Testosterone Aromatization to Estradiol in Course of Ovarian Functioning Brenner Tumor Associated With Endometrial Carcinoma and Endometriosis (Roncati-Manenti Triad).

Abstract

OBJECTIVE:

Aromatization is the biochemical process in which aromatase catalyzes the conversion of testosterone into estradiol, the fundamental pathway for the synthesis of estrogens. When enhanced, it can lead to hyperestrogenism, a well-known risk factor for gynecological cancers.

METHODS:

The surgical specimens, coming from 2 postmenopausal women with hyperestrogenism on pap smear and bioptic diagnosis of endometrial endometrioid carcinoma, were fixed in 10% neutral buffered formalin, paraffin embedded, and then submitted for routine hematoxylin/eosin staining and immunohistochemical characterization for antiestrogen, antiprogesterone, antitesterone, anti-MLH1, anti-PMS2, anti-MSH2, and anti-MSH6.

RESULTS:

The presence of an undescribed triad represented by ovarian functioning Brenner tumor, endometrial carcinoma, and pelvic endometriosis has been ascertained. The immunohistochemical investigation proved a normal expression of the DNA mismatch repair proteins and revealed a bimodal hormonal status in the pathological tissues, that is, the Brenner tumor cells showed a high expression of testosterone, contrariwise endometrioid carcinoma and endometriosis a high estrogen and progesterone immunolabeling.

CONCLUSIONS:

This synchronous triad underlines the importance of aromatization and hyperestrogenism in the development of gynecological malignancies in which the immunohistochemical detection of an active source of hormone production - to always keep in consideration during synchronous diseases - can guide subsequent antihormone chemotherapy based on aromatase inhibitors.

• Authors: Luca Roncati, Antonio Manenti, Teresa Pusiol, Francesco Piscioli, Giuseppe Barbolini, Antonio Maiorana
• Journal: International journal of gynecological cancer : official journal of the International Gynecological Cancer Society (Int J Gynecol Cancer) Vol. 26 Issue 8 Pg. 1461-4 (10 2016) ISSN: 1525-1438 [Electronic] England
• PMID: 27465894 (Publication Type: Case Reports, Journal Article)

Chemical References

• Testosterone
• Estradiol
• Aromatase
• CYP19A1 protein, human

Topics

• Aromatase (metabolism)
• Brenner Tumor (metabolism, surgery)
• Carcinoma, Endometrioid (metabolism, surgery)
• Endometrial Neoplasms (metabolism, surgery)
• Endometriosis (metabolism, surgery)
• Estradiol (metabolism)
• Female
• Humans
• Immunohistochemistry
• Middle Aged
• Ovarian Neoplasms (metabolism, surgery)
• Testosterone (metabolism)