Gestational trophoblastic disease abbreviated gtd, also gestational trophoblastic neoplasia abbreviated gtn, includes choriocarcinoma and hydatidiform moles. Products of conception, abbreviated poc, is stuff formed from the union of egg and sperm. To evaluate the value of histopathological examination of products of conception in first trimester abortion. Regarding ki67 labelling index in villous stromal cells, a significant. Fetal malformations with hydropic dysmorphic placental villi. The sonogram showed atrioventricular canal defect, meningocele, and omphalocele. Histological analysis was made according to the main diagnostic. Hydropic leiomyoma of the uterus presenting in pregnancy the british journal of radiology, august 2009 e165. Clinical usefulness of immunohistochemical staining of. Molar gestations and hydropic abortions differentiated by p57. Fortunately, the local pathologists correctly diagnosed pm in the two other patients who were then registered for hcg followup. Spontaneous abortion and the pathology of early pregnancy. The main rationale of routine histopathologic examination of products after firsttrimester miscarriages is to detect an ectopic pregnancy or a molar pregnancy, which require further management. If the process that causes the hydropic abortion is the.
A complementary method to the pathologic interpretation is immunohistochemistry ihc. Pathology of chorionic villi in spontaneous abortions. Read a clinical, histopathological and flow cytometric study of 149 complete moles, 146 partial moles and 107 non. Comparison of p53 expression in partial hydatidiform mole phm and hydropic abortion.
Histological analysis was made according to the main diagnostic histopathological features described in the. Diagnostic utility of twist1, ki67, and ecadherin in. A 37yearold woman with a history of one firsttrimester spontaneous abortion, two thirdtrimester fetal demises, and one live preterm birth was in the seventeen week of her fifth pregnancy. Cytogenetic and molecular diagnosis in gestational disorders katherine geiersbach, m. Clin pathol use of proliferation cell nuclear antigen. Attesting to this fact is a 1993 study by howat and associates that found 5 of 7 pathologists could reach diagnostic agreement in only 70% 35 of 50 of hydropic placentas when employing histologic criteria alone, under. Hydropic abortion was observed approximately equally in both chromosomally normal and abnormal cases, and its incidence was high in cases of trisomy 16 and tetraploid placenta.
Molar gestations and hydropic abortions differentiated by p57 immunostaining article pdf available in fetal and pediatric pathology 2323. Of the 3000 patients with pm, 15 required chemotherapy for persisting gtd. Department of anatomy and embryology, faculty of medicine, port said university, egypt. This study aims to assess whether the expression of twist1, ki67, and ecadherin can guide the differential diagnosis of complete hydatidiform mole chm, partial hydatidiform mole phm, and hydropic abortion ha. Pdf the usefulness of p57kip2 immunohistochemical staining.
She continued to bleed per vaginem and ultrasonography 14 days later showed retained products. Differentialdiagnoses include partialhydatidiform mole, hydropic abortion,and early nonmolar gestationwith some degree of trophoblastichyperplasia. In previous years, most cases of hydrops were caused by severe erythroblastosis fetalis secondary to rh iso. The other cases cases 1, 7, 8, and 14 in table 1 remained equivocal cases of partial mole, or hydropic abortion. Dna flow cytometric analysis in variable types of hydropic. The big deal for pathologists, therefore, is the correct distinction of all three.
Pdf molar gestations and hydropic abortions differentiated by p57. Hydropic spontaneous abortion normally has 46,xx or xy from both parents. Article pdf available in fetal and pediatric pathology 2323. Our study showed many dysmorphic features in the villi like reduced vessels per villous 72%, fibrosis 21. Choriocarcinoma and partial hydatidiform moles the lancet. Among the immunohistochemical markers, p63 is of great value in studying the biologic behavior of gestational trophoblastic diseases. Histologically, complete mole has floridcistern formation,trophoblasticproliferation,and absence of fetal parts.
Update on the diagnosis and management of gestational. Grossly, chm consists of hydropic villi to semitransparent vesicles of variable sizes with absence of normal placenta. In contrast, such histologic features are less marked in partial mole and fetal parts or cells are present. Thepractical implications of the problem are quite clear park, 1971. The widespread use of ultrasound in the diagnosis and management of intrauterine fetal death has resulted in moles being evacuated earlier than before. Pdf molar gestations and hydropic abortions differentiated. Oct 24, 2017 molar and nonmolar hydropic placental changes are the most common forms of gtd. Pathology, and obstetrics and gynecology, university of miamijackson memorial. Although in most cases the diagnosis of hydropic abortion. This patient nearly died before the diagnosis of choriocarcinoma was made.
Analysis of p53 expression in partial hydatidiform mole. We used p57 for the differential diagnosis of hydropic abortions and molar gestations and correlated the findings with the clinical outcome of patients in each category. Is there a correlation between histology and karyotype in. These findings signify the importance of the combined use of conventional histology and ploidy analysis in the differential diagnosis of complete hydatidiform mole, partial hydatidiform mole and hydropic abortion. When hcg became normal without chemotherapy, this occurred earlier in patients with hydropic abortion than in those with partial moles means of 46. Branches of the umbilical arteries carry embryonic blood to the villi. First, 86 cases were originally classified by histomorphology into hydropic abortion 42 and molar gestations 23 complete and 21partial. Because there are differences in the origin, morphology, and natural history of hydropic placental villous issues, it is important to identify and document rare specimens that deviate from the diploid complete hydatidiform mole cm, triploid partial hydatidiform mole pm, or diploid hydropic abortion ha. Original article histopathological study of villous. Assessment of the role of histopathology and dna image. Assessment of the role of histopathology and dna image analysis in the diagnosis of molar and nonmolar abortion. Immunohistochemical staining of p57kip2, which is an. Flow cytometric dna analysis and histopathologic reevaluation of paraffin embedded samples from hydatidiform moles and hydropic abortions.
As there is no agreement, we aimed to study whether routine histopathological examination of tissues. These included hydropic change, numbers of vessels, patency of vessels, stromal. Differential diagnosis between complete mole and hydropic. Internal examination revealed a globoid heart with an atrialventricular septal defect. Differential expression of p63 in hydropic and molar. Immunohistochemical characterization of p57kip2 expression. Value of histopathologic examination of uterine products. Department of pathology, faculty of medicine, alazhar university, damietta. Analysis of p53 expression in partial hydatidiform mole and.
In this descriptive retrospective study, formalinfixed, paraffinembedded gestational products from 40 placental tissue samples, including 10 chms, 10 phms, 10 hydropic ha and 10 non hydropic or simple spontaneous abortions sa were retrieved from the files of the department of pathology, imam reza and qaem hospitals, mashhad university of medical. Oct 31, 2015 the current study, using flow cytometry as an ancillary techniques to improve the accuracy of histopathological diagnosis, further reveals the difficulty in making the correct diagnosis in hydropic abortions especially in early gestation based on histopathology. If the betahcg is 1500 miuml there is a good chance an ultrasound is diagnostic. Differentialdiagnoses include partialhydatidiform mole, hydropic abortion,and early nonmolar gestationwith some degree of tropho. Validity of p57kip2 immunohistochemical marker in differential. Conversely, hydropic abortions carry no increased risk for neoplasia and do not require the same close followup. Dna ploidy analysis and histopathologic reevaluation were\ud performed on paraffinembedded tissue from 36 17 complete and 19 partial molar and\ud 24 hydropic abortus ha cases which were previously diagnosed based on histomorphologic\ud study. Mohammad hadi, pathology department, ghaem hospital, mashhad university of medical. Fetal malformations with hydropic dysmorphic placental.
Role of the immunohistochemical marker ki67 in diagnosis. The potential risks of operative management of this mass were discussed with the. There are separate articles for chorionic villi and gestational trophoblastic disease. Flow cytometric dna analysis and histopathologic re. Depending on the severity and cause of hydrops, there may be edema of fetus and placenta, ascites, pleural effusions andor pericardial effusions.
A dilatation and curettage d and c was done and histology was reported locally as either a hydropic abortion or partial mole. Fifteen percent of recognized pregnancies terminate in spontaneous abortion. Molar gestations and hydropic abortions differentiated by. The woman started taking an oral contraceptive pill and after irregular periods for 7 months was readmitted with bleeding after 45 days of amenorrhoea. The triploid cases, however, contributed the majority of cases with these villous changes. Recently, p53 expression was identified as a good marker for distinguishing gtd types. It can occur in a number of situations which include. Norwegian fjord periphery, circumferential or multifocal trophoblastic proliferation, fetal parts. Of the 17 cases initially diagnosed as complete hm chm, 9 were diploid,\ud 2 were. This staining did not differentiate partial moles from hydropic abortions. Complete hydatidiform mole pathology, histology, pathophysiology completely paternal genetic material no evidence of fetus no normal villi enlarged villi with central cisterns. A combination of clinical, laboratory and imaging data raises the possibility of molar pregnancy poor interobserver agreement in differentiating between complete mole, incomplete mole and hydropic abortus when using histology alone, with discordance predominantly seen in partial mole vs.
Formalinfixed, paraffinembedded gestational products from 29 patients, including 11 complete hydatidiform moles, 8 partial hydatidiform moles and 10 hydropic spontaneous abortions diagnosed in the imam reza and qhaem departments of pathology, mashhad university of medical sciences were gathered. Differentiation between hydropic abortion and molar pregnancy immunohistochemical study salaheldin sayed semary 21, alsayed a. Placental examination showed large fluidfilled grapelike structures, which microscopically appeared as dysmorphic hydropic edematous giant, avascular villi. Abortion is the commonest complication of pregnancy. Departments of histopathology and medical oncology trophoblastic disease unit, imperial. Chorionic villi are villi that sprout from the chorion to provide maximal contact area with maternal blood they are an essential element in pregnancy from a histomorphologic perspective, and are, by definition, a product of conception. A partial hydatidiform mole with scalloping of the villous border and trophoblastic inclusion. A case of molar ectopic pregnancy fertility sterility. The diagnostic implications of routine ultrasound examination in. Hydrops fetalis, also fetal hydrops, is interstitial fluid excess edema in a fetus. In this study, we have evaluated 111 products of conception from the first trimester. Proliferative activity in placentas with hydropic change and. To determine whether the expres sion ofproliferating cell nuclear antigen pcna in villous cytotrophoblast could distinguish betweenplacental tissue from a hydropic abortion and that from a. Such hydropic change in placental tissue has long been recognized as a relatively common finding in abortuses meyer, 1919 and has been investigated in detail byhertigandedmonds1940 andbynilsson 1957.
This was identified as choriocarcinoma in three cases. An alternative approach is to examine the products only when there is a definite indication. Cm can occur as ectopie pregnancy but ober and maier 2z accepted as genuine only 4 of 22 reported cases. The histology was not sent for a specialist opinion and the patient was not registered for hcg followup.
It does not help distinguish complete mole from hydropic abortion. In order to clarify clinicopathologic features of early partial mole pm, morphology and dna ploidy of early. Prenatal diagnosis by amniocentesis has been advocated to rule out triploidy or any other genetic abnormalities, before advising the continuation of a pregnancy 4,12. Differential diagnosis between hydropic abortion, partial mole and complete mole is still a challenge for pathologists but really important for patient management.
Serum hcg is usually moderately elevated and a fetus may be seen on the ultrasound. Histological differential diagnosis of hydatidiform moles. Hydropic abortion was observed approximately equally in both chromosomally. The usefulness of p57kip2 immunohistochemical staining and genotyping test in the diagnosis of the hydatidiform mole. We investigated the apparently high incidence of tubal ectopic hydatidiform moles in women referred for treatment to a supraregional trophoblastic tumour. Ki67 expression in hydatidiform moles and hydropic abortions. These patients are usually followed postevacuation by betahuman chorionic gonadotrophin bhcg serum levels 1. Hydropic degeneration of the placenta is a phenomenon where numerous cystic spaces are formed within the placenta which is often accompanied by placental enlargement. Molar and nonmolar hydropic placental changes are the most common forms of gtd. Early complete hydatidiform moles have minimal or no gross evidence of abnormal villi. Differential diagnosis between complete mole and hydropic abortus by deoxyribonucleic acid fingerprints author links open overlay panel toshikatsu nohunaga md chihiro azuma md, dmsci tadashi kimura md yoshihiro tokugawa md masahiko takemura md shoji kamiura iud fumitaka saji md, dmsci osamu tanizawa md, dmsci. After circulating through the capillaries of the villi, blood returns to the embryo. We investigated the apparently high incidence of tubal ectopic hydatidiform moles in women referred for treatment to a supraregional trophoblastic tumour screening and treatment centre between 1986 and 1996. Molar gestations and hydropic abortions differentiated by p57 immunostaining.
Typically, complete mole is diploid and has 46,xx chromosomes with both xs from paternal origin whereas partial mole is triploid with maternal and paternal genetic origin. Is there a correlation between histology and karyotype in early spontaneous abortion. Hydropic leiomyoma of the uterus presenting in pregnancy. Tubal ectopic hydatidiform moles are rare lesions, and only 40 cases have been reported in the world literature.
Since the interval from the causative pregnancy to the time of gtn diagnosis carries prognostic information, genotyping can be helpful particularly in patients with multiple pregnancies 1. There may be many more abortions in early and unrecognized pregnancies. Cytogenetic and molecular diagnosis in gestational disorders. Pdf histological analysis of the products of conception. A clinical, histopathological and flow cytometric study of. Tab probably reasonable to sign out on one slide with normal villi. Report twin pregnancy with hydatidiform mole and co.
To describe the diagnostic methods enabling histological differential diagnosis of complete hydatidiform mole, immature complete hydatidiform mole, partial hydatidiform mole, proliferative mole and hydropic abortion. Hydropic definition of hydropic by medical dictionary. Immunohistochemical characterization of p57kip2 expression in. Because there are differences in the origin, morphology, and natural history of hydropic placental villous issues, it is important to identify and document rare specimens that deviate from the diploid complete hydatidiform mole cm, triploid partial hydatidiform mole pm, or diploid hydropic abortion.
Hydropic villi from a miscarriage showing no tropho. Differential diagnosis of gtd is sometimes problematic. However, none of the complete hydatidiform moles analyzed exhibited p57 positivity in cytotrophoblasts and stromal cells. Attesting to this fact is a 1993 study by howat and associates that found 5 of 7 pathologists could reach diagnostic agreement in only 70% 35 of 50 of hydropic placentas. There is a significant statistical relationship regarding ki67 labeling index in villous cytotrophoblasts between partial moles and hydropic abortion, complete mole and partial moles, hydropic abortion and complete mole. The utility of p53, p63, p57 and ki67 immunohistochemistry. Hydrops fetalis is an excess accumulation of fluid in the fetus. Pathology of chorionic villi in spontaneous abortions anwar ul haque, saadia siddique, mahera mustafa jafari, imjaad hussain and. Female reproductive system pathology abortion interruption of pregnancy prior to fetal viability abortion fetus and placenta expelled, normal function returns incomplete abortion retention of some fetal or placental material.
These 4 cases of complete moles as well as the other cases were followed to. Methods material from 18 partial hydatidiform moles and 15 hydropic abortions was retrieved from the files of the department of reproductive. Hydropic degeneration of the placenta radiology reference. In cases of doubt regarding the type of molar pregnancy, dna.
423 802 1194 393 752 541 812 315 1435 46 468 82 1255 1438 1396 691 389 947 661 1545 351 1472 267 1042 701 1273 132 755 51 1488 1338 614 1496 1551 264 810 351 1344 761 977 785 166 394 1253