Laboratoire d'anatomie et de cytologie pathologiques, CHU Farhat Hached, Sousse, Tunisie. h
Pathol Res Pract. 2011 Aug 15;207(8):498-504. doi: 10.1016/j.prp.2011.06.004. Epub 2011 Jul 20.
Classification of molar gestations into complete hydatidiform mole (CHM) and partial hydatidiform mole (PHM) and their differentiation from nonmolar hydropic abortions (HA) are traditionally accomplished by morphology alone. Sometimes, the process may be inaccurate or inconclusive especially in early diagnosed cases. With the availability of p57(KIP2) immunostaining (the product of a strongly paternally imprinted and maternally expressed gene), it may be possible to classify these lesions objectively. P57(KIP2) immunostaining is absent in CHM because it lacks a maternal genome, whereas PHM and HA show positive staining. The aims of this study were to evaluate the results of routine histopathological examination and p57(KIP2) immunoreactivity in a large series of molar and nonmolar HA in Tunisia, and to compare the accuracy of p57(KIP2) immunohistochemistry with that of nuclear DNA microsatellite polymorphism in identifying CHM. The immunohistochemical expression of p57(KIP2) protein was investigated in 220 specimens of first trimester hydropic abortuses, and it was compared with the original diagnosis based on morphology, including 132 CHM, 49 PHM, and 39 HA. Concordant results were obtained in 210 cases. In 9 of 10 cases with a discordant diagnosis (negative immunostaining in 8 cases morphologically diagnosed as PHM and one case diagnosed as HA), microsatellite DNA genotyping analysis agreed with the results of p57(KIP2) staining, confirming the diagnosis of CHM in these cases. Twenty cases of CHM with negative p57(KIP2) immunostaining were also analyzed by genotyping and indicated the absence of maternal contribution and the homozygosity for a single paternal allele in concordance with the androgenetic and monospermic origin of CHM in these cases. We confirm that for distinguishing CHM from its mimics, p57(KIP2) immunohistochemistry can be used as successfully as DNA microsatellite genotyping. However, molecular techniques are still required for the evaluation of some difficult cases with discordant positive p57(KIP2) staining.
传统上，通过形态学将葡萄胎妊娠分为完全性葡萄胎（CHM）和部分性葡萄胎（PHM），并将其与非葡萄胎性水肿性流产（HA）区分开来。有时，该过程可能不准确或不确定，特别是在早期诊断的病例中。随着 p57（KIP2）免疫染色（一种强烈父系印记和母系表达的基因产物）的可用性，可能可以客观地对这些病变进行分类。CHM 中不存在 p57（KIP2）免疫染色，因为它缺乏母体基因组，而 PHM 和 HA 则显示阳性染色。本研究的目的是评估 p57（KIP2）免疫反应在突尼斯一系列葡萄胎和非葡萄胎性 HA 中的常规组织病理学检查结果，并比较 p57（KIP2）免疫组化与核 DNA 微卫星多态性在识别 CHM 中的准确性。研究人员研究了 220 例早孕期水肿性流产标本中 p57（KIP2）蛋白的免疫表达，并将其与基于形态学的原始诊断进行了比较，其中包括 132 例 CHM、49 例 PHM 和 39 例 HA。在 210 例病例中获得了一致的结果。在 10 例具有不一致诊断的病例中（8 例形态学诊断为 PHM 的病例免疫染色阴性，1 例诊断为 HA 的病例），微卫星 DNA 基因分型分析与 p57（KIP2）染色结果一致，证实了这些病例的 CHM 诊断。20 例 CHM 免疫染色阴性的病例也进行了基因分型分析，结果显示缺乏母体贡献，并且与这些病例中 CHM 的雄性和单倍体起源一致，均为单个父系等位基因的纯合性。研究人员证实，为了将 CHM 与其模拟物区分开来，p57（KIP2）免疫组化可与 DNA 微卫星基因分型一样成功使用。然而，对于一些具有不一致阳性 p57（KIP2）染色的困难病例，仍需要分子技术进行评估。
