a rare, usually benign condition that clinically simulates a disseminated malignancy, occurring predominantly in women of childbearing age. Till date, only 8 cases of LPD associated with endometriosis (all in non-radiology journals) and a very few cases of metastasizing leiomyomatosis have been reported. We report a case of LPD in association with an ovarian endometrioma and nodal metastases.
Cellular diversity of human placental stem villi: An ultrastructural and immunohistochemical study
2007, Acta Histochemica
The aim of the study was to investigate the distribution and differentiation of cell types in the stroma of human placental stem villi (SV). A total of 14 human term placental tissues were studied. Double immunolabeling was performed for desmin-vimentin, desmin-α-smooth actin and vimentin-α-smooth actin. Cytokeratin 7, proliferating cell nuclear antigen immunolabeling was also performed. Parallel tissue samples were examined by transmission electron microscopy. HSCORE was performed for the semi-quantitative analysis of distribution of cells in the stroma of SV. Vimentin-labeled cells were mostly distributed in the subtrophoblastic area. Desmin-vimentin double immunolabeling was mainly localized in the triangular area and to a lesser degree in the perivascular area and vessel walls (p=<0.001). However, desmin-α smooth actin labeling was observed predominantly in the vessel wall and perivascular area. Vimentin-α smooth actin immunoreactivity was significantly stronger in the triangular and perivascular areas compared to the vessel walls (p=0.003).
Ultrastructurally, cells in the stroma of SV were mesenchyme cells, reticulum cells, fibroblasts, myofibroblasts, smooth muscle cells, and Hofbauer cells, filamented and vacuolated cells. The differentiation of myofibroblasts in the triangular and perivascular areas may play a role in maturation of SV and villous contractility, modulation of the intervillous space and this may have effects on maternofetal placental circulation.
Smooth muscle in the female pelvic peritoneum: A clinicopathological analysis of 31 women
2005, Pathology
To study the presence and morphological features of smooth muscle in the subcoelomic mesenchyme with the aim of establishing both a normal range for the female pelvis, and its possible relationship to endometriosis, diffuse peritoneal leiomyomatosis (LPD) and other forms of ‘müllerianosis’.
Seventy laparoscopically obtained pelvic peritoneal biopsies accessioned over a 16-month period were examined from 31 women clinically suspected of endometriosis. These biopsies were selected for the presence of assessable, appropriately oriented peritoneum, sufficiently distant from focal endometriosis to allow a presumption of ‘normality’. The histological features and morphometric measurements of smooth muscle in these biopsies were documented. Pathological changes, where present, were recorded.
Focal endometriosis was identified in 28 (40%) of the biopsies, nine (12.9%) displayed other manifestations of ‘mullerianosis’, 11 (15.7%) showed focal chronic inflammation or fibrosis only, and 22 (31.4%) displayed no specific pathological changes. Of 70 biopsies, 52 contained smooth muscle within the subcoelomic mesenchyme, directly below the peritoneal mesothelium. Biopsies in which smooth muscle was identified were predominantly from the region of the uterosacral ligaments (16/18) and pelvic side wall (22/25). The biopsies without a smooth muscle layer were predominantly from the pararectal area (7/8) or the rectal serosa (2/4). Where present, smooth muscle varied in prominence, depth, thickness of the layer and organisation of muscle bundles. Patterns ranged from thin, widely spaced and wispy fibres to a more or less continuous band of either horizontally and/or vertically organised fibres. Both focal and diffuse arrangements were evident. ‘Neovascularisation’ was observed laparoscopically in some areas that corresponded with prominent smooth muscle development.
Smooth muscle occurs sufficiently frequently immediately beneath the peritoneum of the female pelvis, and with a sufficiently predictable anatomical distribution, to be regarded as a normal component of the microanatomy of this tissue in the patients studied.

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Progesterone-induced smooth muscle—like cells in the subperitoneal nodules produced by estrogen: Experimental approach to leiomyomatosis peritonealis disseminata

Abstract

Multiple peritoneal leiomyomas associated with a granulosa cell tumor of the ovary

Am. J. Obstet. Gynecol

Histogenesis of leiomyomatosis peritonealis disseminata (disseminated fibrosin deciduosis

Obstet. Gynecol

Leiomyomatosis peritonealis disseminata: an ultrastructural study

Am. J. Clin. Pathol

Leiomyomatosis peritonealis disseminata with endometrium

Obstet. Gynecol

Leiomyomatosis peritonealis disseminata

Obstet. Gynecol

Electron microscopic studies of leiomyomatosis peritonealis disseminata

Obstet. Gynecol

Smooth muscle within ovarian decidual nodules: A link to leiomyomatosis peritonealis disseminata

Obstet. Gynecol

Structure and origin of uterine and extragenital fibroids induced experimentally in the guinea pig by prolonged administration of estrogens

Cancer Res