Correlation between the growth of uterine
leiomyomata and estrogen and
progesterone receptor content in needle
Tomoyuki Ichimura, M.D., Naoki Kawamura, M.D., Fumihiro Ito, M.D.,
Sachiko Shibata, M.D., Kumiyo Minakuchi, M.D., Akemi Tsujimura, M.D.,
Naohiko Umesaki, M.D., and Sachio Ogita, M.D.
Department of Obstetrics and Gynecology, Osaka City University Medical School, Osaka, Japan
Objective: To examine the relationship between estrogen receptor (ER) and progesterone receptor (PR) content in needle
biopsy specimens and the growth of uterine leiomyomata after biopsy.
Design: Prospective clinical study.
Setting: University teaching hospital.
Patient(s): Thirty-one women with uterine leiomyomata and a normal menstrual cycle.
Intervention(s): Transcervical needle biopsy of uterine leiomyomata.
Main Outcome Measure(s): The relationships between histologic features (smooth muscle content, immunohistochemical
expression of ER and PR) and the percent increase over a 12-month observation period in the volume of the largest myoma
nodule measured by magnetic resonance imaging were analyzed.
Result(s): Both the density and intensity of immunohistochemical staining of PRs in uterine leiomyoma tissue showed
signiﬁcant positive correlation with leiomyoma growth.
Conclusion(s): The growth of uterine leiomyomata can be determined by histologic and immunohistochemical analysis of
needle biopsy specimens from uterine leiomyomata. (Fertil Steril 1998;70:967–71. ©1998 by American Society for
Key Words: Uterine leiomyoma, natural history, estrogen receptor, progesterone receptor, needle biopsy
Uterine leiomyomata are the most common
solid pelvic tumors, occurring in 20%–30% of
women Ͼ30 years of age (1). Ovarian hor-
mones are believed to stimulate the growth of
leiomyomata because there is an increased in-
cidence of leiomyomata after menarche and
because these tumors enlarge during pregnancy
and regress after menopause. However, leiomy-
oma growth is variable among women with reg-
ular menstruation cycles and even among my-
oma nodules in the same uterus. One possible
reason for this variation is that individual my-
oma nodules are stimulated by ovarian hor-
mones to different degrees.
To understand the mechanism of this varia-
tion in their growth, direct analysis of leiomy-
oma tissue and, in particular, the status of es-
trogen receptor (ER) and progesterone receptor
(PR) expression, is required. However, such an
analysis has not been reported because studies
of prediction of leiomyoma growth cannot be
performed after hysterectomy or myomectomy
and gynecologists infrequently perform biopsies
of uterine leiomyomata.
Beginning in May 1994, we obtained trans-
cervical needle biopsy specimens of uterine
myomatous tumors in cases in which conser-
vative management was deemed suitable,
i.e., the absence of malignant tumor, in par-
ticular leiomyosarcoma, was deﬁnitively es-
tablished (2). The purpose of the present
study was to examine the relationship be-
tween the immunohistochemical staining
pattern of ERs or PRs in leiomyoma tissue
obtained by needle biopsy and leiomyoma
growth after biopsy.
Received March 9, 1998;
revised and accepted
June 1, 1998.
Presented at the 49th
Annual Congress of Japan
Society of Obstetrics and
Gynecology, Tokyo, Japan,
April 5–8, 1997.
Reprint requests: Naoki
Department of Obstetrics
and Gynecology, Osaka
City University Medical
School, 1-5-7 Asahimachi,
Abeno-ku, Osaka 545-
8585, Japan (FAX: ϩ81-6-
FERTILITY AND STERILITY
VOL. 70, NO. 5, NOVEMBER 1998
Copyright ©1998 American Society for Reproductive Medicine
Published by Elsevier Science Inc.
Printed on acid-free paper in U.S.A.