Osterheld M C, Caron L, Chaubert P, Meagher-Villemure K
Institut Universitaire de Pathologie Rue du Bugnon 25 1011 Lausanne-CHUV.
Clin Med Pathol. 2008;1:61-7. doi: 10.4137/cpath.s601. Epub 2008 Mar 19.
Differential diagnosis between hydropic abortion, partial mole and complete mole is still a challenge for pathologists but really important for patient management.
In this study, we have evaluated 111 products of conception from the first trimester. Histological analysis was made according to the main diagnostic histopathological features described in the literature and the cases were categorized in hydropic abortus (HA), partial mole (PM) and complete mole (CM). Immunohistochemistry was performed using monoclonal antibody against p57(kip) protein a putative paternally imprinted inhibitor gene and DNA ploidy was analysed in all cases by image cytometry.
All 23 HAs presented a diploid DNA content and were p57(kip2) positive. From the 28 CMs, 12 cases (43%) were diploid and 16 cases (57%) were tetraploid but no expression of p57(kip2) was found with positive internal controls. From the 60 PMs, 58 cases were positive for p57(kip2) expression and 53 cases (88%) were triploid, 6 cases (10%) tetraploid and 1 case (2%) diploid.
This study on 111 cases of early pregnancies confirms the usefulness of immunohistochemistry and cytometry but demonstrates the importance of the combination of both techniques to assist histology for the best reliable diagnosis.
稽留流产、部分性葡萄胎和完全性葡萄胎的鉴别诊断对病理学家来说仍是一项挑战，但对患者的治疗管理非常重要。
在本研究中，我们评估了111例孕早期的妊娠产物。根据文献中描述的主要诊断组织病理学特征进行组织学分析，并将病例分为稽留流产（HA）、部分性葡萄胎（PM）和完全性葡萄胎（CM）。使用抗p57（kip）蛋白（一种假定的父系印记抑制基因）的单克隆抗体进行免疫组织化学检测，并通过图像细胞术分析所有病例的DNA倍体。
所有23例稽留流产均呈现二倍体DNA含量且p57（kip2）呈阳性。在28例完全性葡萄胎中，12例（43%）为二倍体，16例（57%）为四倍体，但在阳性内对照情况下未发现p57（kip2）表达。在60例部分性葡萄胎中，58例p57（kip2）表达阳性，53例（88%）为三倍体，6例（10%）为四倍体，1例（2%）为二倍体。
这项对111例早期妊娠的研究证实了免疫组织化学和细胞术的有用性，但表明了两种技术相结合以辅助组织学进行最可靠诊断的重要性。
