الفهرس 
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Abstract
ER and PR receptors belong to the nuclear steroid receptor superfamily. They are ligand dependent transcriptional factors, which can bind to different DNA sites to initiate the expression of specific genes.
They exert their actions by one of two different mechanisms; the classical pathway of gene activation which takes from 30 minutes to several hours, and the non-genomic pathways, which takes a more rapid response time, from a few seconds to about ten minutes.
AUB occurs in 9–14 % of women of all ages and is responsible for about 25 % of gynecological surgeries.
Endometrial hyperplasia represents a non-physiological, non-invasive proliferation of the endometrium that results in a morphologic pattern of glands with irregular shapes and varying size.
Hyperplasia without atypia is considered a status that may regress with medical treatment. A large percentage (up to 60%) of atypical endometrial hyperplasia are found to be coexistent with invasive endometrial carcinoma or develop into invasive endometrial carcinoma within the space of just a few years.
Atypical endometrial hyperplasia exhibits many of the mutations typical for invasive endometrioid endometrial carcinoma. In up to 60% of cases, patients have coexisting invasive cancer or are at extremely high risk of developing invasive cancer.
Endometrial hyperplasia develops in a setting of estrogen excess. Detection of high levels of steroid receptors denotes a good response to hormonal therapy namely progesterone in simple and
complex hyperplasia. Decrease in receptor activity which is found in atypical hyperplasia results in low sensitivity to progesterone therapy.
Therefore, this work was planned to investigate the expression of ER and PR in perimenopausal bleeding by IHC staining technique, and to correlate their expression with the available clinicopathological features.
The prospective case control study was carried out on selected 33 cases of AUB with endometrial hyperplasia to be compared with 25 control cases that had non hyperplastic/non neoplastic associated endometrial lesions for the evaluation of IHC expression of ER and PR.
The studied cases included 19 (57.58%) cases with hyperplasia without atypia, 14 (42%) cases with hyperplasia with atypia, seven (28%) cases with proliferative endometrium, nine (36%) cases with secretory endometrium and nine (36%) cases with disordered proliferative endometrium.
Immunohistochemical evaluation was done. Positive ER α and PR β staining was considered when nuclear brown staining was seen.
Comparing between control and study groups as regards to IHC expression of ER and PR in both glands and stroma, there were significant differences between control group and hyperplasia group as regarding to IHC glandular and stromal expression of ER and PR (P<0.001 for all), as H score is higher in control group than in hyperplasia.
Comparing between IHC expression of ER and PR in both glands and stroma in hyperplasia subgroups, there were significant differences between different hyperplasia subgroups as regarding H score of glandular and stromal expression of ER (P=0.009 and 0.01, respectively). Similarly there were statistical differences between different hyperplasia subgroups as regarding H score of glandular and stromal expression of PR (P<0.001 for both) as H score for both receptors was higher in hyperplasia without atypia than hyperplasia with atypia. Moreover, There were significant differences between different hyperplasia subgroups as regarding H score group for both ER and PR (P=0.02 and 0.003 respectively), whereas 78.6% of hyperplasia with atypia group belonged to low H score group.
Comparing between IHC expression of ER and PR in both glands and stroma in control subgroups, there were significant differences between different control subgroups as regarding H score of glandular expression of ER (P=0.01 for proliferative versus secretory groups, P=0.04 for proliferative versus disordered proliferative groups, and P<0.001 for secretory versus disordered proliferative groups) and also in stromal expression of ER (P=0.001for proliferative versus secretory groups, P=0.001 for proliferative versus disordered proliferative groups, and P<0.001 for secretory versus disordered proliferative groups) as H score was higher in proliferative than disordered proliferative than secretory. Moreover, there were statistical differences between different control subgroups as regarding H score of glandular and stromal expression of PR (P=0.001 for all)