Over-diagnosis of hydatidiform mole in early tubal ectopic pregnancy

Unpacking the importance of histopathology in ectopic pregnancy: Vital for follow up

The incidence of ectopic molar pregnancy is very rare with an incidence estimated to be 1.5 per 1,000,000 pregnancies. The pre-operative diagnosis is rare and needs careful histopathological examination of salpingectomy specimen. A case of a 34-year-old female is discussed who presented in shock with clinical and radiological diagnosis of ruptured ectopic pregnancy and histopathology report revealed partial mole in ectopic specimen.

Ruptured ectopic pregnancy as complete hydatidiform mole: Case report and review of the literature

Usually, a hydatidiform mole (HM) develops inside the uterus. The occurrence of HM in ruptured tubal pregnancy is exceptional. Cases reported in the literature are scarce. In this article, a case of haemoperitoneum secondary to a ruptured fallopian tube by a complete mole is reported. A 50-year-old gravida 2, para 1 was admitted to the emergency department for acute abdominal pain. After the clinical examination, an abdominal sonography and CT scan were done, revealing the presence of an adnexal left mass associated with an important haemoperitoneum. A urine pregnancy test was done and was positive, indicating an immediate laparoscopic exploration. The laparoscopy revealed a haemoperitoneum secondary to a ruptured tubal mass. The pathological exam concluded a complete hydatidiform mole (CHM) invading the wall of the fallopian tube. Any acute abdominal pain in a potentially pregnant woman imposes first the routine realization of a pregnancy test. The occurrence of CHM in a ruptured fallopian tube is particularly rare and has exceptionally been diagnosed before the laparoscopic exploration.

Partial Molar Pregnancy Presenting as a Tubal Ectopic Pregnancy

Background

Tubal molar pregnancy is extremely rare, with no more than 200 cases reported in the literature. The incidence is approximated at 1.5 per 1,000,000 pregnancies.

Case

We report the case of a 22-year-old woman with an overall initial stable clinical presentation who was noted to have a ruptured ectopic pregnancy. She was surgically treated, and pathology revealed partial hydatidiform molar ectopic pregnancy. At the time of surgical intervention, the treating physicians had not considered molar ectopic pregnancy within the differential diagnosis, since this is a very rare presentation. Once the pathology was discovered, the patient was contacted to be scheduled for close follow-up and counseling to reduce progression to choriocarcinomas.

Conclusion

This case report highlights the importance of sending, reviewing, and following up on pathologic specimens for all patients undergoing surgical intervention for presumed ectopic pregnancy and ensuring that appropriate follow-up is in place for those patients.

Diagnostic value of glycophorin-A in comparison with P57 immunohistochemical staining method in differentiating complete and partial molar pregnancies

INTRODUCTION

Current histomorphological criteria in distinguishing two subtypes of hydatidiform moles has considerable inter-observer variability and limitations. In this regard, ancillary studies can aid pathologist to obtain an accurate diagnosis. Herein, we evaluated the utility of Glycophorin-A (GLA) in differentiating complete and partial moles.

MATERIALS AND METHODS

In this case-control study, formalin-fixed paraffin-embedded blocks of 47 patients with pathologic diagnosis of complete and 42 partial hydatidiform moles were included and the diagnoses were confirmed by immunohistochemistry (IHC) for P57. Sections from all samples were stained for GLA using IHC method. Using 2 × 2 tables, the sensitivity, specifity, Positive and Negative Predictive Values (PPV and NPV) as well as accuracy of GLA were determined.

RESULTS

Primary pathologic diagnosis was changed in 7.1% and types of hydatidiform mole were specified in 11.9% of the cases after review of the slides and IHC study for P57. NRBCs were found in 52.7% of the PM cases and none of CMs by pathologist in H&E sections. IHC study for GLA revealed positive result in one case of complete moles (2%) and 31 case of partial mole samples (73.8%). It was negative in 98% of the complete mole and 11 (26.2%) of partial mole cases.

DISCUSSION

The results of this study showed a significant association between GLA immunoreactivity and type of molar pregnancy. Diagnostic sensitivity, specificity and accuracy of this marker for discrimination of molar pregnancy were 73.8%, 98% and 86.5%, respectively. Therefore, this marker can be utilized in differentiating partial and complete hydatidiform mole.

Partial Hydatidiform Mole in an Ectopic Tubal Pregnancy

Fallopian tubal molar pregnancy is extremely rare, and the main diagnostic tool is the post-operative histopathological diagnosis, as the pre-operative diagnosis is difficult. We report a case of ectopic partial molar pregnancy in the right fallopian tube of a 35-year-old lady that was sent for routine histopathological examination with the clinical diagnosis of ectopic pregnancy and the histopathology report revealed an unusual result.

Gestational Trophoblastic Disease Presents as an Ectopic Tubal Pregnancy, a Rare Entity

Ectopic molar pregnancy is an uncommon event in clinical practice. In this paper, we report a case of ectopic complete molar pregnancy in a 39-year-old lady who presented to the emergency department with lower abdominal pain, abdominal distention, and low-grade fever. Based on radiological and laboratory investigations, the differential diagnosis included ruptured ectopic pregnancy versus metastatic diseases. Ectopic hydatidiform molar pregnancies can occur at any extrauterine pelvic sites, yet more frequently affecting fallopian tubes. The histopathological examination remains the gold standard for the diagnosis.

Tubal hydatidiform mole treated with salpingotomy: A case report

Tubal hydatidiform mole is rare and mostly treated with salpingectomy. This manuscript presented a case treated with salpingotomy plus methotrexate that possessed a satisfactory outcome. Our report adds to the experience of using salpingotomy in tubal molar patients.

Heterotopic Pregnancy Including Intrauterine Normal Gestation and Tubal Complete Hydatidiform Mole: A Case Report and Review of the Literature

We report a rare case of heterotopic pregnancy with intrauterine normal gestation alongside tubal complete hydatidiform mole (CHM) that resulted in a viable pregnancy after removal of molar tissue. Because of their rarity and inherent complexity, such cases represent a significant challenge in diagnosis and management. A 34-year-old female in her 10th week of gestation presented with nausea, vomiting, and intermittent abdominal pain that progressively worsened. Imaging studies revealed a normal intrauterine fetus and an 11-cm heterogenous mass in the left adnexal region. The patient's serum human chorionic gonadotropin was higher than the reference range. Diagnostic laparoscopy revealed a large hemorrhagic mass involving the left adnexa that was removed completely. The mass was composed of blood clots admixed with necrotic tissue of vesicular appearance on gross inspection. Microscopic examination revealed large chorionic villi with circumferential trophoblastic proliferation and cisterns, all of which are characteristic of CHM. An implantation site was identified at the tubal fimbriae. Immunohistochemistry p57 demonstrated negative staining in the villous stromal and cytotrophoblastic cells, supporting the diagnosis of CHM. Chromosomal karyotyping and cytogenetic analysis were performed on chorionic villi samples from the intrauterine gestation and reported as normal (46, XX). The patient elected to continue the intrauterine pregnancy, delivering a healthy female infant at 39 weeks. Our case reaffirms that to successfully manage this rare yet life-threatening condition, heterotopic pregnancy should be included in the differential diagnosis for any gravid women presenting with persistent abdominal pain and/or extrauterine mass.

Insights into dovetailing GTD and Cancers

Gestational trophoblastic diseases (GTD) encompass a group of placental tumors which mostly arise due to certain fertilization defects, resulting in the over-proliferation of trophoblasts. The major characteristic of this diseased state is that β-hCG rises up manifold than that is observed during pregnancy. The incidence of GTD when analyzed on a global scale, figures out that there is a greater risk in South-East Asia, the reason of which remains unclear. An insight into any possible correlation of GTD incidence with cancers, other than choriocarcinoma, is being attempted here. Also, we review the recent developments in research on the molecular etiopathology of GTD. This review would render a wider eye towards a new paradigm of thoughts to connect GTD and breast cancer, which has not been into the picture till date.

A Molar Pregnancy within the Fallopian Tube

Background. Discussion of the incidence of molar pregnancy and ectopic pregnancy. Role of salpingostomy and special considerations for postoperative care. Case. The patient is a 29-year-old G7P4 who presented with vaginal bleeding in the first trimester and was initially thought to have a spontaneous abortion. Ultrasound was performed due to ongoing symptoms and an adnexal mass was noted. She underwent uncomplicated salpingostomy and was later found to have a partial molar ectopic pregnancy. Conclusion. This case illustrates the rare occurrence of a molar ectopic pregnancy. There was no indication of molar pregnancy preoperatively and this case highlights the importance of submitting and reviewing pathological specimens.

Molar Pregnancy Presents as Tubal Ectopic Pregnancy: A Rare Case Report

The incidence of hydatidiform mole is 1 per 1000 pregnancies. The occurrence of hydatidiform mole in ruptured tubal pregnancy is very rare. We report an unusual case of molar pregnancy in the right fallopian tube which presented as an adherent adnexal mass. The present case conveys the importance of histological examination of products of conception which helps the pathologist to provide an appropriate diagnosis, thereby the clinician can offer appropriate counseling and follow up to the patient.

Rare case of peritoneal complete hydatidiform mole

A 23-year-old woman, gravida 1, para 1, was transferred to our hospital with acute lower abdominal pain and vital signs consistent with shock. Her urine concentration of human chorionic gonadotrophin was 8000 mIU/mL. Transvaginal ultrasound revealed an echo-free space with mosaic echo pattern in the right adnexal area and no gestational sac in the uterus. With a preoperative diagnosis of ruptured ectopic pregnancy, emergency laparotomy was performed. The rectouterine pouch was filled with many clots containing small amounts of villous tissue. After removal of the conceptus, which was infiltrating into the peritoneum of the Pouch of Douglas, bleeding was controlled by Argon laser. Histological examination of the conceptus by immunohistochemical staining with p57(kip2) showed features of complete hydatidiform mole. This case demonstrates that the peritoneum in the Pouch of Douglas is a possible site of ectopic complete hydatidiform mole occurrence and that immunohistochemical stain is useful to confirm the diagnosis of ectopic complete hydatidiform mole.

Ectopic Complete Hydatidiform Mole Presenting as an Adnexal Tumor in a Postmenopausal Patient

Hydatidiform mole (HM) is rare in postmenopause, with only 7 cases reported. The occurrence of ectopic HM is also rare, with 26 fully documented tubal cases. We are not aware of any reported cases of ectopic HM in a postmenopausal patient. In a 51-year-old patient with 3 years amenorrhea, surgery revealed a necrotic, hemorrhagic mass involving the right peritubal space. Microscopically, chorionic villi were seen within the hemorrhagic mass accompanied by circumferential trophoblast hyperplasia. Immunohistochemically, p57(kip2) positive nuclei were prominent in the extravillous (intermediate) trophoblast. The HER2 FISH expression was diploid, consistent with the diagnosis of an early complete HM.

A case of true tubal hydatidiform mole and literature review

Tubal hydatidiform mole is an uncommon condition with about 40 confirmed cases in the accessible literature. The patient usually presents with symptoms and signs of a classical ectopic pregnancy and it is only after histological examination and DNA ploidy analysis of the conceptus that a hydatidiform mole is diagnosed. Management requires complete removal of the conceptus and follow-up needs to be arranged with an appropriate supraregional centre. The authors present a case of complete molar tubal pregnancy and a review of the literature.

Gastrointestinal bleeding caused by ileal metastasis of a tubal complete mole: a case report

BACKGROUND

Tubal hydatidiform mole is known to be an extremely rare disease, moreover, gastrointestinal metastasis from an ectopic complete mole has never been reported.

MATERIALS AND METHODS

A 33-year-old woman presented with gastrointestinal bleeding. She had undergone laparoscopic left salpingectomy for a tubal complete mole a month earlier. An ileal invasion of mole was identified. The patient received nine cycles of adjuvant methotrexate chemotherapy after small bowel resection and anastomosis. She was been without recurrence 20 months after therapy.

DISCUSSION

Gestational trophoblastic diseases in ectopic pregnancy are rare and gastrointestinal tract metastasis is very infrequent. There have been a few case reports of choriocarcinoma presenting gastrointestinal tract metastasis. To our knowledge, this is the first report of molar pregnancy in a Fallopian tube with ileal metastasis.

CONCLUSION

Ectopic molar pregnancy with gastrointestinal metastasis carries a high risk of intestinal perforation and uncontrollable gastrointestinal bleeding. Despite its rarity, gastrointestinal metastasis should nevertheless be considered a possible cause for gastrointestinal bleeding in ectopic molar pregnancy patients after elimination of the more common etiologies.

Histopathological diagnosis of hydatidiform mole: contemporary features and clinical implications

Gestational trophoblastic neoplasia (GTN) encompasses several entities including complete (CHM) and partial (PHM) hydatidiform mole (HM), malignant choriocarcinoma, and placental-site trophoblastic tumor. HMs are genetically abnormal, nonviable conceptions, which are associated with significantly increased risk for development of complications due to persistence of abnormal trophoblast (persistent GTN; pGTN), which occurs following 15% of CHM and 0.5% of PHM. Diagnostic histological features of HM are present in the first trimester but these features differ from those traditionally described in the later second trimester. The characteristic morphological findings of early HM include aspects of villous dysmorphism and abnormal villous trophoblast hyperplasia, with other specific features allowing reliable distinction between CHM and PHM. Optimal management of molar disease depends on its early histological identification and subsequent surveillance by measurement of maternal human chorionic gonoadotropin (hCG) for detection of pGTN based on rising or plateuing hCG levels such that early effective treatment is possible.

The pathology of gestational trophoblastic disease: recent advances

When inundated with numerous specimens of products of conception as the consequence of miscarriage, it is all too easy for histopathologists to forget that the biology of trophoblast and the events of early placental implantation continue to fascinate because of the inherently invasive properties of the non-villous (extravillous) trophoblast. However, unlike the invasion of a malignant tumour, the invasion of trophoblast is controlled. The failure of adequate conversion of maternal uteroplacental arteries is a major pathogenetic phenomenon of important disorders of pregnancy including pre-eclampsia. However, it is in the field of gestational trophoblastic disease that diagnostic acumen is most called for. There are several problematic areas that give rise to diagnostic error; e.g., the diagnosis of early complete mole as partial mole, the over-diagnosis of hydatidiform mole in tubal pregnancy and the diagnosis of placental site non-villous trophoblast as placental site trophoblastic tumour or choriocarcinoma, particularly if associated with atypia, as frequently observed in complete mole. The chorionic villi of early diploid complete mole show characteristic features of villous profile, stromal mucin and stromal nuclear debris. The distinction between complete mole and triploid partial mole can be facilitated by ploidy analysis and immunohistochemistry for the product of the paternally imprinted, maternally expressed gene, p57kip2. Persistent trophoblastic disease (PTD) is a clinical not a histopathological diagnosis and the role of the histopathologist once a diagnosis of PTD has been made is limited. Invasive mole and choriocarcinoma are encompassed by PTD. Tumours of the non-villous trophoblast are placental site trophoblastic tumour and the more recently recognised epithelioid trophoblastic tumour. The role of immunohistochemistry in the elucidation of trophoblastic lesions is discussed pragmatically.

Clinicopathologic characteristics and subsequent pregnancy outcome in 139 complete hydatidiform moles

OBJECTIVE

The most common form of gestational trophoblastic disease is the complete hydatidiform mole (CHM). The study reports our experience of clinicopathologic characteristics and subsequent pregnancy outcome of patients with CHM.

STUDY DESIGN

One hundred fifty-one subsequent cases with initial diagnosis of CHM were re-evaluated histopathologically. Clinical characteristics, the need for chemotherapy and subsequent pregnancy outcome were evaluated.

RESULTS

Twelve out of 151 cases were re-evaluated as hydropic abortion, as partial hydatidiform moles or were insufficient for morphologic examination and therefore excluded from further analysis. The leading clinical symptoms of the remaining 139 cases were irregular vaginal bleeding (67%) and uterine enlargement (41%). Twenty-six patients (19%) required chemotherapy because of gestational trophoblastic neoplasia (GTN; low-risk: 23 out of 26). All patients were cured successfully. The subsequent pregnancy rate was 15% (21/139). Five patients suffered from abortions, 12 women delivered a healthy offspring. Four women presented with recurrent CHM with a spontaneous normalization of HCG levels after D&C.

CONCLUSIONS

The clinical and morphologic diagnosis of CHM is a challenge, and diagnosis as well as treatment should be multidisciplinary and centralised. One fifth of CHM are at risk of a GTN, but the cure rate is 100% with adequate management. Pregnancy outcome following CHM is complicated by an increased risk of abortion.

Overdiagnosis of Complete and Partial Hydatidiform Mole in Tubal Ectopic Pregnancies

Partial or complete hydatidiform mole (HM) affects approximately 1 in 500 to 1,000 pregnancies. Previous small series suggest that histopathologic diagnosis of HM may be difficult in tubal ectopic pregnancies. The histopathology database of a regional Trophoblastic Disease Unit was searched to identify cases with a referral diagnosis of tubal HM, and the histopathologic findings were reviewed. During the study period (1986-2004 inclusive), there were 132 cases. After central review by specialist histopathologists, the final diagnosis was ectopic partial mole in two, ectopic complete mole in five, and ectopic hydatidiform mole (not otherwise specified) in one. The final diagnosis of definite hydatidiform mole was made in eight (6%) cases, significantly less than in referred uterine curettage specimens, in which approximately 90% have a confirmatory diagnosis of HM (Z = 12.9; p < 0.0001). No cases in this series developed persistent gestational trophoblastic disease, the human chorionic gonadotropin concentration spontaneously returning to normal. Ectopic pregnancies, where managed surgically, should be submitted for histopathologic examination; however, the pathologist should be aware that the degree of extravillus trophoblastic proliferation may appear more florid compared with evacuated uterine products of conception. Molar pregnancy should only be diagnosed when strict criteria regarding morphologic abnormalities previously described in uterine evacuation material are applied.

p57KIP2 immunohistochemistry in early molar pregnancies: emphasis on its complementary role in the differential diagnosis of hydropic abortuses

Morphologic examination still forms the main diagnostic tool in the differential diagnosis of molar pregnancies. However, the criteria are subjective and show considerable interobserver variability among pathologists. Once a diagnosis of molar pregnancy is made, DNA ploidy studies help to differentiate a triploid partial mole from diploid complete mole (CM). However, with earlier diagnosis and therapeutic evacuation of molar pregnancies, the differentiation of molar pregnancies from early nonmolar placentation is becoming increasingly difficult. The p57(KIP2) gene ( CDKN1C ) is strongly paternally imprinted and expressed from the maternal allele. Because CM lacks a maternal genome, p57(KIP2) immunostaining is correspondingly absent, whereas hydropic abortuses and partial mole show positive staining. We compared the use of p57(KIP2) staining in the differential diagnosis of 68 morphologically challenging cases of early first-trimester hydropic placentas. Diagnosis based on p57(KIP2) staining was compared with the original diagnosis based on morphology and DNA ploidy analysis. Concordant results were obtained in 65 of 68 cases studied. In 2 of 3 cases with a discordant diagnosis, microsatellite DNA genotyping analysis agreed with the results of p57(KIP2) staining, confirming that positive p57(KIP2) staining is a highly sensitive and specific marker for excluding CM in this setting. In addition, p57(KIP2) staining has the advantage of differentiating hydropic abortuses from CMs, a distinction not made by ploidy analysis. p57(KIP2) staining can be used in concert with ploidy studies to refine the diagnosis of early molar pregnancies.

[Gestational trophoblastic disease, Villous gestational trophoblastic disease]

Gestational trophoblastic disease (GTD) represents a wide range of clinical and pathological distinct entities. The villous forms of GTD includes developmental disorders of the placental tree, like blighted ovum, embryonal, partial and complete moles. The risk of persistent GTD is estimated of 2-14% in partial and up to 50% in complete moles. So, the morphologic differentiation between the different entities of villous forms of GTD is clinical very important. Sometimes, early forms of complete moles (up to 12th weeks of gestation) may represent diagnostic problems, even in the diagnosis of regressive alterations of the placental villous tree after intrauterine retention.

A case of molar ectopic pregnancy

OBJECTIVE

To evaluate the occurrence of molar pregnancy in tubal ectopic pregnancy.

DESIGN

Case report.

SETTING

Outpatient clinic.

PATIENT(S)

A 27-year-old woman.

INTERVENTION(S)

Salpingectomy.

MAIN OUTCOME MEASURE(S)

Molar ectopic pregnancy.

RESULT(S)

Ectopic partial molar pregnancy.

CONCLUSION(S)

Molar pregnancy can occur in ectopic pregnancy. Molar pregnancy clinically mimics normal tubal ectopic pregnancy.

Metastatic trophoblastic disease after an initial diagnosis of partial hydatidiform mole: genotyping and chromosome in situ hybridization analysis

BACKGROUND

Hydatidiform mole (HM) is classified into partial (PHM) and complete (CHM) subtypes according to histopathologic and genetic criteria. Traditionally, it is believed that PHM carries a better prognosis and rarely develops metastasis. However, making a distinction between PHM and CHM using histologic criteria alone may be difficult.

METHODS

The authors used fluorescent microsatellite genotyping following laser-capture microdissection and chromosome in situ hybridization (CISH) to perform a genetic analysis of six patients with histologically diagnosed PHM who subsequently developed metastatic gestational trophoblastic neoplasia.

RESULTS

Patients ranged in age from 25 years to 44 years (mean, 33.2 years). The gestational age of the molar pregnancies varied from 6 weeks to 20 weeks. All six patients had pulmonary metastases, with additional liver metastasis in two patients. Among the six patients with histologically diagnosed PHM, it was found that four patients had a diploid karyotype and no maternal alleles; thus, their neoplasms actually were CHM. Maternal genome was detected in the remaining two patients consistent with a biparental origin, and these patients had a triploid karyotype. CISH findings in all patients correlated with the genotyping findings. Triploid HM had maternally derived alleles, whereas diploid HMs were purely androgenetic.

CONCLUSIONS

In the current study, which may be the largest series of genetically analyzed metastatic PHMs to date, the difficulty of histologic distinction between PHM and CHM was confirmed. Molecular analysis may help to refine the classification of HM. Although the current findings support the belief that most aggressive trophoblastic diseases are derived from CHM, a small number of PHMs do progress to metastatic disease. Thus, the current study reaffirmed that all patients with HM should be followed closely irrespective of histologic subclassification.

The clinical presentation, treatment, and outcome of patients diagnosed with possible ectopic molar gestation

The objective of this study was to determine the clinical presentation, treatment, and outcome of patients diagnosed with possible ectopic molar gestation registered with the Trophoblastic Disease Screening and Treatment Centre, Weston Park Hospital, Sheffield between 1986 and 2000. From the 5581 women registered, those with a diagnosis of ectopic molar pregnancy were identified from a computer database. Information regarding the relevant history of each patient and the clinical presentation, treatment, and outcomes of gestational trophoblastic disease (GTD) was determined by reviewing referral forms, case notes, and pro formas completed by the referring gynecologist. Histological review of the cases was undertaken where possible. Suspected ectopic molar gestations comprised 31/5581 (0.55%) of registrations. Known risk factors for ectopic pregnancy were identified in 79% of cases. Central histological review confirmed only six cases of GTD: three choriocarcinoma and three early complete moles. Four patients subsequently required chemotherapy. All patients are now in complete remission. We conclude that ectopic GTD is uncommon, with a UK incidence of approximately 1.5 per 1,000,000 births. Initial management is usually surgical removal of the conceptus, pathological suspicion of the diagnosis and registration with a screening center. Chemotherapy may be required and the prognosis is excellent.

Pathology of gestational trophoblastic diseases

Gestational trophoblastic disease (GTD) is a heterogeneous group of diseases. This used to include partial and complete hydatidiform moles, invasive mole, choriocarcinoma and placental site trophoblastic tumour. In recent years, new entities, including epithelioid trophoblastic tumour, have been added to this family. Non-neoplastic and neoplastic lesions derived from implantation site and chorion intermediate trophoblast have been gaining attention in the literature. New markers for trophoblasts have been identified facilitating histological diagnosis in cases with unusual clinical or pathological features. It is worth noting that histological distinction between hydropic abortion and partial mole and between complete and partial moles, especially at early gestational age, may be difficult. It may not be possible to predict progress of the heterogeneous group of GTD from histopathological features, except probably in placental site trophoblastic tumour. Alternative biological markers may be explored for better patient management.

Refining the diagnosis of hydatidiform mole: image ploidy analysis and p57KIP2 immunohistochemistry

AIM

To determine whether image analysis of ploidy status and immunohistochemical analysis of p57KIP2 (a paternally imprinted, maternally expressed gene) can be used to refine the diagnosis of molar pregnancy.

METHODS AND RESULTS

The original histological diagnosis in 40 randomly selected cases of hydatidiform mole was reviewed and confirmed in 38 cases (22 complete moles, 16 partial moles). These cases were anonymized and submitted for further analysis. Tissue from each case was submitted for flow cytometric assessment of DNA ploidy using a FACSort flow cytometer and for automated image cytometric assessment using a novel digital imaging system. Tissue sections from each case were immunostained with a monoclonal mouse antibody to p57KIP2. Correlations between the histopathological diagnosis, image cytometry, flow cytometry and p57KIP2 immunohistochemistry were determined using kappa statistics. The concordance between histological diagnosis and p57KIP2 was very good (kappa = 0.89). Twenty of the 22 (90.9%) complete moles showed no immunoreactivity for p57KIP2. The remaining two cases showed nuclear immunoreactivity in villous cytotrophoblast. In one of these, the pattern of staining resembled that of a partial mole. In the other, the staining pattern supported the diagnosis of a twin molar/non-molar pregnancy. All 16 partial moles were p57KIP2 immunoreactive. On flow cytometry, all 22 complete moles were diploid and 12/16 partial moles were triploid (the remaining four cases originally diagnosed as partial moles were found to be diploid). On image cytometry, one case originally diagnosed as complete mole was found to contain a triploid population. Thus, by using a combination of image cytometry and p57KIP2 status we were able to refine the diagnosis of molar pregnancy in five (13%) of the cases studied.

CONCLUSIONS

Automated image cytometry is a readily performed investigation which is comparable to, but more sensitive than, flow cytometry. Complementary use of ploidy analysis and p57KIP2 status can now help to distinguish a diploid hydropic miscarriage (p57KIP2-positive), diploid complete mole (p57KIP2-negative) and triploid partial mole (p57KIP2-positive).