Termination of a partial hydatidiform mole and coexisting fetus: A case report

BACKGROUND We describe the treatment strategy for a patient who was found to have a partial hydatidiform mole and coexisting fetus(PHMCF)during the second trimester.The patient was a 38-year-old Chinese woman who had become pregnant following in vitro fertilization and embryo transplantation.We wanted to determine the safest therapeutic strategy to terminate the PHMCF during the second trimester.CASE SUMMARY In this case,we present a patient who was found to have a PHMCF complicated with serious continuous vaginal bleeding and pre-eclampsia during the second trimester.After careful evaluation,the pregnancy was considered to be unsustainable and was terminated via caesarean section(CS).An infant with weak vital signs and a partially cystic placenta measuring 110 mm×95 mm×35 mm were delivered by CS.The patient was discharged after 4 d.The serum levels ofβ-human chorionic gonadotropin decreased to within a normal range 5 wk after the operation,and no evidence of persistent trophoblastic disease or lung metastases was noticed at the 6-mo follow-up.CONCLUSION CS termination of PHMCF during the second trimester may be a relatively safe therapeutic strategy.

Single Nucleotide Polymorphism-Based Chromosomal Microarray Evaluation of Hydatidiform Moles: A US National Reference Laboratory Experience

Objectives: This retrospective study evaluated 1) benefits of single nucleotide polymorphism (SNP)-based chromosomal microarrays (CMAs) in the diagnosis of complete hydatidiform mole (CHM) and partial HM (PHM) in products of conception (POC) and amniotic fluid (AF) specimens, and 2) frequency of whole-genome uniparental disomy (wgUPD) and triploidy in POC and AF specimens received at a US national reference laboratory. Methods: We reviewed consecutive 2138 POC and 3230 AF specimens and identified the cases with wgUPD and triploidy which are associated with molar pregnancy. Results: Of 2138 consecutive POC specimens tested, SNP-based CMA detected wgUPD in 10 (0.47%) and triploidy in 84 (3.93%). Of the 10 wgUPD cases, 9 (90%) were confirmed as CHM. Of 3230 consecutive AF specimens, the array detected wgUPD in 1 case (0.03%) and triploidy in 11 (0.34%). Conclusions: SNP-based microarray allows detection of wgUPD in POC and AF specimens at a US national reference laboratory. Correctly diagnosing HM and differentiating CHM from PHM are important for clinical management. The effective SNP-based CMA detection of wgUPD in CHM may enable physicians to monitor patients at risk for gestational trophoblastic disease and neoplasm. Conventional chromosome analysis of POC has a high failure rate, cannot be performed on formalin-fixed paraffin embedded samples, and cannot detect wgUPD. Further multi-institutional collaborative assessmen on accuracy, cost-effectiveness, and adequate access to SNP-based CMA, may lead this testing platform to be considered as the first-tier analysis tool for POC specimens, including those showing PHM or CHM.

PAPP-A与P对PHM和稽留流产的早期诊断意义

目的探讨血清孕酮(P)和妊娠相关蛋白-A(PAPP-A)在早期诊断部分性葡萄胎和稽留流产中早期诊断的价值。方法选择确诊的部分性葡萄胎患者20例及稽留流产患者30例,用酶联免疫吸附法检测血清P、PAPP-A水平。结果与宫内早孕组比较,部分性葡萄胎和稽留流产组血清P和PAPP-A水平低于宫内早孕组,差异有统计学意义(P<0.05),部分性葡萄胎组和稽留流产组之间比较,差异无统计学意义(P>0.05);同一孕周时,正常宫内早孕者血清PAPP-A的含量高于部分性葡萄胎患者,且差异有统计学意义(P<0.05)。结论血清孕酮、妊娠相关血浆蛋白A检测有助于部分性葡萄胎和稽留流产的早期诊断。

部分性葡萄胎的超声诊断价值及漏误诊分析

目的通过分析部分性葡萄胎(partial hydatidiform mole,PHM)的二维及彩色多普勒超声(CDFI)声像图特征,探讨超声检查技术在部分性葡萄胎诊断中的临床应用价值及漏误诊原因分析。方法选取本院收治经病理确诊的45例部分性葡萄胎患者临床资料,并与其超声检查结果对比分析。结果45例中超声检查诊断完全正确39例(86.7%);漏诊2例(4.4%),分别为PHM合并21三体胎儿1例、染色体正常胎儿1例;误诊4例(8.8%),分别误诊为稽留流产、不全流产、异位妊娠、胎盘血管瘤。结论超声检查技术是诊断妊娠滋养细胞疾病的首选检查方法,能较为准确检出部分性葡萄胎,对临床诊断、治疗具有指导意义。但不典型者仍需要结合患者临床表现、血β-HCG值作进一步综合诊断,以提高诊断准确率。

Twin pregnancy and partial hydatidiform mole following in vitro fertilization and embryos transfer： a novel case of placental mosaicism

Twin pregnancy with mosaic partial hydatidiform mole （PHM） and survival of two healthy fetuses following in vitro fertilization and embryos transfer （IVF-ET） is a rare situation and is considered a challenge for management. A 32-year-old Chinese woman conceived twin pregnancy following IVF-ET. At 22 weeks＇ gestation, an additional intrauterine echogenic mass with features of PHM were shown by successive ultrasound examinations. At 35 weeks＇ gestation, two live male infants and two placentas were delivered by caesarean section （CS）. Histologic examination of the abnormal placenta confirmed mosaic PHM. Genetic study showed the abnormal placental mosaicism （expressed in molar-69XXY and normal vili-46XY）, co-existing with a hypospadia new-born （46XY） in one amniotic sac. However, the other one was normal. Serial serum β-hCG levels showed a declining trend and serum β-human chorionic gonadotropin （hCG） were undetectable at 6 months after delivery. The case demonstrated that it is possible to prolonged gestation by PHM under close surveillance during the entire pregnancy.

Analysis of p53 expression in partial hydatidiform mole and hydropic abortion

BACKGROUND： Gestational trophoblastic disease （GTD） is a heterogeneous group of disorders characterized by abnormal trophoblast tissue. Molar and non-molar hydropic placental changes are the most common forms of GTD. Differential diagnosis of GTD is sometimes problematic. Recently, p53 expression was identified as a good marker for distinguishing GTD types. ALMS： Comparison of p53 expression in partial hydatidiform mole （PHM） and hydropic abortion. METHODS： In this prospective cross-sectional study, molar and non-molar hydropic pregnancy specimens were collected. Immunohistochemical staining, based on the Labeled Streptavidin Biotin （LSAB） technique, was carried out on multiple 4 Ixm paraffin block sections prepared from formalin-fixed trophoblastic tissues. Polymer-based Envision was used to assess p53 tumor suppressor protein immunoreactivity, p53 expression was then compared between both groups. RESULTS： In the study, 40 patients were included： 20 with confirmed PHM and 20 with hydropic pregnancy, p53 protein was positive in 60% of patients with PHM and 25% of patients with hydropic pregnancy. The p53 positive rate was significantly higher in patients with PHM （p = 0.027）. Moreover, patients with PHM had a significantly high grade of staining （p 〈 0.001）. CONCLUSION： Our findings indicate that immunohistochemical analysis of p53 protein can be used to distinguish PHM and hydropic pregnancy.

印迹基因p57^kip2蛋白在水泡状胎块诊断和分型中作用

目的探讨p57kip2蛋白表达在水泡状胎块诊断和分型中的作用和意义。方法应用免疫组化SP法检测p57kip2蛋白30例在完全性水泡状胎块(complete hydatidiform moles,CHMs)、25例部分性水泡状胎块(partial hydatidiform mole,PHMs)和20例水泡状流产(hydropic abortions,HAs)三组病变中的表达情况,正常成熟胎盘(normal mature placentas,NMPs)为正常对照。结果p57kip2蛋白在10例NMPs、20例HAs组织中的细胞滋养层细胞、绒毛间质细胞和绒毛外滋养细胞团核表达阳性,合体滋养层细胞不表达;CHMs的绒毛间质细胞和细胞滋养层细胞p57kip2蛋白不表达,阳性表达仅见于绒毛外散在滋养细胞团中;25例CHMs的绒毛间质细胞和细胞滋养层细胞p57kip2均表达阳性。结论p57kip2蛋白在CHMs和PHMs的表达和分布有明显差异,可作为胎块分型诊断的客观辅助指标,值得在国内妇产科病理诊断常规工作中推广应用。

部分性葡萄胎58例临床分析

部分性葡萄胎５８例临床分析１００８５３北京解放军总医院赵秀云，傅才英摘要对５８例性葡萄胎进行了回顾性分析，主要表现为少量阴道出血及子宫小于孕龄。术前８２．８％误诊为过期流产，３例恶变为转移性恶葡，经治疗全部缓解。部分性葡萄胎可发生恶变，应严格随防血ｈ...

彩色多普勒超声对部分性葡萄胎的诊断价值

目的探讨彩色多普勒超声对部分性葡萄胎的诊断价值。方法常规经腹或阴道探查对36例超声诊断部分性葡萄胎病人与术后病理结果对照,分析其二维声像图特征及彩色多普勒检测结果。结果超声诊断部分性葡萄胎病人36例,病理结果符合30例,符合率为83.3%,6例误诊。其中13例患者的妊娠囊内可见死胎,2例可见活胎。31者胎盘组织中部分胎盘呈小蜂窝状液性暗区,或圆形及椭圆形液性暗区,5例胎盘组织仅表现为回声增强,稍增厚。部分性葡萄胎少见黄素化囊肿,本组患者仅5例可见单侧卵巢囊肿。结论用彩色多普勒超声检查在部分性葡萄胎诊断中具有重要作用。

P57^(kip2)蛋白表达与水泡状胎块分型的关系

目的探讨P57kip2蛋白在水泡状胎块分型诊断中的作用。方法完全性和部分性水泡状胎块分别为78和42例,应用免疫组织化学SP法检测其P57kip2蛋白表达情况。结果P57kip2蛋白在完全性水泡状胎块中表达主要呈弱阳性,在部分性水泡状胎块中以强阳性为主,在部分性水泡状胎块中的阳性率为(92.86%),显著高于完全性水泡状胎块(P<0.01)。结论检测水泡状胎块中P57kip2蛋白表达,有助于水泡状胎块的分型和判断预后。

几种特殊情况下葡萄胎的管理

葡萄胎是一类良性妊娠滋养细胞疾病,但有进一步发展为妊娠滋养细胞肿瘤的可能,被视为癌前病变。葡萄胎分为完全性葡萄胎和部分性葡萄胎,二者遗传病理学特征和恶变概率均不相同,现代分子诊断技术为其准确诊断和亚分类带来了可能。本文对极早期葡萄胎的鉴别诊断、预防性化疗后的葡萄胎、葡萄胎清宫术后6个月血人绒毛膜促性腺激素持续异常、葡萄胎合并肺结节的处理、复发性葡萄胎等特殊情况下葡萄胎的管理做一综述,以期为葡萄胎的精准诊治提供借鉴。

P57和Ki-67在葡萄胎鉴别诊断中的作用

目的:探讨P57和Ki-67蛋白在完全性和部分性葡萄胎鉴别诊断中的作用。方法:分别收集正常胎盘绒毛、部分性葡萄胎和完全性葡萄胎石蜡标本各12例,应用免疫组织化学方法检测P57和Ki-67蛋白在这些病变中的分布及表达水平。结果:P57蛋白在正常绒毛及部分性葡萄胎组织中主要分布于绒毛的细胞滋养叶细胞及间质细胞,两组间阳性率未见明显差异;而在完全性葡萄胎中细胞滋养叶细胞及间质细胞P57表达缺失。Ki-67蛋白主要表达于绒毛的细胞滋养叶细胞。正常绒毛组、部分性葡萄胎组和完全性葡萄胎组Ki-67阳性细胞百分率比较差别具有统计学意义(P<0.05)。结论:P57结合Ki-67免疫组织化学检测可有效鉴别完全性和部分性葡萄胎。

完全性葡萄胎与部分性葡萄胎P57KIP2表达分析

目的:检测P57KIP2在完全性葡萄胎(CHM)和部分性葡萄胎(PHM)中的表达差异。方法:对比分析33例CHM和32例PHM中P57KIP2蛋白免疫组化阳性表达率。结果:P57KIP2在CHM中表达阳性比例为0(0/33),在PHM中,P57KIP2阳性表达比例为84.4%(27/32),CHM与PHM的P57KIP2阳性表达率差异有统计学意义(P<0.01)。结论:P57KIP2免疫组化染色能够帮助鉴别诊断CHM和PHM,提高诊断准确率。

P57^(KIP2)对完全性葡萄胎和部分性葡萄胎的诊断意义

目的:探讨细胞周期抑制因子P57KIP2对早期葡萄胎诊断分类的作用。方法:采用免疫组化二步法检测P57KIP2在41例完全性葡萄胎、12例部分性葡萄胎和5例水肿流产组织中的表达。结果:P57KIP2在完全性葡萄胎和部分性葡萄胎中的表达,前者的滋养细胞和基质细胞阳性表达率分别为2.4%和2.4%,明显低于后者91.7%和100%(P<0.01),而两者的中间型滋养细胞阳性表达率分别为92.6%和91.7%,比较差异无统计学意义(P>0.05)。结论:P57KIP2基因的免疫组化分析有助于早期葡萄胎的诊断分类。

水泡状胎块中p57、p53及Ki-67的表达及意义

目的：探讨p57、p53和Ki-67的表达在水泡状胎块病理诊断与鉴别诊断中的作用和意义。方法：应用SP法检测74例完全性水泡状胎块（complete hydatidiform mole,CHM）、72例部分性水泡状胎块（partial hydatidiform mole,PHM）和79例水肿性流产胎（hydropic abortion,HA）三组病变组织中p57、p53和Ki-67的表达情况,以正常成熟胎盘（normal mature placenta,NMP）10例为正常对照。同时分析患者的年龄及血中HCG浓度在鉴别各组疾病中的价值。结果：p57在CHM组中的表达明显低于PHM组、HA组及NMP组（P〈0.01）;p53和Ki-67在PHM组和CHM组的阳性表达高于HA及NMP组（P〈0.05）。完全性水泡状胎块的发病高峰在21～25岁,部分性水泡状胎块发病高峰在25～30岁,水肿性流产胎发病高峰在30～35岁。PHM组患者血中β-HCG含量高于CHM组,CHM组又高于HA组。结论：Ki-67和p53的表达对于鉴别水泡状胎块与流产水肿绒毛有重要价值,但对于区别完全性与部分性水泡状胎块其价值有限;而p57蛋白在CHM和PHM的表达和分布有明显差异,可作为水泡状胎块分型诊断的客观辅助指标。HA、PHM和CHM的发病高峰在不同的年龄阶段,可作为辅助鉴别诊断的参考。患者血中HCG的浓度是鉴别水泡状胎块与水肿性流产胎重要的临床客观辅助指标。

部分性葡萄胎的超声诊断

目的探讨部分性葡萄胎的声像图特点,以提高部分性葡萄胎的诊断符合率。方法回顾性分析西安交通大学医学院第一附属医院2013年1月至2014年12月35例部分性葡萄胎患者(超声诊断29例,病理诊断6例)的病史、病理结果及超声声像图。结果 29例超声诊断为部分性葡萄胎的患者,与病理结果相符合的有25例,其诊断符合率为86.2%(25/29);误诊病例4例,其中稽留流产2例,不全流产1例,肌瘤变性1例。6例病理诊断为部分性葡萄胎而超声漏诊的患者中,有3例超声诊断为稽留流产,1例诊断为不全流产,1例诊断为肌瘤变性,1例诊断为完全性葡萄胎。结论超声检查结合病史能够诊断绝大多数的部分性葡萄胎,但不典型的患者往往需结合病理以及实验室检查进行诊断。

双胎妊娠合并部分性葡萄胎胎儿存活产后肺转移一例

妊娠合并部分性葡萄胎较为少见,且一般不发生转移。该文报道了一例双胎妊娠合并部分性葡萄胎胎儿存活产后肺转移患者的诊治经过。该例患者为双胎妊娠,在妊娠期间无临床症状,因胎膜早破行剖宫产术,术中发现宫腔内子宫后壁处有一内容物。术后经胎盘及内容物病理检查证实为双卵双胎,其一为正常胎儿,另一为部分性葡萄胎与胎儿共存。术后随访发现患者人绒毛膜促性腺激素(h CG)上升较快,胸部X线片示右肺中野异常密度,诊断为侵蚀性葡萄胎(肺转移)。经过3个疗程化学治疗后,患者h CG下降,肺部病灶缩小。该例患者的诊治过程提示,部分性葡萄胎临床表现无特异性,对于产时才发现葡萄胎且h CG上升较快者应警惕其出现远处转移,及早行化学治疗有助于改善预后。

p57、CD34和Ki-67在胎盘绒毛水肿性病变中的表达及意义

目的观察p57、CD34、Ki-67在完全性葡萄胎(CHM)、部分性葡萄胎(PHM)和水肿性流产胎(HA)组织中的表达,探讨其在胎盘绒毛病变诊断及鉴别诊断中的作用。方法收集2003年1月至2013年12月安丘市人民医院保存的CHM组织45例、PHM组织40例、HA组织28例及正常妊娠胎盘组织22例,采用免疫组织化学法检测胎盘绒毛组织中p57、CD34、Ki-67的表达。结果 CHM、PHM、HA及正常妊娠组织中p57阳性表达率分别为2.22%(3/45)、85.00%(34/40)、89.29%(25/28)、95.45%(21/22),CHM组织中p57阳性表达率显著低于PHM、HA及正常妊娠组织(χ~2=59.908、57.055、58.238,P<0.01),PHM、HA及正常妊娠组织中p57阳性表达率比较差异均无统计学意义(χ~2=0.022、0.681、0.074,P>0.05)。CD34在CHM、PHM、HA及正常妊娠组织中的表达分别为10.27±3.00、11.13±2.58、35.57±2.36、35.55±2.22,CHM、PHM组织中CD34表达显著低于HA及正常妊娠组织(t=37.89、37.86、39.79、37.40,P<0.01),HA与正常妊娠组织中CD34表达比较差异无统计学意义(t=1.485,P>0.05),CHM与PHM组织中CD34表达比较差异无统计学意义(t=1.404,P>0.05)。Ki-67在CHM、PHM、HA及正常妊娠组织中的阳性表达率分别为64.44%(29/45)、55.00%(22/40)、14.29%(4/28)、9.09%(2/22),CHM、PHM组织中Ki-67阳性表达率显著高于HA及正常妊娠组织(χ~2=18.21、12.61、17.53、11.56,P<0.01),HA与正常妊娠组织中Ki-67阳性表达率比较差异无统计学意义(χ~2=0.015,P>0.05),CHM与PHM组织中Ki-67阳性表达率比较差异无统计学意义(χ~2=0.787,P>0.05)。结论 p57有助于鉴别CHM与其他胎盘绒毛水肿性病变,CD34和Ki-67有助于鉴别葡萄胎和HA;p57、CD34和Ki-67联合检测有助于CHM、PHM及HA的鉴别诊断。

Analysis of Clinicopathologic Classification Features of Hydatidiform Mole Misdiagnosed as Missed Abortion Preoperatively

Objective:To analyze clinicopathologic classification features of the cases that were diagnosed as missed abortion preoperatively but turn out to be hydatidiform mole(HM)postoperatively.Methods:A retrospective analysis was conducted on the patients who had a missed abortion in our hospital from 2017 to 2018.Clinical and pathological characteristics of different types of HMs were observed.Diagnostic value of karyotype in HM was discussed based on the karyotype analysis of villi chromosome.Results:A total of 278(11.2%)HM patients were misdiagnosed as missed abortion.Naked-eye detection rate of HM was 26.61%,and sensitivity of transvaginal ultrasound on HM was 7.91%.One hundred and forty-seven(52.88%)HM cases could not be genotyped via pathological hematoxylin and eosin(HE)staining.70 HM patients underwent P57 immunohistochemistry,which had guiding significance to the classification.In addition,the karyotype diagnosis of the tissues from 15 cases basically matched their P57 classifications.Conclusions:P57 should be listed as a routine test in hydatidiform pathological examination at the same time of HE staining,and what’s more,P57 expression is consistent with genotyping,which should be recommended for the patients with HM if observed by naked eye.

Special epithelioid trophoblastic tumor:A case report

BACKGROUND Epithelioid trophoblastic tumor(ETT)is a special type of gestational trophoblastic tumor.However,its pathogenesis has been incompletely elucidated.ETT rarely occurs in the ovaries and fallopian tubes,unlike placental site trophoblastic tumor,requiring a histopathological biopsy and immunohistochemistry for further diagnosis.CASE SUMMARY A 29-year-old woman with irregular vaginal bleeding and elevated serum chorionic gonadotropin(β-hCG)levels presented similar symptoms to ectopic pregnancy.Transvaginal ultrasound revealed abnormal echoes of the left adnexa.Postoperatively,the pathology of the left ovary and fallopian tube was reported as ETT.The patient was followed up with regular hCG measurements and ultrasounds.The blood hCG values showed an upward trend 3 mo after the operation and then chemotherapy was prescribed.The current health status is normal.CONCLUSION For women of childbearing age with elevated serumβ-hCG levels,practitioners should consider ETT and be alert to the poor prognosis of the disease.After surgery,the patient’s condition should be closely observed to prevent recurrence and metastasis.Postoperative chemotherapy is only helpful for treating the disease to a certain extent.