脱氧核糖核酸图像细胞计量学和间期细胞遗传学分析在葡萄胎鉴别诊断、预后及临床随访中的作用。荷兰中央葡萄胎登记处的报告。

The role of deoxyribonucleic acid image cytometric and interphase cytogenetic analyses in the differential diagnosis, prognosis, and clinical follow-up of hydatidiform moles. A report from the Central Molar Registration in The Netherlands.

作者信息

van de Kaa C A, Schijf C P, de Wilde P C, Hanselaar A G, Vooijs P G

机构信息

Department of Pathology, University Hospital Nijmegen, The Netherlands.

出版信息

Am J Obstet Gynecol. 1997 Nov;177(5):1219-29. doi: 10.1016/s0002-9378(97)70043-7.

DOI:10.1016/s0002-9378(97)70043-7

PMID:9396922

Abstract

OBJECTIVES

To assess the value of deoxyribonucleic acid ploidy in the differential diagnosis and clinical follow-up of hydatidiform moles, the histopathologic features, deoxyribonucleic acid ploidy, and clinical follow-up were compared in 347 cases: 143 complete moles, 52 partial moles, and 152 abortions, of which 56 cases were hydropic abortions with histologic features of triploidy but lacked trophoblastic hyperplasia.

STUDY DESIGN

In all cases deoxyribonucleic acid image cytometry was performed, and in 85 of these cases interphase cytogenetics was also performed.

RESULTS

With use of deoxyribonucleic acid image cytometry and interphase cytogenetics, a bimodal polyploid deoxyribonucleic acid pattern was present in 97% of complete moles, 27% of partial moles, and 4% of abortions. All these cases of partial mole were reclassified to complete mole on the basis of this deoxyribonucleic acid pattern and the histopathologic features in spite of the presence of fetal blood cells, amnion, or yolk sac. Deoxyribonucleic acid triploidy was found in 95% of the remaining partial moles, in 77% of hydropic abortions with histologic features of triploidy, and in 14% of the remaining abortions. Reliable differentiation between deoxyribonucleic acid triploid partial moles and hydropic abortions with histologic features of triploidy was not possible on basis of the histopathologic features (trophoblastic hyperplasia) or 3.5c exceeding rates. Deoxyribonucleic acid diploidy was found in 1% of complete moles, 23% of hydropic abortions with features of triploidy, and 78% of the remaining abortions. Deoxyribonucleic acid tetraploidy was rarely found (1% of complete moles, 2% of partial moles, 1% of abortions). Persistent gestational trophoblastic disease developed in 33% of the bimodal deoxyribonucleic acid polyploid cases (all complete moles), in 1% of the diploid cases (concerning one of the two diploid complete moles), and in 1% of the triploid cases (partial moles).

CONCLUSION

Deoxyribonucleic acid analysis is essential in the diagnosis of hydatidiform moles to decide on clinical follow-up.

摘要

目的

为评估脱氧核糖核酸倍体在葡萄胎鉴别诊断及临床随访中的价值，对347例病例的组织病理学特征、脱氧核糖核酸倍体及临床随访情况进行了比较，其中包括143例完全性葡萄胎、52例部分性葡萄胎和152例流产病例，其中56例为具有三倍体组织学特征但缺乏滋养细胞增生的水肿性流产。

研究设计

对所有病例均进行了脱氧核糖核酸图像细胞术检测，其中85例还进行了间期细胞遗传学检测。

结果

应用脱氧核糖核酸图像细胞术和间期细胞遗传学检测发现，97%的完全性葡萄胎、27%的部分性葡萄胎和4%的流产病例呈现双峰多倍体脱氧核糖核酸模式。尽管存在胎儿血细胞、羊膜或卵黄囊，但所有这些部分性葡萄胎病例均根据这种脱氧核糖核酸模式和组织病理学特征重新分类为完全性葡萄胎。在其余部分性葡萄胎的95%、具有三倍体组织学特征的水肿性流产的77%以及其余流产病例的14%中发现了脱氧核糖核酸三倍体。基于组织病理学特征（滋养细胞增生）或3.5c超标率，无法可靠地区分脱氧核糖核酸三倍体部分性葡萄胎和具有三倍体组织学特征的水肿性流产。在1%的完全性葡萄胎、23%的具有三倍体特征的水肿性流产以及78%的其余流产病例中发现了脱氧核糖核酸二倍体。脱氧核糖核酸四倍体很少见（完全性葡萄胎的1%、部分性葡萄胎的2%、流产病例的1%）。在双峰脱氧核糖核酸多倍体病例（均为完全性葡萄胎）的33%、二倍体病例（涉及两个二倍体完全性葡萄胎中的一个）的1%以及三倍体病例（部分性葡萄胎）的1%中发生了持续性妊娠滋养细胞疾病。