Immunohistologic localization of estrone sulfatase in uterine endometrium and adenomyosis

To clarify histologic localization of estrone sulfatase in normal uterine endometrium and adenomyotic tissue and to confirm that estrone sulfatase is one of the enzymes that supplies estrogen to adenomyotic tissue.

Specimens from 21 patients who had undergone hysterectomy were obtained from uteri with histopathologically proven adenomyosis. Specimens from 28 patients who had undergone hysterectomy for a disease of the uterine cervix were used as control specimens of normal uterine endometrium. Cases of hormone-dependent disease, such as leiomyoma, adenomyosis, and endometrial neoplasm, were excluded from cases of normal endometrium. The myometrium in patients with adenomyosis was examined. These tissues were examined by immunohistochemistry using anti-estrone sulfatase monoclonal antibodies. Power analysis was performed. With alpha = 0.05, 1 - beta = 0.8, P1= 25%, and P2 = 75%, 14 specimens from each group were sufficient to detect significant differences among them. The Fisher exact test, sign test, and McNemar test were used for statistical analysis.

In normal endometrial tissue, immunostaining for estrone sulfatase was observed only on the glandular epithelial cells of the basilar layer of the endometrium. However, all functional layers of the endometria were negative for staining for estrone sulfatase. In adenomyotic tissue, glandular epithelial cells showed immunostaining for estrone sulfatase. Rates of immunostaining in adenomyotic tissue were higher than those in the basilar layer of normal uterine endometrium (76% and 43%, respectively, P =.02). The myometrium was not stained.

Estrone sulfatase may be one of the enzymes supplying estrogen for growth of adenomyosis.