双胎之一完全性葡萄胎与胎儿共存3例临床病理观察

Twin pregnancy consisting of a complete hydatidiform mole and coexistent fetus:a clinicopathological analysis

目的探讨双胎之一完全性葡萄胎与胎儿共存的病理特征及临床意义。方法分析3例双胎之一完全性葡萄胎与胎儿共存的临床资料、大体形态、组织学表现、免疫组化染色及荧光原位杂交结果,结合相关文献,探讨其临床病理特征和鉴别诊断。结果 3例孕周分别为11周、14周和35周。3例大体检查均显示为两个分离的组织,一个为正常胎盘,一个为葡萄胎。正常胎盘绒毛发育良好,葡萄胎绒毛水肿。免疫组化示两部分的绒毛对p57,p53,Ki-67呈不同的表达。荧光原位杂交显示葡萄胎绒毛的细胞滋养细胞为二倍体。结论双胎之一完全性葡萄胎与胎儿共存病例较为罕见,正确诊断对预后有重要临床意义。免疫组化p57和荧光原位杂交对诊断有帮助。

Objective To explore the pathologic characteristics and clinical significance of twin pregnancy consisting of a complete hydatidiform mole and coexistent fetus.Methods The clinical presentation,gross morphology,microscopic appearance,immunohistochemical staining,fluorescence in situ hybridization （FISH） results were analyzed in 3 cases and related literature was reviewed,and the clinicopathological features and differential diagnosis were discussed.Results In the 3 cases,the gestational age was 11 weeks,14 weeks and 35 weeks,respectively.On gross,two distinct masses were identified in 3 cases：one exhibited a normal placenta and the other exhibited a complete hydatidiform mole.On microscopic examination,the normal placenta showed well-developed chorionic villi,the complete hydatidiform mole showed hydropic villi.Immunohistochemical staining showed different expression of P57,P53,and Ki67 in two part mole.Fluorescence in situ hybridization （FISH） detected the diploid karyotype of cytotrophoblastic cells in complete hydatidiform moles.Conclusions Twin pregnancy consisting of a complete hydatidiformmole and coexistent fetus is rare.Correct diagnosis plays an important role in clinical treatment,prognostic evaluation and follow-up.The application of immunohistochemistry for p57 and fluorescence in situ hybridization can be help in diagnosis.