scholarly journals Expression of Pro-Apoptotic Bax and Anti-Apoptotic Bcl-2 Proteins in Hydatidiform Moles and Placentas With Hydropic Changes

2019 ◽  
Author(s):  
Alireza Khooei ◽  
Fatemeh Atabaki Pasdar ◽  
Alireza Fazel ◽  
Mahmoud Mahmoudi ◽  
Mohammad Reza Nikravesh ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Diagnostic Tool ◽  
Stromal Cells ◽  
Hydatidiform Mole ◽  
Complete Hydatidiform Mole ◽  
Tissue Samples ◽  
Partial Hydatidiform Mole ◽  
Significant Difference ◽  
Hydropic Abortion ◽  
Hydatidiform Moles

Abstract- Morphologic examination still forms the main diagnostic tool in the differential diagnosis of molar placentas. However the criteria are subjective and show considerable inter-observer variability among pathologists. The aim of the present study was to investigate the role of Bcl-2 and Bax immunostaining in the differential diagnosis of molar placentas. Bax and Bcl-2 immunohistochemical staining were performed in 19 molars (8 partial and 11 complete hydatidiform mole) and 10 non-molar (hydropic abortion) formalin-fixed, paraffin-embedded tissue samples. Ploidy analysis using flow cytometry had confirmed diploidy in hydropic abortions and complete hydatidiform moles and triploidy in partial hydatidiform moles. Bcl-2 expression was observed only in syncytiotrophoblasts, No immunoreactivity was detected in Cytotrophoblasts, and stromal cells, the total score averages of Bcl-2 immunoexpression in partial hydatidiform moles and hydropic abortions were significantly higher than in complete hydatidiform moles, whereas no significant difference was observed between partial hydatidiform moles and hydropic abortions. Bax immunoreactivity was observed in cytotrophoblasts, stromal cells and occasionally in syncytiotrophoblasts. No statistically significant difference in Bax immunoexpression total score was observed among various groups. Based on the results of this study, Bcl-2 immunostaining offers a potential adjunctive diagnostic tool to distinguish complete hydatidiform mole from partial hydatidiform mole and hydropic abortion, but not partial hydatidiform mole from hydropic abortion, Bax immunostaining cannot be helpful in this regard.

Immunohistochemical Characterization of p57Kip2 Expression in Tetraploid Hydropic Placentas

2004 ◽  
Vol 128 (8) ◽  
pp. 897-900 ◽  
Author(s):  
Masaharu Fukunaga
Keyword(s):  
Flow Cytometry ◽  
Stromal Cells ◽  
Dna Ploidy ◽  
Hydatidiform Mole ◽  
Abnormal Development ◽  
Complete Hydatidiform Mole ◽  
Hydropic Abortion ◽  
History Of ◽  
Formalin Fixed

Abstract Context.—Because there are differences in the origin, morphology, and natural history of hydropic placental villous issues, it is important to identify and document rare specimens that deviate from the diploid complete hydatidiform mole (CM), triploid partial hydatidiform mole (PM), or diploid hydropic abortion (HA). Tetraploid hydropic placentas have rarely been studied. Objectives.—To evaluate the frequency of p57Kip2 protein (p57) expression in tetraploid hydropic placentas and to determine its clinicopathologic significance. Design.—Forty hydropic DNA tetraploid placental specimens were evaluated by immunohistochemistry of formalin-fixed tissues, using a monoclonal antibody against p57, a putative paternally imprinted inhibitor gene. DNA ploidy in all cases was analyzed by flow cytometry. Results.—Thirty cases were histologically diagnosed as CMs, 10 were HAs, and none were PMs. In all HAs, nuclear p57 was strongly expressed in cytotrophoblasts, intermediate trophoblasts, and villous stromal cells. In contrast, in CMs, p57 expression in cytotrophoblasts and villous stromal cells was either absent (26 cases) or very low (4 cases). Assuming that the degree of molar change roughly correlates with the proportion of paternal chromosomes present, all chromosomes might be paternally derived in all tetraploid CMs and the 10 HAs, including 2 that were karyotyped as 92,XXYY or 90,XXYY,−13,−14, which were presumably due to 2 sets of chromosomes each from paternal and maternal origin. Conclusions.—Expression of p57 is aberrant in tetraploid CMs. This finding is in line with the hypothesis that the loss of p57 is involved in the abnormal development of androgenetic CMs. For the evaluation of a patient with trophoblastic disease, p57 immunostaining is an ancillary diagnostic method that may be used in concert with flow cytometry.

scholarly journals Hydatidiform Moles: Ancillary Techniques to Refine Diagnosis

2018 ◽  
Vol 142 (12) ◽  
pp. 1485-1502 ◽  
Author(s):  
Brigitte M. Ronnett
Keyword(s):  
Interobserver Variability ◽  
Hydatidiform Mole ◽  
Immunohistochemical Analysis ◽  
Gestational Trophoblastic Disease ◽  
Complete Hydatidiform Mole ◽  
Algorithmic Approach ◽  
Genetic Features ◽  
Polymerase Chain ◽  
Dna Genotyping ◽  
Hydatidiform Moles

Context.— Distinction of hydatidiform moles from nonmolar specimens and subclassification of hydatidiform moles as complete hydatidiform mole versus partial hydatidiform mole are important for clinical practice and investigational studies. Risk of persistent gestational trophoblastic disease and clinical management differ for these entities. Diagnosis based on morphology is subject to interobserver variability and remains problematic, even for experienced gynecologic pathologists. Objectives.— To explain how ancillary techniques target the unique genetic features of hydatidiform moles to establish diagnostic truth, highlight the issue of diagnostic reproducibility and importance of diagnostic accuracy, and illustrate use of p57 immunohistochemistry and polymerase chain reaction–based DNA genotyping for diagnosis. Data Sources.— Sources are the author's 10-year experience using ancillary techniques for the evaluation of potentially molar specimens in a large gynecologic pathology practice and the literature. Conclusions.— The unique genetics of complete hydatidiform moles (purely androgenetic), partial hydatidiform moles (diandric triploid), and nonmolar specimens (biparental, with allelic balance) allow for certain techniques, including immunohistochemical analysis of p57 expression (a paternally imprinted, maternally expressed gene) and genotyping, to refine diagnoses of hydatidiform moles. Although p57 immunostaining alone can identify complete hydatidiform moles, which lack p57 expression because of a lack of maternal DNA, this analysis does not distinguish partial hydatidiform moles from nonmolar specimens because both express p57 because of the presence of maternal DNA. Genotyping, which compares villous and decidual DNA patterns to determine the parental source and ratios of polymorphic alleles, distinguishes purely androgenetic complete hydatidiform moles from diandric triploid partial hydatidiform moles, and both of these from biparental nonmolar specimens. An algorithmic approach to diagnosis using these techniques is advocated.

scholarly journals A Case of Invasive Mole

2017 ◽  
Vol 12 (2) ◽  
pp. 86-87
Author(s):  
Shahana Ahmed ◽  
Dipti Rani Shaha
Keyword(s):  
Hydatidiform Mole ◽  
The Body ◽  
Emergency Laparotomy ◽  
Molar Pregnancy ◽  
Complete Hydatidiform Mole ◽  
Partial Hydatidiform Mole ◽  
Normal Limits ◽  
History Of ◽  
Invasive Mole

Invasive mole is a condition where a molar pregnancy, such as a partial hydatidiform mole or complete hydatidiform mole, invades the wall of the uterus, potentially spreading and metastasizing to other parts of the body. Here is a case who presented with history of evacuation for molar pregnancy. She presented with irregular P/V bleeding on and off and after admission silent perforation with massive haemoperitoneum was detected for which emergency laparotomy was done. She recovered and was followed up till her b-hCG levels were within normal limits. As patient presented to us with haemoperitoneum and on laparotomy, there was invasion into whole of the uterus, it could not be saved and hysterectomy was done.Faridpur Med. Coll. J. Jul 2017;12(2): 86-87

scholarly journals Pemphigoid Gestationis after Spontaneous Expulsion of a Massive Complete Hydatidiform Mole

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Naoki Matsumoto ◽  
Marie Osada ◽  
Kou Kaneko ◽  
Ken Ohara ◽  
Daito Noguchi ◽  
...  
Keyword(s):  
Hydatidiform Mole ◽  
Vital Signs ◽  
Oral Prednisolone ◽  
Skin Lesions ◽  
Complement C3 ◽  
Entire Body ◽  
Complete Hydatidiform Mole ◽  
Pemphigoid Gestationis ◽  
Spontaneous Expulsion ◽  
Hydatidiform Moles

Pemphigoid gestationis (PG) is a rare, perinatal, autoimmune, and blistering dermatosis. Only few cases of PG involving hydatidiform moles have been reported. Complete hydatidiform moles are usually evacuated by dilatation and curettage. We report a patient with a massive complete hydatidiform mole that underwent spontaneous expulsion; she subsequently developed PG. A 19-year-old unmarried nulligravid woman was referred to our hospital following excessive vaginal bleeding after an uncertain amenorrheal period. The patient presented with preshock vital signs, severe anemia, and a positive urine pregnancy test. Imaging examinations revealed a massive intrauterine mass (19 × 15 × 10 cm), suggesting a complete hydatidiform mole. She was hospitalized and treated with blood transfusion. Sixteen hours after hospitalization, the massive molar mass underwent spontaneous expulsion and bleeding ceased. Three days after the expulsion, she developed pruritic skin lesions including papules, erythemas, and bullae, which spread over her entire body. Skin biopsy revealed PG and subepidermal blister formation and linear complement C3 deposition along the basement membrane zone, and the serum anti-BP180 antibody level was found to be high on measurement. She was effectively treated with 50 mg/day of oral prednisolone. Her skin lesions disappeared, leaving pigmentation.

scholarly journals Successful Primary Treatment of a Hydatidiform Mole with Methotrexate and EMA/CO

2009 ◽  
Vol 2009 ◽  
pp. 1-3 ◽  
Author(s):  
M. De Vos ◽  
M. Leunen ◽  
C. Fontaine ◽  
Ph. De Sutter
Keyword(s):  
Surgical Treatment ◽  
Complete Remission ◽  
Treatment Option ◽  
Hydatidiform Mole ◽  
Uterine Fibroids ◽  
Treatment Method ◽  
Primary Treatment ◽  
Molar Pregnancy ◽  
Complete Hydatidiform Mole ◽  
Hydatidiform Moles

Background. The preferred treatment method of most hydatidiform moles is suction aspiration. In rare circumstances uterine abnormalities may preclude surgical treatment.Case. We report a case of complete molar pregnancy successfully treated with methotrexate followed by EMA/CO. A 38-year-old woman with a complete hydatidiform mole and multiple uterine fibroids underwent a failed attempt at suction aspiration. Following treatment with methotrexate, a nonmetastatic persistent trophoblastic tumour developed. Six cycles of EMA/CO led to complete remission.Conclusion. We propose that primary treatment of molar pregnancies with chemotherapy is a useful treatment option in cases where uterine abnormalities interfere with suction aspiration.

scholarly journals Role of the Immunohistochemical Marker (Ki67) in Diagnosis and Classification of Hydatidiform Mole

2020 ◽  
Vol 18 (3) ◽  
Author(s):  
Hasan Abu Deka FF ◽  
Abd Ali Al Saeng ZH ◽  
Khalid Almukhtar Z
Keyword(s):  
Stromal Cells ◽  
Hydatidiform Mole ◽  
Labeling Index ◽  
Statistical Relationship ◽  
Ki 67 ◽  
Cross Sectional ◽  
Complete Mole ◽  
Partial Mole ◽  
Hydropic Abortion

Introduction: Since the hallmark of gestational trophoblastic disease is trophoblastic proliferation, Ki67 is regarded as the best marker in studying hydatidiform mole.This study was conducted to evaluate the role of this proliferative marker in distinguishing among hydropic abortion, partial and complete hydatidiform mole. Materials and methods: This is a cross sectional study involving the application of Ki67 on a total of 90 histological samples of curetting materials from molar (partial and complete mole) and non molar hydropic abortion belong to Iraqi females, so three study groups were created. Immunohistochemical expression in villous cytotrophoblasts, syncytiotrophoblasts and stromal cells were recorded separately by three independent observers and the results were correlated statically. Results: The mean number of stained nuclei of villous cytotrophoblasts and stromal cells was the highest in complete mole and the lowest in non molar hydropic abortion. There is a significant statistical relationship regarding Ki67 labeling index in villous cytotrophoblasts between partial moles and hydropic abortion, complete mole and partial moles, hydropic abortion and complete mole. Regarding Ki67 labelling index in villous stromal cells, a significant statistical relationship achieved when the correlation done between partial mole and hydropic abortions, hydropic abortion and complete mole, while a non significant statistical relationship was achieved if the correlation done between partial and complete mole. All villous syncytiotrophoblasts showed negative results. Conclusion: Ki-67 labeling index in villous cytotrophblastic cells are useful in separating between partial moles and hydropic abortion, partial mole and complete mole, hydropic abortion and complete mole. While Ki-67 labeling index in villous stromal cells is only useful in separating between partial moles and hydropic abortion, hydropic abortion and complete mole.

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