CXCL12/CXCR4 Expression in Trophoblasts Takes Part in Materno-fetal Immune Tolerance and Vascular Remodeling

Summary： In this study, we investigated the expression of CXCL12 （SDF-1）/CXCR4 in trophoblasts and the role they play in the gestation. Immunochemistry was used to detect the expression of CXCR4 and CXCLI 2 in human villi and placenta. Highly purified extra-viUous trophoblasts （EVTs） ere detected for CXCR4 and CXCL12 in vitro by immunocytochemistry. The chemotaxis of CXCL12 was tested in transweU and the chemotactic activity was quantitatively examined. It was suggested that both CXCR4 and CXCL12 were expressed in trophoblasts and were decreased with the gestation time P〈0.05）. In a certain coverage, CXCL12 exhibited chemotactic activity which was positively correlated with its concentration [（r）=0.68, P〈0.01], the maximum chemotactic index （CI） was 1.62±0.12. Our results suggest that interaction between CXCR4 and CXCL12 is involved in materno-fetal immunological tolerance in all three trimesters of gestation and contributes to the invasion of EVTs during pregnancy.

Effect of Different Concentrations of Neogenin on Proliferation,Apoptosis and Related Proliferative Factors in Human Trophoblasts

The underlying effect of different concentrations of neogenin on proliferation, apoptosis and the related proliferative factors in human trophoblasts was explored in order to understand the function of neogenin during placentation. TEV-1 cell line was cultured and the expression of netrin-1 was detected by using indirect cellular immunofluorescence. Exponentially growing TEV-1 cells were treated by different concentrations of neogenin (0, 1, 5, 10, 50 ng/mL) for 24 h. Cell viability was measured by 3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay. TEV-1 cell apoptosis was assessed by flow cytometry (FCM). The expression of netrin-1 mRNA and protein in TEV-1 cells was examined by using real-time PCR and Western blot, respectively. It was found that immunoreactivity for netrin-1 was observed in cytoplasm of the trophoblasts. Immediately after treatment with different concentrations of neogenin for 24 h, the netrin-1 expression began to increase. Real-time PCR revealed that the expression level of netrin-1 mRNA was 37.59±10.25 times higher than control group when TEV-1 cells were exposed to 50 ng/mL neogenin (P<0.01), and the same tendency was seen by using Western blot. MTT results showed that proliferation of TEV-1 cells was independent of neogenin. Meanwhile, apoptosis was significantly increased to (22.15±6.15)% at 50 ng/mL neogenin and (6.55±0.25)% without neogenin (P<0.01). It is suggested that neogenin regulates proliferation and apoptosis of TEV-1 cells. And it can enhance the ability of TEV-1 cells to express netrin-1 in a dose-dependent manner. Neogenin may play an important biological role in the normal human pregnancy and contribute to the physiological pregnancy process.

Increased Apoptosis in Chorionic Trophoblasts of Human Fetal Membranes with Labor at Term

Objective: To determine the association of apoptosis in the layers of human fetal membranes distal to rupture site with labor at term. Study Design: Fetal membranes were collected from elective cesarean sections (n = 8) and spontaneous vaginal deliveries (n = 8) at term. The extent of apoptosis within fetal membrane layers was determined using terminal deoxynucleotidyl transferase deoxy-UTP-nick end labeling (TUNEL) assay and western blots for pro-apoptotic active caspase-3 and anti-apoptotic Bcl-2. Results: Apoptotic index in chorionic trophoblasts of membranes distal to rupture site obtained after vaginal delivery was 3-fold higher than those obtained from elective cesarean (11.57% ± 4.98% and 4.05% ± 2.4% respectively;p = 0.012). The choriodecidua layers after vaginal deliveries had higher expression of the pro-apoptotic active caspase-3 and less expression of the anti-apoptotic Bcl-2 than those obtained from elective cesarean sections. Conclusions: Labor at term is associated with increased apoptosis in chorionic trophoblast cells of human fetal membranes distal to rupture site.

Upregulation of sFlt-1 by Trophoblasts Induces the Barrier Dysfunction of Glomerular Endothelial Cells

This study examined the effect of over-expression of sFlt-1 by trophoblasts on the barrier function of glomerular endothelial cells and the role of VEGF in this process in order to explore the pathogenesis of glomerular disease in preeclampsia. SFlt-1 expression in the human trophoblasts （TEV-1 cells） was enhanced by transfecting sFlt-1 plasmid DNA into TEV-1 cells. The monolayer barrier fimction of glomerular endothelial cells （ciGEnCs） was determined by measuring the fluorescence intensity of bovine serum albumin （BSA） that crossed the monolayer of glomerular endothelial cells. The results showed that the over-expression of sFlt-1 by TEV-1 cells led to the barrier dysfunction of ciGEnCs, and the exogenous VEGF could alleviate the ciGEnCs dysfunction resulting from the over-expression of sFlt- 1 to a certain extent. It was concluded that the dysregulation of sFlt- 1 and VEGF in preeclamptic pregnancy may contribute to the barrier dysfunction of glomerular endothelial cells, and VEGF may play an important role in maintaining the barrier function of glomerular endothelial cells, but it may not be the sole factor.

Impact of Silencing MMP9 Gene on the Biological Behaviors of Trophoblasts

This study examined the effect of MMP9 gene on the biological behaviors of trophoblasts and explore the relation between MMP9 gene and the ＂superficial implantation of placenta＂. In vitro cultured trophoblasts （TEV-1 cells） were transfected with synthesized double-stranded MMP9 RNA （siRNA） by using lipofectamine2000TM technique and the expressions of MMP9 mRNA and protein and the growth and invasiveness of the TEV-1 cells were determined. Our results showed that siRNA transfection could significantly inhibit the expression of MMP9 gene in the TEV-1 cells and the growth and invasiveness of the TEV-1 cells transfected RNA was significantly reduced （P0.01）. We are led to conclude that silencing of MMP9 gene with siRNA can inhibit the growth and invasiveness of trophoblasts and increasing the expression of MMP9 might help prevent and treat preeclampsia.

Uterine epithelioid trophoblastic tumor with the main manifestation of increased human chorionic gonadotropin:A case report

BACKGROUND Epithelioid trophoblastic tumor(ETT)is an extremely rare malignant gestational trophoblastic neoplasm commonly presenting with abnormal vaginal bleeding,abdominal pain,and increased human chorionic gonadotropin(hCG).This study reported a case of uterine ETT with the main manifestation being increased hCG.CASE SUMMARY A 39-year-old female was referred to the Ningbo Maternal and Child Hospital of China in December 2022,complaining of increased hCG levels for 1 month.Magnetic resonance imaging revealed gestational trophoblastic tumor,and hysteroscopic electrotomy and curettage of intrauterine hyperplasia were performed.The patient was diagnosed with uterine ETT through postoperative pathological examination and immunohistochemical results.Total laparoscopic hysterectomy and bilateral salpingectomy were performed,and hCG levels returned to normal.The patient was without recurrence during the postoperative 3-month follow-up.CONCLUSION This study reported a case of uterine ETT with the main manifestation being increased hCG,highlighting that ETT should be considered in the presence of abnormal hCG.A total laparoscopic hysterectomy is recommended.

胶艾汤对模拟特发性流产的线粒体调控作用机制

目的:探究胶艾汤对模拟特发性流产的线粒体调控作用机制。方法:细胞实验设置对照组、胶艾汤组、miR-29α-3p模拟物组、胶艾汤+miR-29α-3p模拟物组,对人绒毛膜滋养层细胞HTR-8/SVneo进行培养和处理,检测miR-29α-3p表达、线粒体凋亡、细胞色素C释放、凋亡相关蛋白表达、细胞迁移和侵袭能力。动物实验选用怀孕的C57BL/6J小鼠建立流产模型,分组进行胶艾汤灌胃治疗和miR-29α-3p模拟物腹腔注射治疗,观察流产情况、胎盘组织学变化、miR-29α-3p表达、线粒体凋亡相关指标。结果:细胞实验中,与对照组相比,胶艾汤组里miR-29α-3p的表达水平于48 h明显提升(P<0.001),miR-29α-3p模拟物组的表达水平也显著高于对照组,而胶艾汤+miR-29α-3p模拟物组的表达水平最高。胶艾汤和miR-29α-3p模拟物能够降低线粒体膜电位变化,减少细胞色素C的释放,调节凋亡相关蛋白(Bax表达降低,Bcl-2表达升高,Caspase-3活性降低)的表达,使其向抗凋亡方向转变,从而抑制线粒体凋亡,联合使用时效果更优。胶艾汤和miR-29α-3p模拟物还能够促进细胞的迁移和侵袭能力,联合使用时效果更为显著。动物实验中,流产模型组的流产率较高,为(31.17±0.67)%;胶艾汤治疗组的流产率降低至(13.30±0.36)%;胶艾汤+miR-29α-3p模拟物组的流产率进一步降低至(5.77±0.36)%(P<0.001)。胶艾汤治疗组胎盘组织的形态和结构得到改善,滋养层细胞的损伤减轻;胶艾汤+miR-29α-3p模拟物组胎盘组织的损伤程度更轻,滋养层细胞形态基本正常。胶艾汤治疗组与胶艾汤+miR-29α-3p模拟物组在胎盘组织中miR-29α-3p的表达水平提升,而且胶艾汤+miR-29α-3p模拟物组的表达水平更高。胶艾汤治疗组和胶艾汤+miR-29α-3p模拟物组胎盘组织中Bax表达降低(P<0.01),Bcl-2表达升高(P<0.001),Caspase-3活性降低(P<0.01)。结论:胶艾汤能够上调miR-29α-3p的表达,调控线粒体凋亡,干预滋养层细胞侵袭迁移,降低流产发生风险,miR-29α-3p在其中发挥重要作用。

高危耐药及复发妊娠滋养细胞肿瘤诊疗现状

妊娠滋养细胞肿瘤(gestational trophoblastic neoplasia,GTN)可根据国际妇产科联盟临床分期及预后评分系统将患者分为低危和高危两大类,其中高危患者具有较高的单药化疗耐药风险,应首选联合化疗。然而,仍有部分高危患者在联合化疗后出现耐药或在治愈后复发,此类患者异质性强,后续治疗难度大,近年来受到研究者广泛关注。本文就高危耐药及复发GTN患者的危险因素及治疗策略进行综述,以期为早期识别高风险患者及其精准治疗提供依据。

毛兰素调节RhoA/Rho相关卷曲螺旋蛋白激酶信号通路对高糖诱导的滋养层细胞损伤的影响

目的 探讨毛兰素对高糖诱导的滋养层细胞损伤的影响及对RhoA/Rho相关卷曲螺旋蛋白激酶信号通路的调节作用。方法 通过体外培养人胎盘绒毛滋养层细胞HTR-8/SVneo,建立高糖诱导的HTR-8/SVneo细胞损伤模型;MTT法筛选实验用毛兰素浓度;将HTR-8/SVneo细胞分为正常组、高糖组、毛兰素组、毛兰素+Y27632组;CCK8实验检测各组HTR-8/SVneo细胞活力;Transwell检测各组HTR-8/SVneo细胞侵袭;划痕实验检测各组HTR-8/SVneo细胞迁移;试剂盒检测各组HTR-8/SVneo细胞氧化应激指标[乳酸脱氢酶(LDH)、超氧化物歧化酶(SOD)、丙二醛(MDA)]变化;Western blot检测各组HTR-8/SVneo细胞中RhoA、Rho相关卷曲螺旋蛋白激酶1(ROCK1)、基质金属蛋白酶-2(MMP2)、Ki67蛋白表达。结果 确定本文用毛兰素浓度为50 nmol/L;与正常组相比,高糖组HTR-8/SVneo细胞OD450值、侵袭数量、划痕愈合率、SOD活性、RhoA、ROCK1、MMP2、Ki67蛋白水平显著降低(P<0.05),MDA水平、LDH活性显著升高(P<0.05);与高糖组相比,毛兰素组HTR-8/SVneo细胞OD 450值、侵袭数量、划痕愈合率、SOD活性、RhoA、ROCK1、MMP2、Ki67蛋白水平显著升高(P<0.05),MDA水平、LDH活性显著降低(P<0.05);与毛兰素组相比,毛兰素+Y27632组HTR-8/SVneo细胞OD 450值、侵袭数量、划痕愈合率、SOD活性、RhoA、ROCK1、MMP2、Ki67蛋白水平显著降低(P<0.05),MDA水平、LDH活性显著升高(P<0.05)。结论 毛兰素可能通过激活RhoA/ROCK信号通路减轻高糖诱导的滋养层细胞损伤,恢复损伤滋养层细胞活力、侵袭和迁移。

妊娠滋养细胞肿瘤膀胱受侵破裂保留生育功能一例

妊娠滋养细胞肿瘤(gestational trophoblastic neoplasia,GTN)是一组与妊娠相关、起源于胎盘滋养细胞的恶性肿瘤。随着医学不断发展,GTN相关并发症已较少见,而膀胱受侵破裂等严重的并发症更为少见。报告1例GTN膀胱受侵破裂经子宫局部病灶切除术、子宫修补术、膀胱修补术及联合化疗后预后良好,成功保留生育功能的病例。提示临床对于年轻、未生育、无耐药表现的子宫病灶出血及转移灶破裂的GTN患者,切不可操之过急切除子宫,止血及化疗是关键。

Challenges in the diagnosis and treatment of gestational trophoblastic neoplasia worldwide

Gestational trophoblastic neoplasia(GTN) is a rare tumor that originates from pregnancy that includes invasive mole, choriocarcinoma(CCA), placental site trophoblastic tumor and epithelioid trophoblastic tumor(PSTT/ETT). GTN presents different degrees of proliferation, invasion and dissemination, but, if treated in reference centers, has high cure rates, even in multi-metastatic cases.The diagnosis of GTN following a hydatidiform molar pregnancy is made according to the International Federation of Gynecology and Obstetrics(FIGO)2000 criteria: four or more plateaued human chorionic gonadotropin(hCG)concentrations over three weeks; rise in hCG for three consecutive weekly measurements over at least a period of 2 weeks or more; and an elevated but falling hCG concentrations six or more months after molar evacuation. However,the latter reason for treatment is no longer used by many centers. In addition,GTN is diagnosed with a pathological diagnosis of CCA or PSTT/ETT. For staging after a molar pregnancy, FIGO recommends pelvic-transvaginal Doppler ultrasound and chest X-ray. In cases of pulmonary metastases with more than 1cm, the screening should be complemented with chest computed tomography and brain magnetic resonance image. Single agent chemotherapy, usually Methotrexate(MTX) or Actinomycin-D(Act-D), can cure about 70% of patients with FIGO/World Health Organization(WHO) prognosis risk score ≤ 6(low risk), reserving multiple agent chemotherapy, such as EMA/CO(Etoposide,MTX, Act-D, Cyclophosphamide and Oncovin) for cases with FIGO/WHO prognosis risk score ≥ 7(high risk) that is often metastatic. Best overall cure rates for low and high risk disease is close to 100% and > 95%, respectively. The management of PSTT/ETT differs and cure rates tend to be a bit lower. The early diagnosis of this disease and the appropriate treatment avoid maternal death,allow the healing and maintenance of the reproductive potential of these women.

Effect of hypoxia on expression of placental trophoblast cells SATB1 and β-catenin and its correlation with the pathogenesis of preeclampsia

Objective: To study the effect of hypoxia on the expression of placental trophoblast cells SATB1 and β-catenin and its correlation with the pathogenesis of preeclampsia. Methods: Trophoblastic cell lines HRT8/SVneo were cultured, SATB1 and β-catenin expression and cell biological behavior were determined after hypoxia reoxygenation treatment; cell biological behavior and the expression of related genes were determined after the transfection of SATB1 and β-catenin siR NA; preeclampsia placenta and normal placenta tissues were collected and the expression of SATB1 and β-catenin were determined. Results: OD value, cell migration rate, m RNA contents of SATB1 and β-catenin of H/R group were significantly lower than those of Nor group, cell apoptosis rate was higher than that of Nor group and the number of invasive cells was less than that of Nor group; OD value and bcl-2 mRNA content of SATB1-siRNA group were lower than those of NC group; cell apoptosis rate as well as Bax, Caspase-3, caspase-6 and caspase-9 mRNA contents were higher than those of NC group; cell migration rate as well as CTSB, CTSD, MMP2 and MMP9 mRNA contents of β-catenin-siRNA group were lower than those of NC group; the number of invasive cells was less than that of NC group; the expression levels of SATB1 and β-catenin in preeclampsia placenta tissue were significantly lower than those in normal placenta tissue. Conclusions: Hypoxia can inhibit the expression of SATB1 and β-catenin in the pathogenesis of preeclampsia, which can affect the proliferation, apoptosis, migration and invasion of cells.

四倍体部分性水泡状胎块2例临床病理分析并文献复习

目的探讨四倍体部分性水泡状胎块(PHM)临床特征、病理形态学特点、发病机制及临床管理方式。方法收集2例四倍体PHM,分析其临床特征、病理形态学、免疫组织化学表型及分子遗传学机制,并复习相关文献。结果2例女性患者年龄分别28岁和30岁,孕早期流产。例1超声示妊囊内未见胚芽,妊囊周围探及散在多个无回声区;例2超声示妊囊内见一细小胚芽,未见心管搏动。例1肉眼观察见水泡状绒毛,最大径0.1~0.3 cm;例2肉眼观察未见水泡状绒毛。2例镜下观察均有绒毛大小不一、轮廓不规则,绒毛不同程度水肿伴中央水池形成,滋养细胞轻度增生,细胞异型性不明显,绒毛间质细胞增生、可见核碎屑及滋养层细胞包涵体,未见绒毛间质纤维化,未见有核红细胞及胚胎成分,其中例1绒毛滋养层细胞基底膜下可见线性矿物质沉积,例2绒毛间质可见黏液样背景。免疫组织化学表型均为p57阳性,阳性率分别为10%~40%、10%~50%;Ki-67阳性率较高,分别为60%~80%和60%~90%。短串联重复序列(STR)基因分型均为四倍体PHM,父本与母本等位基因比例为3∶1,父本等位基因来自2个精子,其中1个精子卵内复制。性染色体FISH检测为XXYY、XXXX。2例行清宫术后分别随访1年、10个月均未发生持续性妊娠滋养细胞疾病。结论四倍体PHM比较少见,临床病理特征不典型,确诊依赖于STR基因分型。

Expression and Immune Effect of Toll-Like Receptor 4 in Human Trophoblast Cells

This study investigated the expression and immune effect of TLR4 in human trophoblast cells. The expression level of TLR4 mRNA in normal and LPS-stimulated human term trophoblast cells （1 mg/L LPS, 12 h） was detected by RT-PCR. In LPS-stimulated human term trophoblast cells of TLR4-blocked group and non-TLR4-blocked group, and normal term trophoblast cells of blank control group, apoptosis rate was measured by flow cytometry （FCM）, and the level of TNF-α determined by using enzyme linked immunosorbent assay （ELISA） respectively. RT-PCR results showed that the expression level of TLR4 mRNA in LPS-stimulated human trophoblast cells was significantly higher than that in normal cells （P〈0.01）. FCM revealed that there was significant difference in apoptosis rate of LPS-stimulated human term trophoblast cells between TLR4-blocked group and non-TLR4-blocked group （P〈0.05）, or between TLR4 antibody-blocked group and blank control group. ELISA indicated that the level of TNF-α in LPS-stimulated human trophoblast cells also had statistical differences between TLR4 antibody-blocked group and non-TLR4 antibody-blocked group （P〈0.05）. Our results suggest that TLR4 plays an important role in the immunological mechanism of apoptosis and secretion of TNF-α of human term trophoblast cells stimulated by LPS.

IL-24 Expression at Maternal-fetal Interface and Its Roles in Trophoblast Invasion

In this study, the expression of IL-24 at maternal-fetal interface and the roles in extravillous trophoblast （the TEV-1 cell line） invasion were examined. Immunohistochemistry was used to detect the expression of IL-24 in villi and decidual tissue. The proliferation of TEV-1 cells under the effect of IL-24 was measured by MTT assay. The invasiveness of TEV-1 cells under the effect of recombinant IL-24 （rhIL-24） was examined by transwell system. Immunohistochemical detection showed that IL-24 was expressed in the villi and decidual tissue, and distributed in villous column, trophoblasts, stroma and blood vessels. The proliferation of TEV-1 cells was not inhibited by rhIL-24 of various concentrations. The examination of invasion in vitro showed that rhIL-24 could inhibit the invasion of TEV-1 cells in a concentration-dependent manner. The results suggested IL-24 could inhibit the invasion of TEV-1 cells. Therefore, IL-24 produced by maternal-fetal interface in human first trimester pregnancy may influence the invasion of trophoblasts and is involved in normal pregnancy.

Effects of maternal diabetes on trophoblast cells

Diabetes mellitus(DM)is a health condition characterized by hyperglycemia over a prolonged period.There are three main types of DM:DM type 1(DM1),DM2 and gestational DM(GDM).Maternal diabetes,which includes the occurrence of DM1 and DM2 during pregnancy or GDM,increases the occurrence of gesttional complications and adverse fetal outcomes.The hyperglycemic intrauterine environment affects not only the fetus but also the placental development and function in humans and experimental rodents.The underlying mechanisms are still unclear,but some evidence indicates alterations in trophoblast proliferation,apoptosis and cell cycle control in diabetes.A proper coordination of trophoblast proliferation,differentiation and invasion is required for placental development.Initially,increased expression of proliferative markers in junctional and labyrinth zones of rat placentas and villous cytotrophoblast,syncytiotrophoblast,stromal cells and fetal endothelial cells in human placentas is reported among diabetics.Moreover,reduced apoptotic index and expression of some apoptotic genes are described in placentas of GDM women.In addition,cell cycle regulators including cyclins and cyclin-dependent kinase inhibitors seem to be affected by the hyperglycemic environment.More studies are necessary to check the balance between proliferation,apoptosis and differentiation in trophoblast cells during maternal diabetes.

Tissue factor expression and methylation regulation in differentiation of embryonic stem cells into trophoblast

Objective:To explore tissue factor(TF)expression and methylation regulation in differentiation of human embryonic stem cells(hESCs)into trophoblast.Methods:Differentiation of hESCs into trophoblast was induced by bone morphogenetic protein 4(BMP4).Expression of gene,protein of TF and DNA methylation at different time points during induction process was detected by RTPCT,Western blot,flow cytometry and MSP-PCR method.Results:The expression of mRNA,protein level of TF could be detected during directional differentiation of hESCs to trophoblast cells,semi methylation-semi non methylation expression appeared at TF DNA promoter region,and it showed decreased methylation level and increased non methylation level with formation of trophoblast cell and increased expression of TF.Conclusions:It shows that during differentiation of hESCs into trophoblast,the differential expression of TF is related with DNA methylation level,and it is changed with the methylation or non methylated degree.It provids new platform to furtherly explore the regulation mechanisms of specific expression of tissue factor in the process of the embryonic stem cell development.

THE ROLE OF HYSTERECTOMY IN THE THERAPY OF GESTATIONAL TROPHOBLASTIC TUMOR

To evaluate the role of hysterectomy for patients with gestational trophoblastic tumor. [WT5”BX]Methods.[WT5”BZ]We retrospectively analyzed 68 cases of gestational trophoblastic neoplasia treated by hysterectomy from 1985～1997 at PUMC hospital. Thirty eight cases were diagnosed of choriocarcinoma and 30 were invasive mole. [WT5”BX]Results.[WT5”BZ]Twenty three elder patients who didn’t desire to preserve fertility were selected for hysterectomy after shorter courses of chemotherapy, 22 of them had a complete remission(95 6%), the total aver age courses of chemotherapy was 4 2. Of twenty seven chemorefractory cases who were suspected of a refractory isolated lesion in the uterus, delayed hysterectomy as an adjunct to chemotherapy was performed, 20 of them got a complete remission(74 1%), the total average courses of chemotherapy were 9 4. Emergency hysterectomy is indicated in 18 patients with uterine perforation or life threatening hemorrhage, 17 cases had a complete remission(94 4%), the total average courses of chemotherapy were 7 6. [WT5”BX]Conclusion.[WT5”BZ]Although the development of effective chemotherapy has resulted in improved survival of patients with gestational trophoblastic tumor, hysterectomy remains an important adjuncts in the treatment of a selected subset of patients; in order to operate more completely and prevent recurrence, it’s better to perform extended hysterectomy for the indicated patients.

EXPRESSION OF P53 PROTEIN AND PROLIFERATING CELL NUCLEAR ANTIGEN IN HUMAN GESTATION TROPHOBLASTIC DISEASE

To study the relationship between p53 protein, proliferating cell nuclear antigen (PCNA) expression and benign or malignant gestational trophoblastic disease (MGTD). Methods: The histotomic sections of 48 patients with gestational trophoblastic disease and 24 patients of normal chorionic villi were stained using immunohistochemistry. The monoclonal antibodies were used to determine p53 protein and PCNA. Results: The frequency of p53 and PCNA positive expression were significantly different among the chorionic villi of normal pregnancy, hydratidiform mole (HM) and MGTD. But neither p53 nor PCNA has any relation with the clinical staging or metastasis of MGTD. Conclusion: Both P53 and PCNA are valuable in diagnosis of human gestational trophoblastic disease.

A COMPARATIVE STUDY OF TRANSVAGINAL ULTRASONOGRAPHY AND PELVIC ARTERIOGRAM IN ASSESSMENT OF PATIENTS WITH GESTATIONAL TROPHOBLASTIC TUMOUR

Objective:To compare the reliability of transvaginal ultrasonography with pelvic arteriography in the assessment of patients with gestational trophoblastic disease. Methods. Transvaginal ultrasonography was performed in 24 patients with gestational trophoblastic tumour. Within one week after ultrasound investigation, pelvic arteriography was carried out in each patient. Of 24 cases, 16 patients hadn’t been treated by chemical reagent, 5 had accepted 2 to 5 courses of chemotherapy, and 3 had achieved complete remission before both investigations performed. Results. In 3 patients with complete remission, 2 had no evidence of abnormal findings either on transvaginal ultrasonography or on pelvic arteriography, 1 showed intramyometrial lesions by both methods. In the remaining 21 patients, all demostrated a abnormal uterine image, and 5 of them accompanied with the finding of parametrium metastatic signs by transvaginal ultrasonography; these abnormal results were confirmed by pelvic arteriographic imaging. However, in two cases without clinical and ultrasonic signs of parametrium metastasis, pelvic arteriography indicated the early metastasis of parametrium ves- sels. Conclusions. Even though it is difficult to predict the early parametrium metastasis in patients with gestational trophoblastic disease by B-ultrasonic investigation, our data would support the introduction of transvaginal ultrasonography in the diagnosis and evaluation of gestational trophoblastic tumour.