P57免疫组化结合CEP17倍体分析在葡萄胎鉴别诊断中的作用

Application of P57 immunohistochemistry and CEP17 ploidy analysis in differential diagnosis of hydatidiform mole

目的探讨P57免疫组化结合CEP17倍体分析在葡萄胎鉴别诊断中的意义。方法收集乌鲁木齐市妇幼保健院病理科45例完全性葡萄胎,25例部分性葡萄胎及25例水肿性流产标本,运用免疫组化进行P57检测和FISH技术进行CEP17的倍体检测。进一步分析P57免疫组化结合CEP17倍体分析在葡萄胎鉴别诊断中的意义。结果 P57蛋白在部分性葡萄胎和水肿性流产组织中主要分布在绒毛的细胞滋养细胞和间质细胞中,阳性表达比例分别为100%(25/25)和100%(25/25);但在绝大部分完全性葡萄胎中滋养细胞和间质细胞中P57表达缺失。P57在完全性葡萄胎中的阳性表达率为4.4%(2/45),与部分性葡萄胎(χ2=61.9,P<0.05)和水肿性流产比较(χ2=61.9,P<0.05),存在统计学差异。FISH分析结果显示:在水肿性流产中90.9%病例为CEP17二倍体(20/22);部分葡萄胎中87.0%病例为CEP17三倍体(20/23);在完全性葡萄胎中97.7%的病例为CEP17二倍体(42/43)。统计学分析结果显示:部分性葡萄胎三倍体的发生率明显高于水肿性流产(χ2=27.3,P<0.05)及完全性葡萄胎(χ2=49.6,P<0.05)。结论 P57免疫组化结合CEP17倍体分析对完全性葡萄胎,部分性葡萄胎和水肿性流产的鉴别诊断中具有重要的作用。

Objective To investigate the significance of P57 immunohistochemistry and CEP17 ploidy analysis in differential diagnosis of hydatidiform mole （HM）. Methods The tissues amples, including 45 cases of complete hydatidiform mole （ CHM）, 25 cases of partial hydatidiform mole （PHM） and 25 cases of hydropic abortuses （HA） , were collected from Urumqi Maternal and Child Health Hospital. The P57 expression and CEP17 ploidy analysis were analyzed using immunohistochemistry and fluorescence in situ hybridization FISH techniques, respectively. The significance of combining P57 immunohistochemistry and CEP17 ploidy analysis in the differential diagnosis of HM was further explored. Results P57 protein expression in PHM and HA was mainly in villous eytotrophoblast cells and stromal cells, and their rates of positive expression were 100% （25/25）. But P57 expression was absent in cytotrophoblast cells and stromal cells in most CHM, and the positive expression rate was 4.4% （2/45） , which was statistically different from that in PHM and HA （χ2 = 61.9, both P 〈0.05）. FISH analysis showed that CEP17 was diploid of CEP17 in 90.9% HA cases. In PHM cases, 87.0% （20/23） showed triploid of CEP17, and in CHM cases, 97.7% （42/43） showed diploid of CEP17. Statistical analysis showed that the incidence of triploid in PHM cases was significantly higher than in HA cases （χ2 = 27.3, P 〈 0.05 ） and CHM cases （χ2= 49.6, P 〈 0.05）. Conclusion The combined analysis of P57 immunohistochemistry and CEP17 ploidy plays an important role in the differential diagnosis of CHM, PHM and HA.