Keep D, Zaragoza M V, Hassold T, Redline R W
Department of Pathology and Genetics, Case Western Reserve University, Cleveland, OH 44106, USA.
Hum Pathol. 1996 Jul;27(7):708-13. doi: 10.1016/s0046-8177(96)90402-5.
Recent trends toward early pregnancy ultrasound have led to evacuation of complete hydatidiform moles at a stage before the development of diffuse trophoblast hyperplasia and villous cavitation. Absence of these recognized diagnostic criteria can lead to misdiagnosis and subsequent trophoblastic neoplasia. The authors identified a case of very early complete hydatidiform mole (VECM) on review of a previous curettage specimen when the patient presented 4 weeks later with increasing human chorionic gonadotropin (HCC) titers and the typical histological features of complete mole on a subsequent curettage. DNA studies on this index case and three subsequent similar specimens confirmed the diagnosis of complete hydatidiform mole using polymerase chain reaction (PCR) amplification of eight microsatellite markers on microdissected maternal and villous tissue. VECM were compared with spontaneous abortions and elective terminations of a similar gestational age to develop diagnostic criteria. Five cardinal diagnostic features were identified: redundant bulbous terminal villi, hypercellular villous stroma, a labyrinthine network of vinous stromal canaliculi, focal cytotrophoblast and syncytiotrophoblast hyperplasia on both villi and the undersurface of the chorionic plate, and enlarged hyperchromatic implantation site trophoblast.
近期早期妊娠超声检查的趋势使得完全性葡萄胎在弥漫性滋养层细胞增生和绒毛空洞形成之前的阶段就得以清宫。缺乏这些公认的诊断标准可能导致误诊及随后的滋养层细胞瘤变。作者在回顾一份既往刮宫标本时发现了一例极早期完全性葡萄胎（VECM），该患者4周后因血清人绒毛膜促性腺激素（HCC）水平升高再次刮宫，其组织学特征符合典型的完全性葡萄胎。对该索引病例及随后3份类似标本进行DNA研究，通过对显微切割的母体和绒毛组织上的8个微卫星标记进行聚合酶链反应（PCR）扩增，证实了完全性葡萄胎的诊断。将VECM与相似孕周的自然流产和选择性终止妊娠病例进行比较，以制定诊断标准。确定了五个主要诊断特征：末端绒毛呈多余的球茎状、绒毛间质细胞增多、绒毛间质小管道呈迷宫样网络、绒毛和绒毛膜板下表面局灶性细胞滋养层细胞和合体滋养层细胞增生、种植部位滋养层细胞增大且核染色质增多。
