Jiao L Z, You S Y, Wang Y P, Zhu C G, Jiang J Y
Department of Gynecology Oncology, Dalian Maternal and Child Health Care Hospital & Dalian Obstetrics and Gynecology Hospital Affiliated to Dalian Medical University, Dalian 116033, China.
Department of Ultrasound, Dalian Maternal and Child Health Care Hospital & Dalian Obstetrics and Gynecology Hospital Affiliated to Dalian Medical University, Dalian 116033, China.
Zhonghua Fu Chan Ke Za Zhi. 2019 Nov 25;54(11):756-762. doi: 10.3760/cma.j.issn.0529-567x.2019.11.008.
To evaluate the clinical characteristics and diagnostic strategies of early hydatidiform mole. A retrospective cohort study was conducted of 526 women with hydatidiform mole who underwent suction curettage and were confirmed by histopathology in Dalian Maternal and ChildHealth Care Hospital from Feb. 2013 to Feb. 2018, including 484 women with gestational age less than or equal to 12 weeks (the early group) and 42 women with gestational age greater than 12 weeks (the late group). The clinical characteristics between the two groups were compared, and the pathological diagnosis and pre-evacuation ultrasound examination of the early group were further discussed. Compared with the late group, the clinical characteristics of the early group tended to be atypical, and the incidence of vaginal bleeding, excessive uterine size, theca lutein cysts (>6 cm) and pregnancy complications decreased significantly (all 0.05). The serum level of β-hCG in the early group was significantly lower than that in the late group (2.382, 0.017). While there was no significant difference in the pre-evacuation ultrasound detection rate between the two groups (53.5% vs 66.7%; χ(2)=2.697, 0.101). Five hundred and fifteen patients completed the follow-up, and 38 patients with post-mole neoplasia were all cured. There was no significant difference in the malignant transformation rate of hydatidiform mole between the two groups (7.0% vs 11.9%; χ(2)=0.745, 0.388). In the early group, 302 cases of complete hydatidiform mole (CHM), 179 cases of partial hydatidiform mole (PHM) and 3 cases of unclassified hydatidiform mole (UHM) were histologically diagnosed, according to pathological morphology combined with p57(KIP2) immunohistochemical staining. Compared with pathological diagnosis, the overall pre-evacuation ultrasound detection rate in the early hydatidiform mole was 53.5% (259/484), which was significantly better for complete (78.1%, 236/302) versus partial (11.7%, 21/179) hydatidiform moles (χ(2)=199.224, 0.01). There was significantly weak negative correlation between the overall ultrasound detection rate and gestational age of hydatidiform mole (=-0.211, 0.01). The gestational age of early PHM was significantly longer than that of CHM (68.0 vs 58.5 days; -8.048, 0.01). The clinical presentations of early hydatidiform mole are not typical. Although ultrasound examination identifies only about half of hydatidiform moles, ultrasonography is still an important auxiliary examination method. Morphological examination combined with p57(K)IP2 immunohistochemical staining could effectively diagnose early hydatidiform mole, so as to reduce the missed diagnosis of hydatidiform mole.
评估早期葡萄胎的临床特征及诊断策略。对2013年2月至2018年2月在大连市妇幼保健院接受刮宫术并经组织病理学确诊为葡萄胎的526例女性进行回顾性队列研究，其中孕龄小于或等于12周的女性484例（早期组），孕龄大于12周的女性42例（晚期组）。比较两组的临床特征，并进一步探讨早期组的病理诊断及清宫前超声检查情况。与晚期组相比，早期组临床特征趋于不典型，阴道流血、子宫大小过大、黄素化囊肿（>6 cm）及妊娠并发症的发生率显著降低（均P<0.05）。早期组血清β-hCG水平显著低于晚期组（Z=2.382，P=0.017）。两组清宫前超声检出率差异无统计学意义（53.5% 对66.7%；χ²=2.697，P=0.101）。515例患者完成随访，38例葡萄胎后肿瘤均治愈。两组葡萄胎恶变率差异无统计学意义（7.0%对11.9%；χ²=0.745，P=0.388）。早期组经组织病理学形态结合p57（KIP2）免疫组化染色诊断完全性葡萄胎（CHM）302例、部分性葡萄胎（PHM）179例、未分类葡萄胎（UHM）3例。与病理诊断相比，早期葡萄胎清宫前超声总体检出率为53.5%（259/484），完全性葡萄胎（78.1%，236/302）超声检出率显著高于部分性葡萄胎（11.7%，21/179）（χ²=199.224，P<0.01）。葡萄胎超声总体检出率与孕龄呈显著弱负相关（r=-0.211，P=0.01）。早期部分性葡萄胎的孕龄显著长于完全性葡萄胎（68.0对58.5天；t=-8.048，P<0.01）。早期葡萄胎临床表现不典型。超声检查虽仅能识别约一半的葡萄胎，但超声检查仍是重要的辅助检查方法。形态学检查结合p57（K）IP2免疫组化染色可有效诊断早期葡萄胎，从而减少葡萄胎的漏诊。
