title: The relationship among HOXA10, estrogen receptor α, progesterone receptor, and progesterone receptor B proteins in rectosigmoid endometriosis: a tissue microarray study.
abstract: BACKGROUND
  Very few studies have evaluated the expression of homeobox A10 (HOXA10) and steroid (estrogen and progesterone) receptors exclusively in deep endometriosis. Conclusions drawn from studies evaluating peritoneal and ovarian endometriosis are usually generalized to explain the pathogenesis of the disease as a whole. We aimed to evaluate the expression of HOXA10, estrogen receptor α (ER-α), progesterone receptor (PR), and PR-B in rectosigmoid endometriosis (RE), a typical model of deep disease.
  
  
  METHODS
  We used RE samples from 18 consecutive patients to construct tissue microarray blocks. Nine patients each were operated during the proliferative and secretory phases of the menstrual cycle. We quantified the expressions of proteins by immunohistochemistry using the modified Allred score.
  
  
  RESULTS
  The HOXA10 was expressed in the stroma of nodules during the secretory phase in 5 of the 18 patients. Expression of ER-α (in 16 of 18 patients), PR (in 17 of 18 patients), and PR-B (17 of 18 patients) was moderate to strong in the glands and stroma of nodules during both phases. Expression of both PR (P = .023) and PR-B (P = .024) was significantly greater during the secretory phase.
  
  
  CONCLUSIONS
  The HOXA10 is expressed in RE, where it likely imparts the de novo identity of endometriotic lesions. The ER-α, PR, and PR-B are strongly expressed in RE, which differs from previous studies investigating peritoneal and ovarian lesions. This suggests different routes of pathogenesis for each of the 3 types of endometriosis.
authors.affiliation: Department of Gynecology, São Paulo University School of Medicine, Sao Paulo, Brazil alysson.zanatta@gmail.com.
authors.forename: Alysson
authors.initials: A
authors.lastname: Zanatta
authors.affiliation: Endometriosis Center, Santa Joana Hospital, Sao Paulo, Brazil.
authors.forename: Ricardo Mendes Alves
authors.initials: RM
authors.lastname: Pereira
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI.
authors.forename: André Monteiro da
authors.initials: AM
authors.lastname: Rocha
authors.affiliation: Department of Molecular and Morphologic Sciences, São Paulo University School of Zootechny and Veterinary Medicine, Sao Paulo, Brazil.
authors.forename: Bruno
authors.initials: B
authors.lastname: Cogliati
authors.affiliation: Department of Gynecology, São Paulo University School of Medicine, Sao Paulo, Brazil.
authors.forename: Edmund Chada
authors.initials: EC
authors.lastname: Baracat
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Hugh S
authors.initials: HS
authors.lastname: Taylor
authors.affiliation: Department of Gynecology, São Paulo Federal University School of Medicine, Sao Paulo, Brazil.
authors.forename: Eduardo Leme Alves da
authors.initials: EL
authors.lastname: Motta
authors.affiliation: Department of Gynecology, São Paulo University School of Medicine, Sao Paulo, Brazil.
authors.forename: Paulo Cesar
authors.initials: PC
authors.lastname: Serafini
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology; D004717:Endometrium / Q000737:chemistry* / Q000473:pathology / Q000503:physiopathology; D004847:Epithelial Cells / Q000737:chemistry; D047628:Estrogen Receptor alpha / Q000032:analysis*; D005260:Female; D000080905:Homeobox A10 Proteins; D018398:Homeodomain Proteins / Q000032:analysis*; D006801:Humans; D007150:Immunohistochemistry; D008597:Menstrual Cycle; D011980:Receptors, Progesterone / Q000032:analysis*; D012002:Rectal Diseases / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology; D012810:Sigmoid Diseases / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology; D017154:Stromal Cells / Q000737:chemistry; D046888:Tissue Array Analysis
chemical_list: C506487:ESR1 protein, human; D047628:Estrogen Receptor alpha; D000080905:Homeobox A10 Proteins; D018398:Homeodomain Proteins; D011980:Receptors, Progesterone; C097314:progesterone receptor B; C069634:HOXA10 protein, human
keywords: HOXA10; deep endometriosis pathogenesis; estrogen receptor; progesterone receptor; rectosigmoid endometriosis