Lelic Melisa, Fatusic Zlatan, Iljazovic Ermina, Ramic Suada, Markovic Sergije, Alicelebic Selma
Medical faculty, University of Tuzla, Tuzla, Bosnia and Herzegovina.
Clinic for Gynecology and Obstetrics, University Clinical Center of Tuzla, Tuzla, Bosnia and Herzegovina.
Med Arch. 2017 Aug;71(4):256-260. doi: 10.5455/medarh.2017.71.256-260.
Hydatidiform moles (HM), presenting as complete (CHM) and partial (PHM) form, are rare pregnancy disorder. Diagnosis is based on clinical presentation, ultrasound imaging findings and pathological examination of products of conception. Protein p57, encoded by CKDN1C gene, is paternally imprinted and maternally expressed gene and provides quick insight in genetic basis of HM and allows distinction of CHM from all other conceptions. compare the preevacuational and pathohistological diagnosis with outcome of p57 immunostaining.
All cases of HM diagnosed between January 2011 and December 2015 were included in this research. Maternal age, gestational age and input diagnosis data were recored. p57 immunostaining was performed in order to evaluate the diagnosis based on tissue slides examination.
There were 198 cases of histologically confirmed HM, 185 PHM, 12 CHM and one case of undefined HM. Mean maternal age in the CHM group was 24,7 and in the PHM group 26,9 years, with no significant differences among these two groups (p=0,27). For CHM mean gestational age was estimated at eight and for PHM 9,2 gestational weeks. Pregnant woman older than 40 years present significant earlier compared with younger woman (p<0,01), and those younger than 20 years tend to present at the beginning of the second trimester more often than older women (p<0,05). In the CHM group, 9 (75%) input diagnoses were mola in obs, and 3 (25%) of them were signed as abortion, unlike the PHM where 126 (67%) were qualified as abortion, 35 (19%) as blighted ovum, and 26 (14%) were suggestive for molar pregnancy. p57 immunostaining results confirmed all pathohistological diagnosis of CHM whereas 8% of PHM demonstrated divergent p57 expression.
PHM, compared with CHM, represent a greater diagnostic challenge for both gynecologist and pathologist even when presenting in more advanced pregnancies.
葡萄胎（HM）表现为完全性（CHM）和部分性（PHM）两种形式，是一种罕见的妊娠疾病。诊断基于临床表现、超声影像学检查结果以及对妊娠产物的病理检查。由CKDN1C基因编码的蛋白质p57是一种父系印记、母系表达的基因，它能快速洞察葡萄胎的遗传基础，并有助于区分完全性葡萄胎与其他所有妊娠情况。比较清宫前诊断和病理组织学诊断与p57免疫染色结果。
本研究纳入了2011年1月至2015年12月期间诊断的所有葡萄胎病例。记录产妇年龄、孕周及初始诊断数据。进行p57免疫染色以基于组织切片检查评估诊断。
共有198例经组织学确诊的葡萄胎，其中185例为部分性葡萄胎，12例为完全性葡萄胎，1例为未明确类型的葡萄胎。完全性葡萄胎组产妇平均年龄为24.7岁，部分性葡萄胎组为26.9岁，两组间无显著差异（p = 0.27）。完全性葡萄胎平均孕周估计为8周，部分性葡萄胎为9.2周。40岁以上孕妇的发病时间明显早于年轻孕妇（p < 0.01），20岁以下孕妇比年长孕妇更倾向于在孕中期开始时发病（p < 0.05）。在完全性葡萄胎组中，初始诊断为产科葡萄胎的有9例（75%），其中3例（25%）诊断为流产，而部分性葡萄胎组中，126例（67%）诊断为流产，35例（19%）诊断为空孕囊，26例（14%）提示为葡萄胎妊娠。p57免疫染色结果证实了所有完全性葡萄胎的病理组织学诊断，而8%的部分性葡萄胎表现出不同的p57表达。
与完全性葡萄胎相比，部分性葡萄胎对妇科医生和病理学家来说都是更大的诊断挑战，即使在妊娠进展到更晚期时也是如此。
