Samadder Abhimanyu, Kar Rakhee
Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India.
Indian J Med Res. 2017 Jan;145(1):133-137. doi: 10.4103/ijmr.IJMR_982_15.
BACKGROUND & OBJECTIVES: There is considerable inter-observer variability in the diagnosis of molar pregnancies by histomorphological examination of products of conception (POC). The p57KIP2 gene is paternally imprinted and expressed from the maternal allele. On immunohistochemistry (IHC) with p57, complete mole (CM) shows absent staining whereas hydropic abortus (HA) and partial mole (PM) show positive staining. This study was undertaken to evaluate the role of p57 IHC along with histomorphology in differentiating between CM, PM and non-molar or HA.
This was a cross-sectional study over a period of three and a half years on archival material. Detailed histomorphological review along with p57 IHC was carried out in 28 diagnosed cases (23 CM, 4 PM and 1 molar pregnancy not categorized) and 25 controls of four normal placentas and 21 POC (8 non-hydropic and 13 HA).
In 14.8 per cent (4/27) cases, there was discordance in accurate subtyping of molar pregnancy. One case of CM showed inconsistent IHC pattern. In 15.4 per cent (2/13) HA, molar pregnancy was final diagnosis. After final review, there were 25 CM, five PM, 22 non-molar controls including 10 HA and one not assigned (PM/HA). IHC with p57 was negative in 96 per cent CM and positive in 100 and 95 per cent PM and non-molar controls, respectively.
INTERPRETATION & CONCLUSIONS: This study showed that negative p57KIP2 immunostaining reliably identified CM and could be used in association with the histological findings to distinguish CM from its mimics.
通过对妊娠产物（POC）进行组织形态学检查来诊断葡萄胎时，观察者间存在相当大的差异。p57KIP2基因是父系印记基因，由母系等位基因表达。在进行p57免疫组织化学（IHC）检测时，完全性葡萄胎（CM）呈无染色，而水肿性流产（HA）和部分性葡萄胎（PM）呈阳性染色。本研究旨在评估p57 IHC联合组织形态学在鉴别CM、PM与非葡萄胎或HA中的作用。
这是一项对存档材料进行的为期三年半的横断面研究。对28例确诊病例（23例CM、4例PM和1例未分类的葡萄胎妊娠）以及25例对照（4例正常胎盘和21例POC，其中8例非水肿性和13例HA）进行了详细的组织形态学检查及p57 IHC检测。
在14.8%（4/27）的病例中，葡萄胎妊娠的准确亚型分类存在不一致。1例CM显示出不一致的IHC模式。在15.4%（2/13）的HA中，最终诊断为葡萄胎妊娠。经过最终复查，有25例CM、5例PM、22例非葡萄胎对照，包括10例HA和1例未分类（PM/HA）。CM中96%的p57 IHC呈阴性，PM和非葡萄胎对照中分别有100%和95%呈阳性。
本研究表明，p57KIP2免疫染色阴性可可靠地识别CM，并可与组织学结果联合用于将CM与其相似病变相鉴别。
