Differential expression of P63, P27, P57, Ki-67, and CD146 in hydropic and molar pregnancies

Objective: In this study, we investigated expressions of immunohistochemical markers P63, P27, P57, Ki-67, and CD146, in hydropic and molar specimens, to explore their role in pathogenesis of molar gestations. Design and Setting: Retrospective study. Methods: We enrolled 37 patients with a definitive pathologic diagnosis of HA (n = 10), PHM (n = 17), and CHM (n = 10). We scored immunoreactivity using antibodies against P63, P27, P57, Ki-67, and CD146 by evaluating the percentage of distinctly stained cells. Results.Compared to PHM and HA patients, CHM patients had severe cytologic atypia in CD146-positive extravillous trophoblastic column (TC) and florid syncytiotrophoblast (ST) proliferation. P57 immunostaining was negative in all but one of the CHM patients, whereas all HA and PHM patients showed positive immunostaining. PHM and HA patients also showed P63 and Ki-67 overexpression in cytotrophoblasts (CTs) compared to CHM patients. P27 was expressed in differentiated, nondividing syncytiotrophoblasts but did not yield any diagnostic aid. Conclusion: The proliferative activity location varied between molar and nonmolar pregnancies. PHM and HA patients have more progenitor cells, which express the highest levels of P63 compared to CHM patients. The loss of endogenous P63 expression in CHM cases may result in up-regulated genes, associated with invasion and metastasis, predisposing the body to a loss of epithelial and acquisition of mesenchymal characteristics.P63 deficiency, like P57 deficiency, induces exaggerated proliferation and differentiation and could be used as an ancillary diagnostic tool for CHM diagnosis. Keyword: Hydatidiform mole, hydropic abortion, p63, p27, p57, Ki-67, CD146. Continuous...

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

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.

Androgenetic Complete Hydatidiform Moles With p57KIP2-Positive Immunostaining

Objectives Complete hydatidiform moles (CHMs) are androgenetic and have a high rate of progression to gestational trophoblastic neoplasia (GTN). CHMs are negative when immunostained for p57KIP2 protein, the product of the maternally expressed gene on chromosome 11p15.5, whereas biparental partial hydatidiform moles and hydropic abortion are positive for p57KIP2. This study presents two cases of p57KIP2-positive androgenetic CHMs and explores the cause of this inconsistency. Methods Androgenetic CHMs were diagnosed using multiplex short tandem repeat polymorphism analysis. Single-nucleotide polymorphism arrays were performed for molecular karyotyping. Results Among the consecutive 188 androgenetic CHMs, two cases were positive for p57KIP2. The first case remitted spontaneously, whereas the second case developed into low-risk GTN. The first case was positive for p57KIP2 in all villi. The karyotype was 48,XX,+7,+11, with the additional chromosome 11 confirmed to be of maternal origin. The second case presented a mosaic of both positively and negatively stained villi. The karyotype was 46,XX. Conclusions The cause of one of the CHMs was trisomy with an additional maternal chromosome 11. Although rare, the confirmation of p57KIP2-positive androgenetic CHM status is necessary to manage GTN risk.

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

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.