Redline R W, Hassold T, Zaragoza M
Department of Pathology, Case Western Reserve University, Cleveland, Ohio, USA.
Mod Pathol. 1998 Aug;11(8):762-8.
The diagnosis of complete and partial mole with its subsequent risk of trophoblastic malignancy relies on histologic criteria that are sometimes seen in nonmolar conceptuses. We performed karyotypic analysis on 1054 spontaneous abortions during a 43-month period. Villous trophoblastic hyperplasia was graded from 0 to 3 in successfully karyotyped cases of complete mole, triploidy, tetraploidy, monosomy X, trisomy, normal 46,XY, and normal 46,XX without contaminating maternal tissues (n = 649). Parental origin of the extra chromosome was analyzed by polymerase chain reaction in 64 trisomic cases. We also evaluated for each case the developmental stage, presence of uniformly hydropic villi, amnion, villous nucleated red blood cells, and fetal tissue. Villous trophoblastic hyperplasia was increased in spontaneous abortions with abnormal karyotype as a group and in the subgroup with trisomy compared with those of a normal karyotype. Hyperplasia and particularly high-grade hyperplasia (Grades 2-3), equivalent in severity to that seen in proliferative partial and complete moles was most frequent in a subgroup of trisomies involving chromosomes 7 (60% hyperplasia, with 30% of high grade), 15 (50% hyperplasia, 15% high grade), 21 (22% hyperplasia, 11% high grade), and 22 (13% hyperplasia, 4% high grade). Frequency of paternal origin for the extra chromosome in these four trisomies was similar in cases with and without hyperplasia There was a nonsignificant increase in female sex chromosomes with hyperplasia in both trisomic and normal conceptuses. Hyperplasia was more common in trisomic abortions of late stage (> 8.5 wk, P = .013), in those that lacked uniformly hydropic villi (P < .001), and in those that lacked fetal tissue (P = .204). This latter phenotype was particularly common with trisomies 15, 21, and 22.
完全性和部分性葡萄胎的诊断及其后续滋养细胞恶性肿瘤的风险取决于组织学标准，而这些标准有时在非葡萄胎妊娠产物中也可见。我们在43个月的时间里对1054例自然流产进行了核型分析。在成功进行核型分析的完全性葡萄胎、三倍体、四倍体、X单体、三体、正常46,XY和正常46,XX且无母体组织污染的病例（n = 649）中，绒毛滋养细胞增生程度从0到3级进行分级。通过聚合酶链反应分析了64例三体病例中额外染色体的亲本来源。我们还评估了每个病例的发育阶段、是否存在均匀性水肿绒毛、羊膜、绒毛有核红细胞和胎儿组织。与正常核型的自然流产相比，核型异常的自然流产组以及三体亚组中的绒毛滋养细胞增生增加。增生，尤其是高级别增生（2 - 3级），其严重程度与增殖性部分性和完全性葡萄胎相当，在涉及7号染色体（60%增生，30%高级别）、15号染色体（50%增生，15%高级别）、21号染色体（22%增生，11%高级别）和22号染色体（13%增生，4%高级别）的三体亚组中最为常见。在有增生和无增生的病例中，这四种三体中额外染色体的父系来源频率相似。在三体和正常妊娠产物中，增生与女性性染色体的增加均无显著差异。增生在晚期三体性流产（> 8.5周，P = 0.013）、缺乏均匀性水肿绒毛的流产（P < 0.001）以及缺乏胎儿组织的流产（P = 0.204）中更为常见。后一种表型在15、21和22三体中尤为常见。
