Loss of phosphatase and tensin homologue deleted on chromosome 10 and phosphorylation of mammalian target of rapamycin are associated with progesterone refractory endometrial hyperplasia

Int J Gynecol Cancer. Jan-Feb 2008;18(1):146-51. doi: 10.1111/j.1525-1438.2007.00958.x. Epub 2007 Apr 26.


The objective of our study was to evaluate the phosphatase and tensin homologue deleted on chromosome 10 (PTEN), p27, and mammalian target of rapamycin (mTOR) expressions in women with progesterone-responsive and refractory endometrial hyperplasia (EH) samples and to determine if these markers could be associated with response or used as potential targets for treatment. Thirty-eight matched pre- and posttreatment pairs of paraffin-embedded endometrial biopsies were obtained from patients with EH. Immunohistochemical analysis for PTEN, p27, and phospho-mTOR were performed on all samples. Median age at diagnosis was 49 years (20-79 years). Median treatment interval was 3 months (1-12 months). Sixteen patients (42.1%) had complete resolution of their hyperplasia (responders), and 22 (57.9%) had persistent hyperplasia (nonresponders) after treatment with progesterone. In the pretreatment samples, no markers were found to predict nonresponders. In posttreatment samples, loss of PTEN expression with phospho-mTOR expression was observed in more nonresponders than responders (40.9% vs 6.3%; P= 0.03). Phospho-mTOR overexpression was found in 63.6% of nonresponders. We found that persistent hyperplasia refractory to progesterone therapy was associated both with the loss of PTEN and with the loss of phosphorylation of mTOR. In select cases of non-responsive progesterone refractory EH, a rational target for treatment may involve the mTOR pathway.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Chromosomes, Human, Pair 10 / genetics*
  • Cyclin-Dependent Kinase Inhibitor p27 / metabolism*
  • Endometrial Hyperplasia / drug therapy*
  • Endometrial Hyperplasia / genetics
  • Endometrial Hyperplasia / pathology
  • Female
  • Gene Deletion*
  • Humans
  • Immunoenzyme Techniques
  • Middle Aged
  • Neoplasm Recurrence, Local / drug therapy
  • Neoplasm Recurrence, Local / metabolism
  • Neoplasm Recurrence, Local / pathology
  • PTEN Phosphohydrolase / genetics*
  • Phosphorylation / drug effects
  • Progesterone / therapeutic use*
  • Progestins / therapeutic use*
  • Protein Kinases / metabolism*
  • TOR Serine-Threonine Kinases


  • Progestins
  • Cyclin-Dependent Kinase Inhibitor p27
  • Progesterone
  • Protein Kinases
  • MTOR protein, human
  • TOR Serine-Threonine Kinases
  • PTEN Phosphohydrolase
  • PTEN protein, human