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Annals of Oncology Advance Access originally published online on January 11, 2006
Annals of Oncology 2006 17(4):637-645; doi:10.1093/annonc/mdj129
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© 2006 European Society for Medical Oncology

Metalloproteinase-2, -7 and -9 and tissue inhibitor of metalloproteinase-1 and -2 expression in normal, hyperplastic and neoplastic endometrium: a clinical-pathological correlation study

O. Graesslin1,2,4, A. Cortez1,2, R. Fauvet2, M. Lorenzato5, P. Birembaut5,6 and E. Daraï2,3,*

1 Service d'Anatomie Pathologique, Hôpital Tenon, AP-HP, Paris; 2 UPRES EA 2396 UFR Saint-Antoine, Université Paris VI, Pierre et Marie Curie; 3 Service de Gynécologie, Hôpital Tenon, AP-HP, Paris; 4 Service de Gynécologie, Institut Mère Enfant Alix de Champagne; 5 Service d'Anatomie Pathologique, Laboratoire Pol Bouin; 6 INSERM UMR-S 514, Reims, France

* Correspondence to: Prof. E. Daraï, Service de Gynécologie-Obstétrique, Hôpital Tenon, 4 rue de la Chine, 75020 Paris, France. Tel: +33-1-56-73-18; Fax: +33-1-56-01-73-17; E-mail: emile.darai{at}tnn.ap-hop-paris.fr

Background: Matrix metalloproteinases (MMPs) and their inhibitors are key-players in extracellular matrix and basement membrane degradation, and are involved in both physiological and malignant processes. The aim of this study was to examine MMP-2, -7 and -9 and TIMP-1 and -2 expression in normal, hyperplastic and malignant endometrium, and their relation to clinical and histological prognostic factors.

Materials and methods: We performed qualitative and semi-quantitative immunohistochemical analysis of 20 samples of normal endometrium (10 in the proliferative phase, 10 in the secretory phase), 39 samples of hyperplastic endometrium (17 without atypia and 22 with atypia) and 38 samples of endometrioid carcinoma, by using specific monoclonal antibodies.

Results: In normal endometrium, epithelial expression of MMP-2 (P = 0.0007), MMP-7 (P = 0.0002) and TIMP-2 (P = 0.0004) was increased during the proliferative phase of the menstrual cycle. MMP-2 expression correlated negatively with TIMP-2 expression (P = 0.001, {rho} = 0.702). Endometrial stromal cells in the secretory phase showed strong MMP-2 expression (P = 0.004) and weak MMP-7 (P = 0.001) and TIMP-1 expression (P = 0.01). In hyperplastic endometrium, the presence of atypia was associated with lower TIMP-2 expression (P = 0.005) and was also associated with a trend towards higher MMP-2 expression. Endometrial stromal cell expression of MMP-2, -7 and -9 and TIMP-1 and -2 did not differ between hyperplastic endometrium with and without atypia. A gradient of MMP-2 and -9 expression was observed from hyperplastic endometrium to endometrial carcinomas. In endometrial carcinomas, MMP-2 expression increased (P = 0.0004) and TIMP-2 expression decreased (P = 0.0005) with the histological grade. TIMP-2 expression correlated with myometrial invasion (P = 0.005), lymphovascular space involvement (P = 0.008) and lymph node involvement (P = 0.007).

Conclusion: These results support the involvement of MMPs and TIMPs in endometrial carcinogenesis. Strong MMP-2 and weak TIMP-2 expression were the most potent markers of endometrial malignancies with a high risk of local and distant spread.

Key words: metalloproteinases, metalloproteinase inhibitors, endometrial cancer, hyperplasia, normal endometrium, immunohistochemistry


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