水泡状胎块及相关异常妊娠孕早期胎盘组织的病理特点

Histopathological features of hydatidiform moles and placenta changes of nonmolar miscarriage in early stage of pregnancy

目的:分析水泡状胎块及相关异常妊娠早期妊娠阶段的胎盘组织学、免疫标记特点,结合荧光原位杂交法分析核型,以提高对该组疾病诊断与分类的认识。方法:收集水泡状胎块、可疑水泡状胎块及水肿性流产共32例(早期妊娠24例,中期妊娠8例),结合免疫组织化学p57K IP2和CD31染色,其中2例分析核型,进行重新评估。32例重新评估后分为4组:完全性水泡状胎块17例,部分性水泡状胎块6例,绒毛形态异常4例和水肿性流产5例。结果:(1)17例完全性水泡胎块中12例为早期妊娠阶段,其中25%(3/12)的病例绒毛水肿和空化改变局限;100%存在滋养叶细胞增生,但75%(9/12)增生的滋养叶细胞异型性不显著。(2)p57K IP2阴性与妊娠早期完全性水泡状胎块组织形态改变(包括绒毛血管发育不良及间质细胞凋亡核碎)有显著相关性(Pearson相关系数:0.001,0.003,P<0.05)。(3)重新评估后诊断结果与原诊断对照发现部分性水泡状胎块和绒毛形态异常组漏诊和误诊率高于完全性水泡状胎块和水肿性流产组,但差异无统计学意义(部分性水泡状胎块30%,50%;绒毛形态异常75%,75%;完全性水泡状胎块15.4%,35.3%;水肿性流产20%,20%,P>0.05)。(4)荧光原位杂交技术可辅助于核型分析。结论:绒毛血管发育不良和间质细胞丰富的凋亡核碎是早期妊娠阶段完全性水泡状胎块的突出特点,p57K IP2阴性是妊娠早期完全性水泡状胎块诊断中的重要依据,部分性水泡状胎块和绒毛形态异常的形态改变常常重叠,在早期妊娠阶段难以区分,需要辅助诊断手段提高确诊率。

Objective： To analyze the histology,immunohistochemistry expression of hydatidiform moles and placenta changes of related conception specimens in early pregnancy stage combined with genotyping detection by fluorescence in situ hybridization method for improving diagnosis of hydatidiform moles.Methods： A total of 32 cases of hydatidiform moles,problem cases,and hydropic abortuses were collected to study the morphology and the expression of p57KIP2,CD31.Two cases were analyzed the genotype with FISH method.Of the 32 cases,24 were in early pregnancy stage and 8 in middle pregnancy stage.After validation study,all of the cases were subclassfied into four groups： complete hydatidiform mole（17 cases）,partial hydatidiform mole（6 cases）,abnormal villous morphology（4 cases） and hydropic abortus（5 cases）.Results：（1） The hydrops and central cistern formation were present but not marked in 25%（3/12） early complete hydatidiform moles.All of the cases of complete hydatidiform moles in early pregnancy stage consisted of trophoblastic hyperplasia but with mild nuclear pleomorphism in 75% cases.（2） P57KIP2 negative expression was significantly related with the morphology changes of early CHMs（Pearson correlation： 0.001 and 0.003,P〈0.05）.（3） The misdiagnosis rate and missing error rate of partial hydatidiform mole and abnormal villous morphology were higher than those of complete hydatidiform mole and hydropic abortus groups,but there was no statistical significance（partial hydati-diform mole 30%,50%;abnormal villous morphology 75%,75%;complete hydatidiform mole 15.4%,35.3%;hydropic abortus 20%,20%,P〉0.05）.（4） The genotyping analysis by fluorescence in situ hybridization method could provide support and might be generally performed in research settings.Conclusion： Immature blood vessels and excessive stromal karyorrhexis and apoptosis are characteristic features in early complete hydatidiform mole.p57KIP2 is a useful marker in diagnosis of complete hydatidiform mole in early pregnancy stage.The ancillary techniques will facilitate the diagnosis in cases of partial hydatidiform mole/abnormal villous morphology where histological features are usually inconclusive.