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Nagy A, Niu N, Sun T, Buza N, Hui P. Diandric triploid partial mole versus digynic nonmolar triploidy: is morphological assessment sufficient for the diagnostic distinction? Histopathology 2024. [PMID: 39031756 DOI: 10.1111/his.15247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 07/22/2024]
Abstract
AIMS Diagnostic separation of diandric triploid gestation, i.e. partial mole from digynic triploid gestation, is clinically relevant, as the former may progress to postmolar gestational trophoblastic neoplasia. The aim of the study was to investigate if the combination of abnormal histology combined with ploidy analysis-based triploidy is sufficient to accurately diagnose partial mole. METHODS AND RESULTS A genotype-phenotype correlation study was undertaken to reappraise histological parameters among 20 diandric triploid gestations and 22 digynic triploid gestations of comparable patient age, gestational weeks, and clinical presentations. Two villous populations, irregular villous contours, pseudoinclusions, and syncytiotrophoblast knuckles, were common in both groups. Villous size ≥2.5 mm, cistern formation, trophoblastic hyperplasia, and syncytiotrophoblast lacunae were significantly more common in the partial hydatidiform mole. Cistern formation had the highest positive predictive value (PPV) (93%) and highest specificity (96%) for diandric triploid gestation, although the sensitivity was 70%. Cistern formation combined with villous size ≥2.5 mm or trophoblast hyperplasia or syncytiotrophoblast lacunae had 100% specificity and PPV, but a marginal sensitivity of 60%-65%. A moderate interobserver agreement (Kappa = 0.57, Gwet's AC1 = 0.59) was achieved among four observers who assigned diagnosis of diandric triploid gestation or digynic triploidy solely based on histology. CONCLUSIONS None of histological parameters are unique to either diandric triploid gestation or digynic triploid gestation. Cistern formation is the most powerful discriminator, with 93% PPV and 70% sensitivity for diandric triploid gestation. While cistern formation combined with either trophoblastic hyperplasia or villous size ≥2.5 mm or syncytiotrophoblast lacunae has 100% PPV and specificity for diandric triploid gestation, the sensitivity is only 60% to 65%. Therefore, in the presence of triploidy, histological assessment is unable to precisely classify 35% to 40% of diandric triploid gestations or partial moles.
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Affiliation(s)
- Agnes Nagy
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Na Niu
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
- Center for the Precision Medicine of Trophoblastic Disease, Yale School of Medicine, New Haven, CT, USA
| | - Tong Sun
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Natalia Buza
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
- Center for the Precision Medicine of Trophoblastic Disease, Yale School of Medicine, New Haven, CT, USA
| | - Pei Hui
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
- Center for the Precision Medicine of Trophoblastic Disease, Yale School of Medicine, New Haven, CT, USA
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2
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Usui H. Auxiliary and experimental diagnostic techniques for hydatidiform moles. J Obstet Gynaecol Res 2022; 48:3077-3086. [PMID: 36098274 DOI: 10.1111/jog.15422] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 08/28/2022] [Indexed: 11/30/2022]
Abstract
Hydatidiform moles are classified into complete hydatidiform moles (CHMs), which are androgenetic and diploid, and partial hydatidiform moles (PHM), which are triploid with two paternal chromosomes and one maternal chromosome. The incidence of gestational trophoblastic neoplasia differs substantially between CHM and PHM. However, they are occasionally difficult to diagnose. In this review, auxiliary and experimental methods based on cytogenetic features and advanced molecular detection techniques applied to the diagnosis and analysis of hydatidiform moles are summarized, including basic principles, characteristics, and clinical implications. Short tandem repeat polymorphism analysis is considered the gold standard for the genetic diagnosis of hydatidiform moles. In clinical settings, immunohistochemical analyses of p57KIP2 , an imprinted gene product, are widely used to differentiate CHMs from other conceptuses, including PHMs. Recently, new molecular genetic techniques, such as single nucleotide polymorphism arrays, have been applied to research on hydatidiform moles. In addition to insights from classical methods, such as chromosome analysis, recently developed approaches have yielded novel findings related to the mechanism underlying the development of androgenetic CHMs.
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Affiliation(s)
- Hirokazu Usui
- Department of Reproductive Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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3
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Choi NY, Bang JS, Park YS, Lee M, Hwang HS, Ko K, Myung SC, Tapia N, Schöler HR, Kim GJ, Ko K. Generation of human androgenetic induced pluripotent stem cells. Sci Rep 2020; 10:3614. [PMID: 32109236 PMCID: PMC7046633 DOI: 10.1038/s41598-020-60363-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 02/10/2020] [Indexed: 11/09/2022] Open
Abstract
In humans, parthenogenesis and androgenesis occur naturally in mature cystic ovarian teratomas and androgenetic complete hydatidiform moles (CHM), respectively. Our previous study has reported human parthenogenetic induced pluripotent stem cells from ovarian teratoma-derived fibroblasts and screening of imprinted genes using genome-wide DNA methylation analysis. However, due to the lack of the counterparts of uniparental cells, identification of new imprinted differentially methylated regions has been limited. CHM are inherited from only the paternal genome. In this study, we generated human androgenetic induced pluripotent stem cells (AgHiPSCs) from primary androgenetic fibroblasts derived from CHM. To investigate the pluripotency state of AgHiPSCs, we analyzed their cellular and molecular characteristics. We tested the DNA methylation status of imprinted genes using bisulfite sequencing and demonstrated the androgenetic identity of AgHiPSCs. AgHiPSCs might be an attractive alternative source of human androgenetic embryonic stem cells. Furthermore, AgHiPSCs can be used in regenerative medicine, for analysis of genomic imprinting, to study imprinting-related development, and for disease modeling in humans.
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Affiliation(s)
- Na Young Choi
- Department of Stem Cell Biology, School of Medicine, Konkuk University, Seoul, 05029, Republic of Korea
- Center for Stem Cell Research, Institute of Advanced Biomedical Science, Konkuk University, Seoul, 05029, Republic of Korea
| | - Jin Seok Bang
- Department of Stem Cell Biology, School of Medicine, Konkuk University, Seoul, 05029, Republic of Korea
- Center for Stem Cell Research, Institute of Advanced Biomedical Science, Konkuk University, Seoul, 05029, Republic of Korea
| | - Yo Seph Park
- Department of Stem Cell Research, TJC Life Research and Development Center, TJC Life, Seoul, 06698, Republic of Korea
| | - Minseong Lee
- Department of Stem Cell Biology, School of Medicine, Konkuk University, Seoul, 05029, Republic of Korea
- Center for Stem Cell Research, Institute of Advanced Biomedical Science, Konkuk University, Seoul, 05029, Republic of Korea
| | - Han Sung Hwang
- Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, 05030, Republic of Korea
| | - Kisung Ko
- Department of Medicine, College of Medicine, Chung-Ang University, Seoul, 06974, Republic of Korea
| | - Soon Chul Myung
- Department of Urology, Chung-Ang University College of Medicine, Seoul, 06974, Republic of Korea
| | - Natalia Tapia
- Institute of Biomedicine of Valencia, Spanish National Research Council, Jaime Roig 11, 46010, Valencia, Spain
| | - Hans R Schöler
- Department of Cell and Developmental Biology, Max Planck Institute for Molecular Biomedicine, 48149, Münster, Germany
- Medical Faculty, University of Münster, 48149, Münster, Germany
| | - Gwang Jun Kim
- Department of Obstetrics and Gynecology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, 06974, Republic of Korea
| | - Kinarm Ko
- Department of Stem Cell Biology, School of Medicine, Konkuk University, Seoul, 05029, Republic of Korea.
- Center for Stem Cell Research, Institute of Advanced Biomedical Science, Konkuk University, Seoul, 05029, Republic of Korea.
- Research Institute of Medical Science, Konkuk University, Seoul, 05029, Republic of Korea.
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4
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Development of a silver in situ hybridisation based assay for the determination of ploidy status in molar pregnancy diagnosis. Pathology 2013; 46:15-20. [PMID: 24300715 DOI: 10.1097/pat.0000000000000025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to establish a scoring method for ploidy analysis using silver in situ hybridisation (SISH) with a chromosome 17 centromere probe. SISH was performed using the Ventana chromosome 17 centromere probe on sections from formalin fixed, paraffin embedded archival cases of complete hydatidiform moles, partial hydatidiform moles and hydropic products of conception with previously established ploidy status (determined by flow cytometry or karyotyping). In order to determine ploidy status, a scoring method was developed based on both the average number of signals per nucleus (ASN) and the percentage of nuclei with three signals (N3S), enumerated in 50 villous cytotrophoblastic and/or stromal cells. The results of four independent observers were compared individually and collectively with previously established ploidy status. There was a highly statistically significant difference between diploid and triploid gestations for ASN (1.86 ± 0.13 and 2.70 ± 0.16 respectively, Student t-test, p < 0.0001) and for N3S (1.14 ± 1.65 and 71.59 ± 14.25 respectively, Student t-test, p < 0.0001). The sensitivity and specificity of the SISH-based assay was 99.1% and 100% respectively for ASN, and 100% and 100% respectively for N3S. A chromosome 17 centromere probe SISH-based assay can reliably distinguish between diploid and triploid gestations. This test has diagnostic utility in distinguishing partial hydatidiform moles from histological mimics.
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5
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Hoffner L, Surti U. The genetics of gestational trophoblastic disease: a rare complication of pregnancy. Cancer Genet 2012; 205:63-77. [DOI: 10.1016/j.cancergen.2012.01.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 12/15/2011] [Accepted: 01/10/2012] [Indexed: 11/28/2022]
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Abstract
Gestational trophoblastic disease consists of well-defined diagnostic entities of proliferative disorder of the placenta, of which hydatidiform moles are common lesions. Even with available ancillary studies, including ploidy and immunohistochemistry analyses, histological diagnosis of molar pregnancies can be challenging in a significant percentage of the cases. Reliable diagnostic approaches with improved sensitivity and specificity are highly desirable. Recently, PCR-based short tandem repeat DNA genotyping has emerged as a powerful diagnostic measure in the workup of gestational trophoblastic disorders, particularly hydatidiform moles.
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Affiliation(s)
- Pei Hui
- Department of Pathology, Yale University School of Medicine, BML 254B, 310 Cedar Street, New Haven, CT 06520-8023, USA.
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7
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Dubé V, Chun K, Osborne R, Sherman C, Nofech-Mozes S, Ismiil N, Saad R, Khalifa M. Androgenetic complete mole with trisomy 13: Report of a case with microsatellite genotyping and review of the literature. Pathol Res Pract 2010; 206:776-81. [DOI: 10.1016/j.prp.2010.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Revised: 02/08/2010] [Accepted: 02/25/2010] [Indexed: 11/28/2022]
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8
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Abstract
Hydatidiform mole (HM) is a human pregnancy with no embryo but cystic degeneration of chorionic villi. The common form of this condition occurs in 1 in every 1500 pregnancies in western societies and at a higher incidence in some geographic regions and populations. Recurrent moles account for 2% of all molar cases and a few of them occur in more than one family member. By studying a familial form of recurrent moles, a recessive maternal locus responsible for this condition was mapped to 19q13.4 and causative mutations identified. The defective protein, NALP7, is part of the CATERPILLAR protein family with roles in pathogen-induced inflammation and apoptosis. The exact role of NALP7 in the pathophysiology of molar pregnancies is unknown yet. NALP7 could have a role either in oogenesis or in the endometrium during trophoblast invasion and decidualization. In this review, we outlined recent advances in the field of HMs and reviewed the literature in the light of the new data.
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Affiliation(s)
- R Slim
- Departments of Human Genetics, McGill University Health Center, Montreal H3G 1A4, Canada.
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Heteroparental blastocyst production from microsurgically corrected tripronucleated human embryos. Fertil Steril 2006; 86:1601-7. [PMID: 17067583 DOI: 10.1016/j.fertnstert.2006.04.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2006] [Revised: 04/28/2006] [Accepted: 04/28/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To prove the efficiency of identification and removal of one of the surplus paternal pronuclei in dispermic IVF zygotes to obtain heteroparental blastocysts. DESIGN Experimental. SETTING One hundred fourteen tripronucleated (3PN) embryos from conventional IVF. PATIENT(S) After informed and signed consent, the patients from Instituto Valenciano Infertilidad (IVI), Valencia, donated their abnormally fertilized embryos. INTERVENTION(S) Seventy-two embryos were diploidized by microsurgical removal of the pronucleus located at the farthest position to the second polar body. Forty-two 3PN embryos served as controls. MAIN OUTCOME MEASURE(S) Survival and correction rate; in vitro development up to the blastocyst stage; X, Y, and 18 chromosome determination by triple fluorescent in situ hybridization and, inheritance analysis for 10 polymorphic repeat regions using polymerase chain reaction (PCR) amplification and sequencing. RESULT(S) Seventy-eight percent of 3PN zygotes (56/72) survived manipulation and eventually 51 zygotes had two pronuclei (71%). Forty-one percent of manipulated embryos progressed in vitro to the blastocyst stage (21/51). Fluorescent in situ hybridization analysis performed on eight manipulated embryos confirmed their diploid state; all four controls were triploid. Heteroparental inheritances were also confirmed in four of six manipulated embryos. CONCLUSION(S) Heteroparental blastocysts can be derived from corrected dispermic zygotes.
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Lai CYL, Chan KYK, Khoo US, Ngan HYS, Xue WC, Chiu PM, Tsao SW, Cheung ANY. Analysis of gestational trophoblastic disease by genotyping and chromosome in situ hybridization. Mod Pathol 2004; 17:40-8. [PMID: 14631372 DOI: 10.1038/modpathol.3800010] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hydatidiform mole is classified into partial and complete subtypes according to histopathological and genetic criteria. Distinction between the two by histology alone may be difficult. Genetically, a complete mole is diploid without maternal contribution, whereas a partial mole is triploid with a maternal chromosome complement. To assess the accuracy of histological diagnosis by correlating with the genetic composition, we performed fluorescent microsatellite genotyping to detect the presence or absence of maternal genome in a hydatidiform mole and carried out chromosome in situ hybridization to analyze the ploidy. For genotyping analysis, paraffin sections of 36 complete and nine partial moles, diagnosed according to histological criteria, were microdissected and DNA was separately extracted from the decidua and molar villi. Six pairs of primers that flank polymorphic microsatellite repeat sequences on five different chromosomes were used. In all, 34 cases, including 31 complete moles and three partial moles diagnosed histologically, showed no maternal contribution by genotyping; thus these could be genetically considered as complete mole. The other 11 cases (five complete moles and six partial moles previously diagnosed by histology) showed the presence of maternal contribution and were genetically diagnosed as partial moles. The genotyping results correlated with histological evaluation in 88% (37/45) of hydatidiform mole and correlated with chromosome in situ hybridization findings in all the cases, that is, triploid hydatidiform moles had maternal-derived alleles, while diploid hydatidiform moles were purely androgenetic. Compared with genetic diagnosis, histological evaluation was more reliable for the diagnosis of a complete mole (91%, 31/34) than that of a partial mole (55%, 6/11) (P=0.0033). Seven complete moles and three partial moles diagnosed genetically developed gestational trophoblastic neoplasia. To conclude, genotyping and chromosome in situ hybridization can provide reliable adjunct to histology for the classification of a hydatidiform mole, especially in cases with difficult histological evaluation and early gestational age. As a partial mole still carries a risk of developing gestational trophoblastic neoplasia, follow-up is considered necessary for both complete and partial moles.
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Affiliation(s)
- Caroline Y L Lai
- Department of Pathology, The University of Hong Kong, Hong Kong, China
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11
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Fan JB, Surti U, Taillon-Miller P, Hsie L, Kennedy GC, Hoffner L, Ryder T, Mutch DG, Kwok PY. Paternal origins of complete hydatidiform moles proven by whole genome single-nucleotide polymorphism haplotyping. Genomics 2002; 79:58-62. [PMID: 11827458 DOI: 10.1006/geno.2001.6676] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Complete hydatidiform moles (CHMs) are diploid tumors that result from fertilization of an empty ovum by a haploid 23,X sperm. In most cases, the resulting duplication of the genome gives rise to a 46,XX genotype and is thought to be androgenetic in origin. If this hypothesis is correct, then the genotypes of all polymorphic markers in CHMs should be homozygous. We used a dense set of single-nucleotide polymorphism (SNP) markers, evenly spaced throughout the genome, to definitively test this hypothesis. We genotyped genomic DNA samples from five CHMs and their corresponding maternal samples with 1494 SNP markers using high-density microarrays (HuSNP). As predicted, the maternal samples were heterozygous at >25% of the markers, which is consistent with the expected average heterozygosity of this panel of SNPs. In contrast, the five CHM samples were heterozygous at <0.75% of the SNP markers, which shows that these diploid tumors consist of a duplicated set of chromosomes. Because the CHM genotypes represent the haplotypes of their genomes, our results show that long-range haplotypes can be obtained easily with this resource and that a collection of such samples is a simple way to obtain reference haplotypes for association studies in various populations.
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Affiliation(s)
- Jian-Bing Fan
- Affymetrix, 3380 Central Expressway, Santa Clara, CA 95051, USA
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12
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Affiliation(s)
- H T Lynch
- Creighton University School of Medicine, Department of Preventive Medicine, Omaha, NE 68178, USA
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13
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Abstract
BACKGROUND Gestational trophoblastic disease consists of a group of interrelated diseases, including molar pregnancy, placental site trophoblastic tumor, and choriocarcinoma. METHODS Advances in the diagnosis and management of gestational trophoblastic diseases over the past 5 years were reviewed. RESULTS Molar pregnancy is now categorized as complete or partial on the basis of gross and microscopic histopathologic and karyotypic findings. Early detection of persistent gestational trophoblastic tumor (GTT) depends on careful postmolar gonadotropin follow-up and consideration of the diagnosis for any woman of reproductive age with unexplained gynecologic and/or systemic symptoms. Triple therapy with methotrexate, actinomycin D, and cyclophosphamide was once the preferred treatment for patients with high risk metastatic GTT but induced remission in only about 50%. Treatment with etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine is now the preferred regimen for treatment of high risk metastatic GTT and has been shown to induce remission in about 70% of patients. CONCLUSIONS Important advances have been made in the diagnosis and treatment of patients with gestational trophoblastic disease, and patients can be reassured that they can anticipate normal reproductive functioning.
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Affiliation(s)
- R S Berkowitz
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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14
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Berkowitz RS, Bernstein MR, Harlow BL, Rice LW, Lage JM, Goldstein DP, Cramer DW. Case-control study of risk factors for partial molar pregnancy. Am J Obstet Gynecol 1995; 173:788-94. [PMID: 7573245 DOI: 10.1016/0002-9378(95)90342-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The purpose of our study was to identify risk factors for partial molar pregnancy from a woman's general, reproductive, and dietary history. STUDY DESIGN Sixty-five women with pathologically confirmed partial molar pregnancy were interviewed, and their experiences were compared with those of 130 age-matched control women who had successfully completed a pregnancy with delivery of a live infant at the same hospital during the same calendar period. RESULTS Multivariate analysis revealed that exposures which independently and significantly predicted increased risk for partial molar pregnancy included irregular cycles, pregnancy histories including only male infants among prior live births, and oral contraceptive use for > 4 years. Dietary factors previously postulated for complete molar pregnancy including protein, fat, vitamin A, or carotene were found not to be related to risk for partial molar pregnancy. CONCLUSION Epidemiologic patterns for complete and partial molar pregnancies appear to differ somewhat; risk for partial mole is associated with reproductive history but not dietary factors.
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Affiliation(s)
- R S Berkowitz
- New England Trophoblastic Disease Center, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
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15
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Yabe N, Maeda T, Kashiwagi N, Obata F. Genetic analysis of hydatidiform moles utilizing the oligonucleotide-DNA typing of the HLA-DRB gene. Placenta 1994; 15:541-9. [PMID: 7997453 DOI: 10.1016/s0143-4004(05)80422-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The genetic origin of hydatidiform moles was analysed utilizing HLA-DNA typing. Using HLA-DR type-specific oligonucleotide probes, the DRB types of seven moles were determined and compared with the parental DRB types to determine the paternal and/or maternal origin of the moles. In four cases, the molar tissues showed single DRB types of paternal origin, although in one, the molar DRB type was also possessed by the mother. These four moles were, therefore, considered to be androgenetic in origin. Chromosomal karyotyping was carried out for three of these cases and confirmed the DR-DNA typing results. Two moles demonstrated a DRB-type triplet, which strongly suggested triploidy. Although one mole showed a heterozygous DRB type, karyotyping indicated triploidy (69, XXX) and suggested that this mole was caused by dispermy-fertilization, in which both of the sperms had the same DRB type. Although the majority (about 80%) of partial hydatidiform moles have been reported to be triploid as a result of dispermy, four of the moles analysed in this study (cases 1, 2, 3 and 4), diagnosed as partial macroscopically and/or histopathologically, were found to be androgenetic in origin using karyotyping and DR-DNA typing. Therefore, HLA-DR DNA typing, combined in some cases with karyotyping, provides an accurate method for diagnosing androgenesis and triploidy in complete and partial hydatidiform moles.
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Affiliation(s)
- N Yabe
- Department of Clinical Pathology, Kitasato University School of Medicine, Kanagawa, Japan
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Dorreen MS. The gestational trophoblastic diseases: a review of their presentation and management. Clin Oncol (R Coll Radiol) 1993; 5:46-56. [PMID: 8381017 DOI: 10.1016/s0936-6555(05)80698-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- M S Dorreen
- Department of Clinical Oncology, Weston Park Hospital, Sheffield, UK
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17
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Ko TM, Hsieh CY, Ho HN, Hsieh FJ, Lee TY. Restriction fragment length polymorphism analysis to study the genetic origin of complete hydatidiform mole. Am J Obstet Gynecol 1991; 164:901-6. [PMID: 1672240 DOI: 10.1016/0002-9378(91)90537-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
To determine the genetic origin of the complete hydatidiform mole, 20 abnormal pregnancies were studied with restriction fragment length polymorphism with five genomic probes: EJ 6.6, beta-globin gene, 3'alpha-hypervariable region, J-Bir, and St14. In the 12 cases of molar pregnancy, pure paternal origin was proved in 11 cases, but both maternal and paternal inheritance were shown in only one case. In the cases with pure paternal origin, all of the restriction fragment length polymorphisms were homozygous, although those of the fathers were heterozygous at 15 loci. In the four cases that mimicked hydatidiform mole but were diagnosed as hydropic change of villi, both paternal and maternal inheritance were noted. In the four pregnancies with blighted ovum, both paternal and maternal inheritance were shown in three cases; and in one case with a balanced translocation between chromosomes 13 and 14, only paternal inheritance was noted. This study showed that most of the complete hydatidiform moles were caused by fertilization of an empty egg by a duplicated haploid sperm, but rare exceptions may exist.
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Affiliation(s)
- T M Ko
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Republic of China
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18
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Takeuchi S. Is production of blocking antibodies in successful human pregnancy an epiphenomenon? Am J Reprod Immunol 1990; 24:108-19. [PMID: 2085393 DOI: 10.1111/j.1600-0897.1990.tb01048.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- S Takeuchi
- Department of Obstetrics and Gynecology, Teiko University School of Medicine, Tokyo, Japan
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19
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Abstract
Hydatidiform moles can be classified into two distinct entities: complete and partial. Complete moles are androgenetically derived, are characterized by a predominance of the 46,XX karyotype, and are associated with a significantly higher incidence of malignant sequelae than are partial moles. A subset of complete moles resulting from dispermy are heterozygous (46,XY) and appear to be associated with the greatest risk of malignancy. Free subunits of human chorionic gonadotropin, beta core fragments, and acidic variants of human chorionic gonadotropin can now be readily measured by radioimmunoassays, fluoroimmunoassays, or isoelectric focusing techniques. Determination of these markers can be of value not only in monitoring response to therapy, but also as prognostic indicators. A subgroup of patients, traditionally classified as "high risk" or poor prognosis, who show poor responses to conventional combination chemotherapy have recently been designated as "ultra-high-risk" patients. They require more complex chemotherapy and possibly surgery and radiotherapy to achieve remission. The development of chemotherapy over the past decade, including the introduction of etoposide and cisplatin into current protocols and the treatment of patients with advanced gestational trophoblastic disease, are considered in this review.
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Affiliation(s)
- W B Jones
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY
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20
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Abstract
Correction of polyspermy through pronucleus extraction in the absence of membrane relaxants was applied to 25 polyspermic human zygotes. Nine zygotes survived the procedure, and seven cleaved normally (two of which were fixed for chromosome analysis); two proceeded to compact and one cavitated. Eighteen of the polyspermic zygotes (14 with three pronuclei and 4 with four pronuclei) were obtained from zona pellucida-intact oocytes, and seven (1 five-pronucleate 3 four-pronucleate, and 3 three-pronucleate) from previously zona-drilled oocytes. Survival and cleavage occurred in all groups except in four- and five-pronucleate zona-drilled zygotes. Criteria used to identify male pronuclei were (1) pronucleus-associated sperm tails, (2) increased pronucleus size, and (3) greater distance (relative to female pronuclei) from the second polar body. Sperm tails were never seen and pronucleus size usually was identical. Therefore, the third criterion was used, although its reliability should be further evaluated. Until complete pronucleus removal techniques and reliable pronucleus selection criteria are perfected, embryo replacement after polyspermy correction could result in aneuploidy and molar pregnancy.
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Affiliation(s)
- H E Malter
- Department of Gynecology and Obstetrics, Emory University Medical School, Atlanta, Georgia 30322
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Fisher RA, Povey S, Jeffreys AJ, Martin CA, Patel I, Lawler SD. Frequency of heterozygous complete hydatidiform moles, estimated by locus-specific minisatellite and Y chromosome-specific probes. Hum Genet 1989; 82:259-63. [PMID: 2567275 DOI: 10.1007/bf00291166] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Restriction fragment length polymorphisms identified with three locus-specific minisatellite probes and banding patterns with Y chromosome-specific probes have been examined in 39 cases of complete hydatidiform mole (CHM) and the parents. All 39 cases were shown to be androgenetic. Of the 39 cases, 8 were identified as heterozygous CHM using the minisatellite probes. Estimates for the total number of heterozygous CHM in the series ranged from 23%-29%, higher than previously reported. Of the eight identified heterozygous CHM, six had Y chromosome-specific sequences whereas two were female; this is not significantly different from the 2:1 ratio expected. The low frequency of 46,XX heterozygous CHM in the literature may reflect difficulties in distinguishing them from 46,XX homozygous CHM. Examination of RFLPs with a small panel of locus-specific minisatellite probes provides a powerful method of classifying hydatidiform mole, enabling the rare heterozygous 46,XX CHM to be accurately identified.
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Affiliation(s)
- R A Fisher
- Institute of Cancer Research, London, UK
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22
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Surti U, Habibian R. Chromosomal rearrangement in choriocarcinoma cell lines. CANCER GENETICS AND CYTOGENETICS 1989; 38:229-40. [PMID: 2720636 DOI: 10.1016/0165-4608(89)90664-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Malignant trophoblastic cells from four choriocarcinoma cell lines were evaluated in detail using Q, G, and C banding at various passages. The modal chromosome numbers for BeWo, DoSmi, ElFa, and Jar were 73, 71, 77, and 72, respectively. All the four tumor cell lines exhibited extensive chromosomal rearrangements with several consistent marker chromosomes in each. The majority of these markers have not been previously recognized in this malignancy. Rearrangements of chromosomes 1, 7, 9, 10, and 12 were noted in all four cell lines, but abnormalities of chromosomes 1 and 12 were not consistently present in ElFa and Jar, respectively. Telomeric associations were observed in two cell lines involving chromosomes 11 and 21 as well as chromosomes 3 and 12, resulting in two consistent marker chromosomes. A total of 86 breakpoints were involved in the consistent rearrangements observed in all four cell lines. Most of these breakpoints were located on chromosomes 1, 3, 9, 13, 12, 7, and 21, in order of frequency.
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MESH Headings
- Choriocarcinoma/genetics
- Chromosome Aberrations
- Chromosome Banding
- Chromosomes, Human, Pair 1
- Chromosomes, Human, Pair 12
- Chromosomes, Human, Pair 13
- Chromosomes, Human, Pair 21
- Chromosomes, Human, Pair 3
- Chromosomes, Human, Pair 7
- Chromosomes, Human, Pair 9
- Genetic Markers
- Humans
- Karyotyping
- Male
- Tumor Cells, Cultured
- Y Chromosome
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Affiliation(s)
- U Surti
- Department of Pathology, Magee Womens Hospital, University of Pittsburgh, Pennsylvania 15213
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23
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Berkowitz RS, Goldstein DP. Diagnosis and Management of the Primary Hydatidiform Mole. Obstet Gynecol Clin North Am 1988. [DOI: 10.1016/s0889-8545(21)00122-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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24
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Habibian R, Surti U. Cytogenetics of trophoblasts from complete hydatidiform moles. CANCER GENETICS AND CYTOGENETICS 1987; 29:271-87. [PMID: 3677047 DOI: 10.1016/0165-4608(87)90238-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The risk of developing choriocarcinoma following a complete hydatidiform mole (CHM) is 2000-4000 times greater than the risk following a normal pregnancy. To understand more fully the increased susceptibility of the molar trophoblast to malignant transformation, we separated the trophoblastic cells from the stromal cells in 14 complete moles and cultured them for cytogenetic analysis. The numerical and structural abnormalities found were compared with those found in the trophoblasts from normal pregnancy and malignant choriocarcinoma cell lines. The percentage of polyploid cells was 2.8 times greater in molar trophoblasts than in normal trophoblasts. Although we found no consistent chromosomal abnormality in the molar trophoblasts, these cells were significantly more vulnerable to chromosomal breakage than the molar fibroblasts, normal trophoblasts, normal fibroblasts, and maternal decidual cells. Out of a total of 103 breakpoints observed in 338 cells, 42 coincided with known fragile sites, 18 with the location of protooncogenes, 27 with breakpoints reported in other neoplasia, and 18 with breakpoints found in four choriocarcinoma cell lines. The chromosomes in choriocarcinoma cell lines have hypotetraploid mode and many structural rearrangements. Our results suggest that the genetic instability found in the molar trophoblasts may be responsible for progressive karyotypic changes and greater susceptibility to malignant transformation.
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Affiliation(s)
- R Habibian
- Department of Pathology, University of Pittsburgh, PA
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25
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Vejerslev LO, Fisher RA, Surti U, Walke N. Hydatidiform mole: cytogenetically unusual cases and their implications for the present classification. Am J Obstet Gynecol 1987; 157:180-4. [PMID: 3474901 DOI: 10.1016/s0002-9378(87)80376-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Unusual observations in hydatidiform moles are of clinical importance as well as of theoretical interest when the present subgrouping into partial or complete moles is evaluated, particularly in view of the more malignant potential of the latter. The purpose of the present review is to summarize, update, and evaluate information on moles with unusual karyotypes or origins. The important factor in the evolution of partial or complete moles appears to be the ratio of maternal to paternal chromosomes and not the ploidy of the tissue. Complete hydatidiform moles develop from androgenetic conceptions while partial hydatidiform moles develop from those conceptions in which the number of paternal sets of chromosomes exceeds the number of maternally derived sets. Rare cases inconsistent with this concept emphasize the value of examining morphologic features, cell ploidy, and genetic markers when one is attempting to classify hydatidiform moles.
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26
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Wake N, Fujino T, Hoshi S, Shinkai N, Sakai K, Kato H, Hashimoto M, Yasuda T, Yamada H, Ichinoe K. The propensity to malignancy of dispermic heterozygous moles. Placenta 1987; 8:319-26. [PMID: 2821529 DOI: 10.1016/0143-4004(87)90056-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Complete hydatidiform moles may originate from either the fertilization of an empty egg by a haploid sperm followed by duplication (producing a monospermic, homozygous mole) or the fertilization of such an egg by two haploid sperms (producing a dispermic, heterozygous mole). This difference in the mechanism leading to the formation of complete moles raises the question of whether the risk of subsequent malignancy is influenced by the zygosity of the mole. We have compared the incidence of postmolar sequelae in patients with homozygous and heterozygous moles. Using chromosomal heteromorphisms, human lymphocyte antigen (HLA) and phosphoglucuromutase 1 (PGM1) polymorphisms, we established the androgenetic origin of complete mole in 84 of 91 cases. Homozygosity was confirmed in 51 moles, and we found ten heterozygous moles. Five of ten patients with heterozygous moles developed postmolar trophoblastic disease, whereas only two of the 51 patients with homozygous moles had postmolar trophoblastic disease (an additional five patients showed signs of degenerating residual trophoblasts). The XY sex chromosome constitution of the two in vitro choriocarcinoma cell lines examined here provides further evidence of the propensity to malignancy of heterozygous moles.
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Affiliation(s)
- N Wake
- Department of Obstetrics and Gynaecology, School of Medicine, Hokkaido University, Sapporo, Japan
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27
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Abstract
In an elective study of 163 hydatidiform moles 38 were classified as partial mole (PHM) and 125 as complete mole (CHM) on the basis of pathology. Genetic studies showed the PHM to be triploid with one maternal and two paternal chromosome sets. In all cases of PHM the molar pregnancy resolved spontaneously after evacuation. On the basis of genetic studies CHM which were diploid could be subdivided into two entities: homozygous androgenetic CHMs that were 46,XX, and heterozygous CHMs which were androgenetic and usually 46,XY. In informative cases in this series the frequency of heterozygous CHM was 10 per cent. Twenty-two (17.6 per cent) of all the patients with CHM required subsequent chemotherapy for post-mole trophoblastic tumour. Where patients with CHM could be classified as having homozygous or heterozygous CHM the requirement for treatment (17.8 per cent and 25 per cent, respectively) was not found to be significantly different in the two groups.
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Surti U, Szulman AE, Wagner K, Leppert M, O'Brien SJ. Tetraploid partial hydatidiform moles: two cases with a triple paternal contribution and a 92,XXXY karyotype. Hum Genet 1986; 72:15-21. [PMID: 3002951 DOI: 10.1007/bf00278810] [Citation(s) in RCA: 69] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In the course of a systematic study of cytogenetics, morphology, and clinical follow-up of hydatidiform moles we encountered two unusual cases of partial hydatidiform moles each with a 92,XXXY karyotype. Previously reported cases of tetraploidy, of 92,XXXX or 92,XXYY karyotype, resulted from a failure of the first mitotic division of a normal zygote. This is to our knowledge the first report of tetraploidy with XXXY sex chromosomes. Study of chromosomal heteromorphisms, isozymes, and restriction fragment length polymorphisms reveal that both present cases resulted from a combination of a haploid ovum with three haploid sets of paternal chromosomes either by the mechanism of trispermy (involving three separate haploid spermatozoa) or through dispermy (involving one haploid and one diploid sperm). Both cases resembled closely partial moles in their morphology; one gave a highly typical clinical picture while the other was recognized at an early voluntary abortion. Partial moles are ordinarily triploids of nearly always diandric constitution that evince focal villous swelling with cistern formation and focal trophoblastic hyperplasia. The findings here presented point to an association of molar phenotype with an excess of paternal over maternal haploid sets.
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Berkowitz RS, Umpierre SA, Taylor-Emery S, Goldstein DP, Anderson DJ. Immunobiology of complete molar pregnancy and gestational trophoblastic tumor. Cancer Metastasis Rev 1986; 5:109-23. [PMID: 3030577 DOI: 10.1007/bf00046426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The unique curability of gestational trophoblastic tumors may in part be attributable to a host immunologic response. The occurrence of rapidly progressive and fatal choriocarcinoma may be favored by histocompatibility between patients and their partners. However, histocompatibility is not a prerequisite for the development and persistence of gestational choriocarcinoma. The expression of HLA by choriocarcinoma cells in culture is enhanced following incubation with gamma-interferon and this may be of both biologic and clinical significance. Complete molar pregnancy is a complete allograft because all molar chromosomes are of paternal origin. Patients with complete mole are sensitized to paternal HLA antigen which is expressed in molar tissue. Other polymorphic antigen systems including trophoblast-leukocyte common antigens and placental-type alkaline phosphatase are also expressed in molar tissue. We have studied the immunopathology of the molar implantation site to investigate possible humoral and cellular immune responses. The relationships among normal placenta, complete mole and choriocarcinoma are not clearly understood. The pattern of expression of oncofetal antigens in these three gestational tissues may be used to assess trophoblastic differentiation. In studies to date, molar trophoblast has the same pattern of expression of oncofetal antigens as normal placental trophoblast. We will review recent advances in our understanding of the immunobiology of gestational trophoblastic disease and suggest new directions for further research.
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31
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Hoshina M, Boothby M, Hussa R, Pattillo R, Camel HM, Boime I. Linkage of human chorionic gonadotrophin and placental lactogen biosynthesis to trophoblast differentiation and tumorigenesis. Placenta 1985; 6:163-72. [PMID: 2991878 DOI: 10.1016/s0143-4004(85)80066-7] [Citation(s) in RCA: 75] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Normal trophoblast of the human placenta elaborates at least two major protein hormones, chorionic gonadotrophin (hCG) and placental lactogen (hPL). Molar and choriocarcinoma tissues characteristically synthesize large amounts of hCG and hPL. To examine the role of trophoblast differentiation in the expression of the hCG and hPL genes, we studied the cytological distribution of their mRNAs in tissue sections of human hydatidiform mole and choriocarcinoma by in situ hybridization. Histologically, these tissues are in different stages of cellular differentiation. In normal placenta, hCG alpha/beta mRNA can be localized to some cytotrophoblasts and primarily to the syncytium, whereas hPL mRNA appears only in the syncytial layer. In hydatidiform mole, which still retains placental villous morphology, the hPL gene and hCG alpha and beta genes are expressed but are poorly localized because of the admixture of cyto- and syncytiotrophoblasts. By contrast, choriocarcinoma, which is devoid of placental villous pattern but in which the cyto- and syncytiotrophoblast-like components are distinguishable, expresses hCG alpha and beta in the syncytial-like areas but little, if any, hPL. These results suggest that a certain level of trophoblast differentiation, such as villous formation, is associated with hPL expression, while the hCG alpha gene and the hCG beta gene can be expressed in more disorganized tissues which contain cytotrophoblastic elements.
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32
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33
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Franke HR. Classic illustration. Chorionepithelioma malignum. By B.J.C. Hartog. 1933. Eur J Obstet Gynecol Reprod Biol 1984; 18:239-40. [PMID: 6394399 DOI: 10.1016/0028-2243(84)90128-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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34
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Oudejans CB. X chromosome expression in normal and molar pregnancy. Med Hypotheses 1984; 15:115-8. [PMID: 6513828 DOI: 10.1016/0306-9877(84)90115-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
In the female mouse embryo the maternal X chromosome is selectively expressed in derivatives of the trophectoderm and the primitive endoderm. In the primitive ectoderm derivatives the expression of the maternally or paternally derived X chromosome is random. Although this selective expression is not an essential condition for the trophectoderm and the primitive endoderm to develop, the purpose of this selective expression is unknown. It is postulated that in human reproductive biology a key to the purpose of this selective expression may be found by the hydatidiform mole, due to its androgenic origin.
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35
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Abstract
The epidemiology of gestational trophoblastic disease is not well understood. Methodologic problems with published reports limit the interpretation of incidence data, although the frequency of hydatidiform mole appears to be about one per 1000 pregnancies. No consistent temporal trends in rates of either hydatidiform mole or choriocarcinoma are evident. Hydatidiform mole appears to be caused by abnormal gametogenesis and fertilization. Age, ethnicity, and a history of hydatidiform mole appear to be important risk factors for hydatidiform mole. Age, ethnicity, a history of hydatidiform mole or fetal wastage, and ABO blood group interactions appear to be important risk factors for choriocarcinoma. Future studies should focus on the mechanisms by which these risk factors influence gametogenesis, fertilization, and malignant transformation of trophoblastic tissue.
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36
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Berkowitz RS, Hoch EJ, Goldstein DP, Anderson DJ. Histocompatibility antigens (HLA-A,B,C) are not detectable in molar villous fluid. Gynecol Oncol 1984; 19:74-8. [PMID: 6381249 DOI: 10.1016/0090-8258(84)90161-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cell-free villous fluid from healthy and necrotic molar villi did not contain detectable soluble HLA Class I (HLA-A,B,C) antigens; therefore, HLA sensitization of the maternal host is probably not attributable to shedding of HLA antigens by viable or degenerating HLA-positive stromal cells. The method developed for this study, a combination of immunoprecipitation and Western blot techniques, employed specific antibodies for positive identification of the HLA heavy chain. The pathogenesis of complete molar pregnancy may be better understood through further study of the mechanisms of HLA sensitization of the maternal host and the host's response to these foreign antigens.
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37
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Kajii T, Kurashige H, Ohama K, Uchino F. XY and XX complete moles: clinical and morphologic correlations. Am J Obstet Gynecol 1984; 150:57-64. [PMID: 6476027 DOI: 10.1016/s0002-9378(84)80110-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The results of clinical, morphologic, and histologic analysis of nine XY complete moles (six karyotyped, three Y-chromatin positive) were compared with the results from analysis of 16 XX moles. Five of the nine XY moles were proved to result from dispermy while all the 16 XX moles studied originated from the doubling of a haploid sperm. At follow-up delayed decrease or rebound of urinary (or serum) human chorionic gonadotropin levels was noted in three of eight women with XY moles and in five of 15 women with XX moles. One woman with an XY mole was treated for lung metastasis, but her condition remained stable over a 4-year follow-up period. No appreciable difference was noted in the gross and microscopic findings between the XY and XX moles. On the other hand, differences were noted between younger (12 weeks or less of menstrual age) and older (13 weeks or more) moles. Younger moles had smaller, elliptic or club-shaped villi with numerous secondary villous sprouts, poorly demarcated central cisternae, and frequent mesenchymal capillaries. Older moles had larger, oval or globular villi with sparse villous sprouts, well-developed central cisternae, and less frequent remnants of capillaries. Trophoblastic hyperplasia was more marked in older than in younger moles.
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38
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Fisher RA, Sheppard DM, Lawler SD. Two patients with complete hydatidiform mole with 46,XY karyotype. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1984; 91:690-3. [PMID: 6743611 DOI: 10.1111/j.1471-0528.1984.tb04832.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In a study to correlate the genetic origin of hydatidiform moles with the subsequent fate of the patients, 62 complete moles were examined for cytogenetic and/or biochemical polymorphisms. Comparisons of polymorphisms in molar tissue with those seen in white blood cells from the parents have shown that the majority of complete hydatidiform moles are androgenetic in origin and homozygous for all polymorphisms examined. Where karyotyped, these moles were found to be 46,XX. Three exceptions were found in which the molar tissue was heterozygous for enzyme polymorphisms. Cytogenetic analysis of two of these cases confirmed heterozygosity and also revealed a 46,XY karyotype which was androgenetic in origin, most likely arising by dispermy. The two patients with 46,XY complete moles have been followed up for a minimum of 9 months and neither has required treatment for persistent trophoblastic disease.
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39
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Hoshina M, Boothby MR, Hussa RD, Pattillo RA, Camel HM, Boime I. Segregation patterns of polymorphic restriction sites of the gene encoding the alpha subunit of human chorionic gonadotropin in trophoblastic disease. Proc Natl Acad Sci U S A 1984; 81:2504-7. [PMID: 6201859 PMCID: PMC345090 DOI: 10.1073/pnas.81.8.2504] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The gene encoding the alpha subunit of human chorionic gonadotropin contains at least two polymorphic sites in its 3' flanking region detected by restriction enzymes HindIII and EcoRI. We used these polymorphic sites as markers of tissue genotype in normal placenta, hydatidiform mole, choriocarcinoma, and peripheral leukocytes. As expected, inheritance patterns of most hydatidiform moles showed only a paternal genetic contribution. However, one uncommon DNA polymorphism pattern, homozygosity for the absence of the EcoRI site and the presence of the HindIII site, predominated in choriocarcinoma. Thus, our results suggest that moles which have this uncommon polymorphism pattern appear particularly likely to develop into choriocarcinoma.
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40
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Davis JR, Surwit EA, Garay JP, Fortier KJ. Sex assignment in gestational trophoblastic neoplasia. Am J Obstet Gynecol 1984; 148:722-5. [PMID: 6322588 DOI: 10.1016/0002-9378(84)90554-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A retrospective survey was performed in 205 cases of gestational trophoblastic neoplasia with the use of routine tissue sections and quinacrine stain after hydrolysis and pronase pretreatment. The method allows scoring of nuclei simultaneously for either Y chromatin or X chromatin (Barr body) and has proved to be a valid test for sex assignment in tissue sections. Y-chromatin positivity (indicating gamete heterozygosity) was found in 16 of 182 cases (9%) of hydatidiform mole, two of four cases (50%) of invasive mole, and 14 of 19 cases (74%) of choriocarcinoma. The cytogenetic literature of 173 cases of complete hydatidiform mole indicates 8.1% have been 46,XY. Our unexpectedly high incidence of Y chromatin in malignant gestational trophoblastic neoplasia would suggest that homozygosity for a recessive mutant oncogene is not an important factor in pathogenesis of choriocarcinoma. The partial allograft theory of pathogenesis after nonmolar antecedents with attendant diminished host immunoreactivity remains a plausible consideration.
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42
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Abstract
One hundred and six patients with complete mole and 35 patients with partial mole were analysed. The clinical behaviour of complete mole was more florid. The clinical diagnosis of partial mole was more difficult. 20.7% of the complete mole patients and 11.4% of the partial mole patients required chemotherapy because of persistent or metastatic trophoblastic disease. The response to chemotherapy was more favourable in the partial moles. All patients with either partial or complete mole needed hCG assay monitor because of the risk of malignant sequelae.
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43
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Szulman AE, Surti U. Complete and partial hydatidiform moles: cytogenetic and morphological aspects. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1984; 176:135-46. [PMID: 6388256 DOI: 10.1007/978-1-4684-4811-5_7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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44
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Lawler SD. Genetic studies on hydatidiform moles. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1984; 176:147-61. [PMID: 6388257 DOI: 10.1007/978-1-4684-4811-5_8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Using an historical approach, this article describes how genetic studies have elucidated the two entities into which the syndrome of hydatidiform mole can now be divided. Partial moles are triploid, have a maternal chromosomal set, and are associated with the presence of a fetus. Complete moles lack a fetus and are always diploid and androgenetic in origin, having two sets of paternal chromosomes. They are most often XX and homozygous, the most likely origin being by duplication of a haploid sperm. About 4% of complete moles have been shown to by XY and heterozygous, the most likely origin being by dispermy. The frequency of partial and complete mole observed depends on the method of ascertainment. Among spontaneous abortions, partial moles are more common than complete moles, but among cases having an elective termination of pregnancy because of a prior diagnosis of hydatidiform mole, complete mole is the more common. Patients with either type of mole may require treatment for persistent trophoblastic activity. More prospective studies of cases in which the type of mole has been confirmed by genetic studies are required in order to find out whether (a) patients with complete moles are more likely than those with partial moles to require treatment for persistence of trophoblastic activity after evacuation; and (b) heterozygous complete moles have a different prognosis from the point of view of malignant sequelae than homozygous complete moles.
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45
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Pattillo RA. Genetic origin, immunobiology, and gonadotropin expression in trophoblast and nontrophoblast neoplasms. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1984; 176:53-79. [PMID: 6093475 DOI: 10.1007/978-1-4684-4811-5_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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46
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Takeuchi S. Immunology in genesis of partial and total hydatidiform mole. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1984; 176:81-110. [PMID: 6388259 DOI: 10.1007/978-1-4684-4811-5_4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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47
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48
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Surti U, Szulman AE, O'Brien S. Dispermic origin and clinical outcome of three complete hydatidiform moles with 46,XY karyotype. Am J Obstet Gynecol 1982; 144:84-7. [PMID: 7114116 DOI: 10.1016/0002-9378(82)90399-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Three new cases of complete, classic hydatidiform mole with a 46,XY karyotype are described. They originated by dispermy as demonstrated by chromosome and enzyme analyses. Levels of human chorionic gonadotropin decreased to normal spontaneously within a short time, indicating a benign course in these three cases. Of a total of 18 cases reported to data, postoperative clinical information was available for 10 patients. Two of these 10 patients had a malignant course with lung metastases. It is of theoretical and clinical importance to establish the magnitude of the risk of malignancy for hydatidiform mole with a 46,XY karyotype.
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49
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Wallace DC, Surti U, Adams CW, Szulman AE. Complete moles have paternal chromosomes but maternal mitochondrial DNA. Hum Genet 1982; 61:145-7. [PMID: 6290372 DOI: 10.1007/bf00274205] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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50
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Jacobs PA, Szulman AE, Funkhouser J, Matsuura JS, Wilson CC. Human triploidy: relationship between parental origin of the additional haploid complement and development of partial hydatidiform mole. Ann Hum Genet 1982; 46:223-31. [PMID: 7125594 DOI: 10.1111/j.1469-1809.1982.tb00714.x] [Citation(s) in RCA: 304] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
One hundred and six triploids were ascertained during a study of 1500 consecutive spontaneous abortions. The mechanism of origin of the additional haploid complement was investigated by comparing parental and foetal cytogenetic heteromorphisms and a histopathological examination of each triploid was done in a subsequent blind study. The mechanism of origin of the additional haploid complement was found to be highly correlated with the development of partial hydatidiform mole and with gestational age. All 51 paternally derived triploids in which a pathologic diagnosis could be made were partial moles, whereas only 3 of 15 maternally derived triploids on which a diagnosis could be made were molar. The mean gestational age of the paternally derived triploids was 122 days while that of the maternally derived triploids was only 74 days. It was suggested that the development of partial mole was primarily associated with the presence of two paternal haploid chromosome complements, the association with relatively long gestational ages being a secondary one consequent upon retention of the molar placentae for many weeks after foetal demise.
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