Sumithran E, Cheah P L, Susil B J, Looi L M
Department of Anatomical Pathology, Monash Medical Centre, Clayton, Vic.
Pathology. 1996 Nov;28(4):311-5. doi: 10.1080/00313029600169254.
Hydropic villi in products of conception continue to pose a diagnostic problem for the anatomical pathologist. It is important to distinguish between complete hydatidiform mole (CM), partial hydatidiform mole (PM) and hydropic degeneration (HD), as hydatidiform moles (especially CM) have a tendency to develop persistent trophoblastic disease. Several studies have demonstrated interobserver variability in the diagnosis of the three conditions, but there have been no studies testing the accuracy of the consensus diagnosis of pathologists experienced in the field. In this study four anatomical pathologists with experience in diagnosing hydatidiform moles selected five cases of HD, seven cases of PM and ten cases of CM on the basis of consensus diagnosis using established criteria. Ploidy studies were done on these 22 cases using fluorescent in situ hybridisation. The 15 cases of HD and CM were diploid, confirming the histological diagnosis. However only five of the seven cases of PM were triploid, the other two being diploid. Review of these two diploid cases showed a mixture of small and large villi with moderate to marked trophoblastic proliferation. On the basis of the significant trophoblastic proliferation and the DNA information, the two cases were reclassified as early complete moles. This study demonstrates that even pathologists experienced in the field have difficulty separating PM from CM. The findings suggest that, in the absence of DNA information, a lesion with hydropic villi showing moderate to marked trophoblastic proliferation should be classified as a complete mole, even if there is a mixture of small and large villi. Ploidy studies are an important adjunct to histological diagnosis, especially when there is an overlap of features.
妊娠产物中的水肿绒毛对解剖病理学家来说仍然是一个诊断难题。区分完全性葡萄胎（CM）、部分性葡萄胎（PM）和水肿变性（HD）很重要，因为葡萄胎（尤其是CM）有发展为持续性滋养细胞疾病的倾向。多项研究表明，观察者之间对这三种情况的诊断存在差异，但尚无研究检验该领域经验丰富的病理学家达成的共识诊断的准确性。在本研究中，四位有诊断葡萄胎经验的解剖病理学家根据既定标准，通过共识诊断选出了5例HD、7例PM和10例CM。使用荧光原位杂交技术对这22例病例进行了倍体研究。15例HD和CM病例为二倍体，证实了组织学诊断。然而，7例PM病例中只有5例为三倍体，另外2例为二倍体。对这两例二倍体病例的复查显示，大小绒毛混合存在，伴有中度至显著的滋养细胞增生。基于显著的滋养细胞增生和DNA信息，这两例病例被重新分类为早期完全性葡萄胎。本研究表明，即使是该领域经验丰富的病理学家，在区分PM和CM时也存在困难。研究结果表明，在缺乏DNA信息的情况下，即使存在大小绒毛混合的情况，伴有中度至显著滋养细胞增生的水肿绒毛病变也应归类为完全性葡萄胎。倍体研究是组织学诊断的重要辅助手段，尤其是在特征存在重叠的情况下。
