Lage J M, Mark S D, Roberts D J, Goldstein D P, Bernstein M R, Berkowitz R S
Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts.
Obstet Gynecol. 1992 Mar;79(3):403-10. doi: 10.1097/00006250-199203000-00016.
Hydropic placentas may be classified by histopathology into hydropic abortus, partial hydatidiform mole, and complete hydatidiform mole. We studied 142 hydropic placentas: 39% were complete hydatidiform moles, 35% partial hydatidiform moles, and 26% hydropic abortuses. Villous vesicle size was predictive of histologic diagnosis. We determined DNA ploidy in 137 cases. Seventy-three percent of hydropic abortuses were diploid and 11% were triploid. Ninety percent of partial moles were triploid or near-triploid; one partial mole was haploid and one diploid. Of the complete moles, 50% were diploid, 43% were tetraploid, 3.6% polyploid, and 1.7% triploid. Partial moles had lower pre-evacuation beta-hCG levels than complete moles. Persistent tumor followed 33% of complete moles and 12% of partial moles. Although the numbers were small, no patient with a diploid, tetraploid, aneuploid, or haploid partial mole developed persistent disease. Among complete moles, the pre-evacuation beta-hCG level was not predictive of persistence (P = .15). Subdividing complete moles by ploidy, we found that tetraploid moles were associated with higher pre-evacuation beta-hCG levels than were diploid moles. However, tetraploidy was not associated with increased persistent tumor among complete moles. Although most partial moles were triploid and most complete moles were diploid or tetraploid, there was wider DNA heterogeneity among molar gestations than previously reported. In this series, DNA ploidy was not an independent predictor of persistence in complete moles.
根据组织病理学，水肿性胎盘可分为水肿流产、部分性葡萄胎和完全性葡萄胎。我们研究了142例水肿性胎盘：39%为完全性葡萄胎，35%为部分性葡萄胎，26%为水肿流产。绒毛水泡大小可预测组织学诊断。我们测定了137例的DNA倍性。73%的水肿流产为二倍体，11%为三倍体。90%的部分性葡萄胎为三倍体或近三倍体；1例部分性葡萄胎为单倍体，1例为二倍体。完全性葡萄胎中，50%为二倍体，43%为四倍体，3.6%为多倍体，1.7%为三倍体。部分性葡萄胎清宫前β-hCG水平低于完全性葡萄胎。33%的完全性葡萄胎和12%的部分性葡萄胎出现持续性滋养细胞肿瘤。尽管病例数较少，但二倍体、四倍体、非整倍体或单倍体部分性葡萄胎患者均未发生持续性疾病。在完全性葡萄胎中，清宫前β-hCG水平不能预测持续性疾病（P = 0.15）。按倍性对完全性葡萄胎进行细分，我们发现四倍体完全性葡萄胎清宫前β-hCG水平高于二倍体完全性葡萄胎。然而，四倍体与完全性葡萄胎中持续性肿瘤增加无关。尽管大多数部分性葡萄胎为三倍体，大多数完全性葡萄胎为二倍体或四倍体，但葡萄胎妊娠中的DNA异质性比之前报道的更大。在本系列研究中，DNA倍性不是完全性葡萄胎持续性疾病的独立预测因素。
