Khooei Alireza, Atabaki Pasdar Fatemeh, Fazel Alireza, Mahmoudi Mahmoud, Nikravesh Mohammad Reza, Khaje Delui Mohammad, Pourheydar Bagher
Department of Pathology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran.
Department of Anatomical Sciences, Urmia University of Medical Sciences, Urmia, IR Iran.
Iran Red Crescent Med J. 2013 Jul;15(7):590-4. doi: 10.5812/ircmj.5348. Epub 2013 Jul 5.
Differential diagnosis of hydatidiform moles from non-molar specimens as well as their sub-classification such as complete and partial hydatidiform moles are important for clinical management and accurate risk assessment for persistent gestational trophoblastic disease, but diagnosis based solely on histomorphology suffers from poor interobserver and intraobserver reproducibility.
This study was undertaken to determine whether the expression of Ki-67 protein could differentiate these entities.
We performed Ki-67 immunohistochemical staining in 19 molar (8 partial and 11 complete moles) and 10 non-molar (hydropic abortions) formalin-fixed, paraffin-embedded tissue samples. Ploidy analysis using flow cytometry had confirmed diploidy in hydropic abortions and complete moles and triploidy in partial moles.
Ki-67 immunoreactivity was assessed in villous cytotrophoblasts, syncytiotrophoblasts and stromal cells. Positive cells were found to be restricted mostly to the villous cytotrophoblasts, while syncytiotrophoblasts showed an absence of immunostaining for Ki-67, and occasional weak nuclear staining was seen in the stromal cells. There was a significant difference in Ki-67 immunoreactivity of cytotrophoblastic cells between hydropic abortions and complete moles (P < 0.001), hydropic abortions and partial moles (P = 0.002) and also between complete and partial moles (P < 0.001). On the other hand, there is significant overlap in the Ki-67 immunoreactivity between complete and partial moles (++ staining category) and between partial moles and hydropic abortions (+ staining category).
Despite the significant differences , Ki-67 immunostaining could not be helpful in distinguishing molar placentas from hydropic abortions as well as partial from complete hydatidiform moles, because there are considerable overlaps between results in different categories.
葡萄胎与非葡萄胎标本的鉴别诊断以及它们的亚分类，如完全性和部分性葡萄胎，对于临床管理和持续性妊娠滋养细胞疾病的准确风险评估很重要，但仅基于组织形态学的诊断在观察者间和观察者内的可重复性较差。
本研究旨在确定Ki-67蛋白的表达是否能区分这些实体。
我们对19例葡萄胎（8例部分性和11例完全性葡萄胎）和10例非葡萄胎（水肿性流产）的福尔马林固定、石蜡包埋组织样本进行了Ki-67免疫组化染色。使用流式细胞术进行的倍体分析已证实水肿性流产和完全性葡萄胎为二倍体，部分性葡萄胎为三倍体。
在绒毛细胞滋养层细胞、合体滋养层细胞和间质细胞中评估Ki-67免疫反应性。发现阳性细胞大多局限于绒毛细胞滋养层细胞，而合体滋养层细胞对Ki-67无免疫染色，间质细胞偶尔可见弱核染色。水肿性流产与完全性葡萄胎之间（P < 0.001）、水肿性流产与部分性葡萄胎之间（P = 0.002）以及完全性与部分性葡萄胎之间（P < 0.001），细胞滋养层细胞的Ki-67免疫反应性存在显著差异。另一方面，完全性与部分性葡萄胎之间（++染色类别）以及部分性葡萄胎与水肿性流产之间（+染色类别）的Ki-67免疫反应性存在显著重叠。
尽管存在显著差异，但Ki-67免疫染色无助于区分葡萄胎胎盘与水肿性流产以及部分性与完全性葡萄胎，因为不同类别结果之间存在相当大的重叠。
