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Harsono AB, Hidayat YM, Winarno GNA, Nisa AS, Alkaff FF. A Case of Rapid Transformation from Hydatidiform Mole to Invasive Mole: The Importance of β-hCG (Human Chorionic Gonadotropin) Serum Levels in Follow-Up Evaluation. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931156. [PMID: 34127641 PMCID: PMC8216494 DOI: 10.12659/ajcr.931156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/11/2021] [Accepted: 04/23/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Gestational trophoblastic disease (GTD) is a spectrum of disorders consisting of premalignant (ie, complete [CHM] and partial hydatidiform moles [PHM]) and malignant conditions (ie, invasive moles, choriocarcinoma, placental site trophoblastic tumors, and epithelioid trophoblastic tumor). If GTD persists after initial treatment and has persistent elevated beta human chorionic gonadotropin (ß-hCG), it is referred to as post-molar gestational trophoblastic neoplasia (pGTN). To date, there is no detailed information regarding how fast invasive moles can develop from CHM. However, the risk of developing any pGTN from CHM is rare within 1 month and is greatest in the first 12 months after evacuation, with most cases presenting within 6 months. CASE REPORT We present a case of a 46-year-old primigravida woman with rapid transformation of an invasive mole. In the beginning, the patient had a chief concern of a uterus size greater than the gestational dates. Laboratory evaluation showed high ß-hCG serum level (>300 000 mIU/mL), and ultrasonography evaluation revealed a hydatidiform mole. Suction evacuation and curettage procedures were then performed. Pathology evaluation afterwards revealed a complete hydatidiform mole without any sign of malignancy. Twenty-two days afterwards, the patient came to the emergency room with vaginal bleeding. ß-hCG serum level was high (53 969 mIU/mL), and ultrasonography examination showed the presence of fluid filling the uterine cavity. The patient was then diagnosed with GTN, and hysterectomy was chosen as the treatment of choice. After the surgery, her ß-hCG serum level gradually reverted back to normal. CONCLUSIONS Invasive moles can develop less than 1 month after suction evacuation and curettage procedure for CHM. Serial ß-hCG serum level evaluation according to the guideline should be performed to prevent late diagnosis, which could lead to the development of metastasis and worsen the prognosis.
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Affiliation(s)
- Ali Budi Harsono
- Department of Obstetrics and Gynecology, Faculty of Medicine, UniversitasPadjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Yudi Mulyana Hidayat
- Department of Obstetrics and Gynecology, Faculty of Medicine, UniversitasPadjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Gatot Nyarumenteng A. Winarno
- Department of Obstetrics and Gynecology, Faculty of Medicine, UniversitasPadjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Aisyah Shofiatun Nisa
- Department of Obstetrics and Gynecology, Faculty of Medicine, UniversitasPadjadjaran-Dr. Hasan Sadikin Hospital, Bandung, Indonesia
| | - Firas Farisi Alkaff
- Division of Pharmacology and Therapy, Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine Universitas Airlangga, Surabaya, Indonesia
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López CL, Figueira Gouvêa AL, Rodrigues FR, Braga A, Valente Machado MD, Lopes VS. Human epidermal growth factor receptor 2 fluorescence in situ hybridization and P57KIP2 immunohistochemistry using tissue microarray: Improving histopathological subtyping of hydatidiform mole. Placenta 2020; 99:166-172. [PMID: 32810764 DOI: 10.1016/j.placenta.2020.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/24/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Trophoblastic neoplasia is detected in approximately 25% of complete hydatidiform moles (CMs) and 0.5% of partial hydatidiform moles (PMs). Hydatidiform mole (HM) subtyping is important to properly monitor and predict patient outcomes. Ploidy studies generally involve diploid CMs and triploid PMs. P57KIP2, expressed in the maternal genome, is usually not detected in CM. We determined whether HER2 FISH and p57 immunostaining contributed to the histopathological classification of HMs. METHODS This retrospective cohort study focused on patients diagnosed with HM by histopathological examination who were followed up at a trophoblastic disease center from 2002 to 2017. Pathological samples of 108 products of conception were reviewed and reclassified according to detailed criteria. Tissue microarray technology (TMA) was used for p57 KIP2 immunostaining and HER2 FISH analysis. RESULTS Histopathological review showed 57 (53%) CMs, 47 (43%) PMs and 4 (4%) inconclusive cases. P57 immunostaining revealed 59 (55%) negative and 22 (20%) positive specimens, and 27 (25%) were inadequate for analysis. FISH HER2 detected 68 (63%) diploid and 33 (30%) triploid cases; two (2%) had oncogene amplification. The three strategies led to a diagnostic change in 28 samples (26%). The final diagnosis was CM in 75 cases (70%) and PM in 30 (28%); three cases remained inconclusive. DISCUSSION TMA is a cost-saving method that allows the simultaneous study of large case series. The combination of histopathology, HER2 FISH and p57 tests can be useful for accurately differentiating CM and PM, thus providing additional information on disease prognosis.
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Affiliation(s)
| | | | | | - Antonio Braga
- Maternal and Child Department, Fluminense Federal University, Niterói, Brazil.
| | | | - Vania Silami Lopes
- Department of Pathology, Fluminense Federal University, Niterói, Brazil.
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Bolze PA, Lopez J, Allias F, Hajri T, Patrier S, Devouassoux-Shisheboran M, Massardier J, You B, Golfier F, Mallet F. Transcriptomic and immunohistochemical approaches identify HLA-G as a predictive biomarker of gestational choriocarcinoma resistance to monochemotherapy. Gynecol Oncol 2020; 158:785-793. [PMID: 32513563 DOI: 10.1016/j.ygyno.2020.05.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 05/26/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Using a transcriptional approach on tissue samples, we sought to identify predictive biomarkers of post molar malignant transformation, and of choriocarcinoma chemosensitivity to mono- (methotrexate or actinomycin D) or polychemotherapy [EMA(Etoposide, Methotrexate, Actinomycin D)-CO(Cyclophosphamide, Vincristine) and EMA-EP(Etoposide, Cisplatine)] regimens. METHODS We studied the expression of a 760-gene panel (PanCancer Pathway) related to oncogenesis and immune tolerance in tissue samples of complete hydatidiform moles and gestational choriocarcinoma. RESULTS We did not identify any differentially expressed gene between moles with post molar malignant transformation in choriocarcinoma (n = 14) and moles with remission (n = 20). In monochemoresistant choriocarcinoma (n = 34), four genes (HLA-G, COL27A1, IL1R2 and GLI3) had a significantly reduced expression and one (THEM4) had an increased expression [FDR (false discovery rate) adjusted p-value ≤ 0.05] when compared to monochemosensitive choriocarcinoma (n = 9). The proportion of trophoblast cells and the intensity of immunohistochemical HLA-G expression were reduced in monochemoresistant choriocarcinoma (p < 0.05). In polychemoresistant choriocarcinoma (n = 20) we did not identify differentially expressed genes with an FDR adjusted p-value ≤ 0.05 when compared to polychemosensitive choriocarcinoma (n = 15). Gene pathway analysis revealed a predicted activation of IFN ᵞ in monochemoresistant choriocarcinoma and inhibited IL2 and TNF in polychemoresistant choriocarcinoma. The main biological functions predicted to be altered in chemoresistant choriocarcinoma were related to immunological homeostasis and leukopoiesis. CONCLUSION HLA-G is a strong candidate gene to predict choriocarcinoma resistance to monochemotherapy and that further studies are required to implement its routine quantification in the decision process for the management of gestational choriocarcinoma.
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Affiliation(s)
- Pierre-Adrien Bolze
- University of Lyon 1, Hospices Civils de Lyon, University Hospital Lyon Sud, Department of Gynecological Surgery and Oncology, Obstetrics, 165 chemin du grand Revoyet, 69495 Pierre Bénite, France; French Center for Trophoblastic Diseases, University Hospital Lyon Sud, 165 chemin du grand Revoyet, 69495 Pierre Bénite, France; Joint Research Unit Hospices Civils de Lyon-bioMérieux, Hospices Civils de Lyon, Lyon Sud Hospital, 165 chemin du grand Revoyet, 69495 Pierre Bénite, France; Medical Diagnostic Discovery Department (MD3), bioMérieux S.A., Marcy l'Etoile, France; Joint Research Unit Hospices Civils de Lyon-bioMérieux, EA 7426 Pathophysiology of Injury-Induced Immunosuppression, PI3, Claude Bernard Lyon 1 University, Edouard Herriot Hospital, Lyon, France.
| | - Jonathan Lopez
- University of Lyon 1, Hospices Civils de Lyon, University Hospital Lyon Sud, Plateforme de Recherche de Transfert en Oncologie, Department of Biochemistry and Molecular Biology, 165 chemin du grand Revoyet, 69495 Pierre Bénite, France; Faculté de Médecine Lyon Est, Lyon, France; Centre de Recherche en Cancérologie de Lyon, INSERM U1052, CNRS UMR5286, Lyon, France
| | - Fabienne Allias
- French Center for Trophoblastic Diseases, University Hospital Lyon Sud, 165 chemin du grand Revoyet, 69495 Pierre Bénite, France; University of Lyon 1, Hospices Civils de Lyon, University Hospital Lyon Sud, Department of Pathology, 165 chemin du grand Revoyet, 69495 Pierre Bénite, France
| | - Touria Hajri
- French Center for Trophoblastic Diseases, University Hospital Lyon Sud, 165 chemin du grand Revoyet, 69495 Pierre Bénite, France
| | - Sophie Patrier
- French Center for Trophoblastic Diseases, University Hospital Lyon Sud, 165 chemin du grand Revoyet, 69495 Pierre Bénite, France; Department of Pathology, University Hospital of Rouen, F-76031 Rouen Cedex, France
| | - Mojgan Devouassoux-Shisheboran
- French Center for Trophoblastic Diseases, University Hospital Lyon Sud, 165 chemin du grand Revoyet, 69495 Pierre Bénite, France; University of Lyon 1, Hospices Civils de Lyon, University Hospital Lyon Sud, Department of Pathology, 165 chemin du grand Revoyet, 69495 Pierre Bénite, France
| | - Jérôme Massardier
- French Center for Trophoblastic Diseases, University Hospital Lyon Sud, 165 chemin du grand Revoyet, 69495 Pierre Bénite, France; University of Lyon 1, University Hospital Femme Mere Enfant, Department of Obstetrics and Gynecology, 51, boulevard Pinel, 69500 Bron, France
| | - Benoit You
- French Center for Trophoblastic Diseases, University Hospital Lyon Sud, 165 chemin du grand Revoyet, 69495 Pierre Bénite, France; University of Lyon 1, Hospices Civils de Lyon, University Hospital Lyon Sud, Medical Oncology Department, Investigational Center for Treatments in Oncology and Hematology of Lyon (CITOHL), 165 chemin du grand Revoyet, 69495 Pierre Bénite, France
| | - François Golfier
- University of Lyon 1, Hospices Civils de Lyon, University Hospital Lyon Sud, Department of Gynecological Surgery and Oncology, Obstetrics, 165 chemin du grand Revoyet, 69495 Pierre Bénite, France; French Center for Trophoblastic Diseases, University Hospital Lyon Sud, 165 chemin du grand Revoyet, 69495 Pierre Bénite, France
| | - François Mallet
- Joint Research Unit Hospices Civils de Lyon-bioMérieux, Hospices Civils de Lyon, Lyon Sud Hospital, 165 chemin du grand Revoyet, 69495 Pierre Bénite, France; Medical Diagnostic Discovery Department (MD3), bioMérieux S.A., Marcy l'Etoile, France; Joint Research Unit Hospices Civils de Lyon-bioMérieux, EA 7426 Pathophysiology of Injury-Induced Immunosuppression, PI3, Claude Bernard Lyon 1 University, Edouard Herriot Hospital, Lyon, France
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Khooei A, Atabaki Pasdar F, Fazel A, Mahmoudi M, Nikravesh MR, Daneshmand Shahbazian S. P53 expression in various types of hydropic placentas (through ploidy analysis as a complementary tool in diagnosis of samples). CASPIAN JOURNAL OF INTERNAL MEDICINE 2019; 10:205-210. [PMID: 31363399 PMCID: PMC6619464 DOI: 10.22088/cjim.10.2.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Placentas characterized by hydropic swelling of chorionic villi occur in a spectrum of pathological conditions including hydropic abortion (HA), partial hydatidiform mole (PHM) and complete hydatidiform mole (CHM). The purpose of this study was to investigate whether the expression of p53 tumour suppressor protein could differentiate these various types of hydropic placentas. Methods: p53 immunohistochemical staining was performed in 19 molar (8 PHM and 11 CHM) and 10 non-molar (HA) formalin-fixed, paraffin-embedded tissue samples. Ploidy analysis using flow cytometry was performed as a complementary tool in diagnosis of samples. Results: DNA histograms obtained from all samples had confirmed diploidy in HAs and CHMs and triploidy in PHMs. p53 immunoreactivity was assessed in villous cytotrophoblasts, syncytiotrophoblasts and stromal cells. The p53 positive reaction was predominantly observed in the nuclei of cytotrophoblastic cells and rarely in stromal cells, no reaction was seen in syncytiotrophoblasts. The mean percentage of p53 positive cells were 6.10±3.75 for HA, 25.87±13.4 for PHM and 39.83±18.76 for CHM. There was a significant difference in P53 immunoreactivity of cytotrophoblastic cells between CHM and HA (P<0.001), and between PHM and HA (P=0.004). There was no significant difference in immunohistochemical reactivity between CHM and PHM (P=0.068). Conclusion: This study confirms that p53 immunostaining may be helpful in distinguishing complete and partial hydatidiform mole from hydropic abortion, but not complete hydatidiform mole from partial hydatidiform mole.
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Affiliation(s)
- Alireza Khooei
- Department of Pathology, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Atabaki Pasdar
- Department of Anatomical Sciences, Faculty of Medicine, Urmia University of Medical Sciences, Urmia
| | - Alireza Fazel
- Department of Anatomical Sciences, Faculty of Medicine, Urmia University of Medical Sciences, Urmia
| | - Mahmoud Mahmoudi
- Immunology Research Center, Bu Ali Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Reza Nikravesh
- Department of Anatomy and Cell Biology, faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shahrzad Daneshmand Shahbazian
- Department of Biomedical Engineering, School of Electrical Engineering, Iran University of Science & Technology (IUST), Tehran, Iran
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Missaoui N, Landolsi H, Mestiri S, Essakly A, Abdessayed N, Hmissa S, Mokni M, Yacoubi MT. Immunohistochemical analysis of c-erbB-2, Bcl-2, p53, p21 WAF1/Cip1, p63 and Ki-67 expression in hydatidiform moles. Pathol Res Pract 2018; 215:446-452. [PMID: 30558966 DOI: 10.1016/j.prp.2018.12.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 11/23/2018] [Accepted: 12/11/2018] [Indexed: 01/02/2023]
Abstract
Hydatidiform moles (HM) are characterized by an abnormal proliferating trophoblast with a potential for a malignant transformation. Similar to other human tumors, trophoblastic pathogenesis is likely a multistep process involving several molecular and genetic alterations. The study was performed to investigate the expression patterns of c-erbB-2 and Bcl-2 oncoproteins, p53, p21WAF1/CIP1 and p63 tumor suppressor proteins and Ki-67 cell proliferation marker in HM. We conducted a retrospective study of 220 gestational products, including 39 hydropic abortions (HA), 41 partial HM (PHM) and 140 complete HM (CHM). The expression of c-erbB-2, Bcl-2, p53, p21WAF1/CIP1, p63 and Ki-67 was investigated by immunohistochemistry on archival tissues. c-erbB-2 expression was observed in three PHM and 10 CHM. Bcl-2 immunostaining was significantly higher in PHM (61%) and CHM (70.7%) compared with HA (7.7%, p = 0.001 and p < 0.0001, respectively). p53 expression was stronger in CHM (73.6%) compared with PHM (24.4%, p < 0.0001) and HA (12.8%, p < 0.0001). p21WAF1/CIP1 staining was observed as well in molar and non-molar gestations (p > 0.05). p63 immunoexpression was significantly described in CHM (85.7%) and PHM (78%) compared with HA (10.2%, p < 0.0001 and p = 0.0001, respectively). Ki-67 was significantly expressed in CHM (72.1%) compared with HA (46.2%, p = 0.005). Altered expression of Bcl-2, p53, p63 and Ki-67 reflects the HM pathological development. Immunohistochemical analysis is beneficial to recognize the HM molecular and pathogenic mechanisms. Furthermore, it could serve as a useful adjunct to conventional methods for refining HM diagnosis.
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Affiliation(s)
- Nabiha Missaoui
- Research Unit UR14ES17, Cancer Epidemiology and Cytopathology in Tunisian Center, Medicine Faculty of Sousse, University of Sousse, 4000 Sousse, Tunisia; Faculty of Sciences and Techniques, Sidi Bouzid, Kairouan University, Tunisia; Pathology Department, Farhet Hached Hospital, 4000 Sousse, Tunisia.
| | - Hanene Landolsi
- Research Unit UR14ES17, Cancer Epidemiology and Cytopathology in Tunisian Center, Medicine Faculty of Sousse, University of Sousse, 4000 Sousse, Tunisia
| | - Sarra Mestiri
- Pathology Department, Farhet Hached Hospital, 4000 Sousse, Tunisia; Medicine Faculty of Sousse, University of Sousse, 4000 Sousse, Tunisia
| | - Ahlem Essakly
- Medicine Faculty of Sousse, University of Sousse, 4000 Sousse, Tunisia
| | - Nihed Abdessayed
- Pathology Department, Farhet Hached Hospital, 4000 Sousse, Tunisia; Medicine Faculty of Sousse, University of Sousse, 4000 Sousse, Tunisia
| | - Sihem Hmissa
- Research Unit UR14ES17, Cancer Epidemiology and Cytopathology in Tunisian Center, Medicine Faculty of Sousse, University of Sousse, 4000 Sousse, Tunisia; Pathology Department, Farhet Hached Hospital, 4000 Sousse, Tunisia; Medicine Faculty of Sousse, University of Sousse, 4000 Sousse, Tunisia
| | - Moncef Mokni
- Pathology Department, Farhet Hached Hospital, 4000 Sousse, Tunisia; Medicine Faculty of Sousse, University of Sousse, 4000 Sousse, Tunisia
| | - Mohamed Tahar Yacoubi
- Pathology Department, Farhet Hached Hospital, 4000 Sousse, Tunisia; Medicine Faculty of Sousse, University of Sousse, 4000 Sousse, Tunisia
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Tse KY, Chiu KWH, Chan KKL, Chu MMY, Ngu SF, Cheung ANY, Ngan HYS, Ip PPC. A Case Series of Five Patients With Pure or Mixed Gestational Epithelioid Trophoblastic Tumors and a Literature Review on Mixed Tumors. Am J Clin Pathol 2018; 150:318-332. [PMID: 29897391 DOI: 10.1093/ajcp/aqy039] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To review the clinicopathologic features of five patients with epithelioid trophoblastic tumor (ETT). METHODS Characteristics of patients diagnosed with ETT in 2000 to 2012 were reviewed. RESULTS Among 190 patients with gestational trophoblastic neoplasia (GTN), two had pure ETT and three had mixed ETT and choriocarcinoma. The median age was 32.5 years. All the patients had localized disease in the uterus. One patient with pure ETT had a recurrence in the ureter 6 years after the initial treatment. Another patient with pure ETT had two full-term deliveries after fertility-sparing surgery. The three patients with mixed tumors had chemotherapy for GTN before their diseases were completely treated by hysterectomy. At a median follow-up of 102 months, all patients survived. CONCLUSIONS ETT is indolent. Recurrence can happen, but the risk factors are not clear. When patients with GTN fail to respond to chemotherapy, the possibility of mixed GTN should be considered.
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Affiliation(s)
- Ka Yu Tse
- Department of Obstetrics and Gynaecology, the University of Hong Kong
| | | | | | - Mandy Man Yee Chu
- Department of Obstetrics and Gynaecology, the University of Hong Kong
| | - Siew Fei Ngu
- Department of Pathology, the University of Hong Kong
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Hasanzadeh M, Sharifi N, Farazestanian M, Nazemian SS, Madani Sani F. Immunohistochemistry Study of P53 and C-erbB-2 Expression in Trophoblastic Tissue and Their Predictive Values in Diagnosing Malignant Progression of Simple Molar Pregnancy. IRANIAN JOURNAL OF CANCER PREVENTION 2016; 9:e4115. [PMID: 27703642 PMCID: PMC5038832 DOI: 10.17795/ijcp-4115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 12/09/2015] [Accepted: 06/05/2016] [Indexed: 11/26/2022]
Abstract
Background Finding a tumor marker to predict the aggressive behavior of molar pregnancy in early stages has yet been a topic for studies. Objectives In this survey we planned to study patients with molar pregnancy to 1) assess the p53 and c-erbB-2 expression in trophoblastic tissue, 2) to study the relationship between their expression intensity and progression of a molar pregnancy to gestational trophoblastic neoplasia, and 3) to determine a cut off value for the amount of p53 and c-erbB-2 expression which might correlate with aggressive behavior of molar pregnancy. Patients and Methods In a prospective cross sectional study by using a high accuracy technique EnVision Tm system for immunohistochemistry staining of molar pregnancy samples, we evaluated p53 and c-erbB-2 expression in cytotrophoblast and syncytiotrophoblast and the correlation of their expression with progression of molar pregnancy to gestational trophoblastic neoplasia (GTN). Normal prostatic tissue and Breast cancer tissue were used as positive controls. Results We studied 28 patients with simple molar pregnancy (SMP) and 30 with GTN. Cytotrophobalst had significantly higher expression of p53 and c-erbB-2 and syncytiotrophoblast had greater expression of p53 in GTN group as compared to SMP group. The cut off values for percentage of p53 positive immunostained cytotrophoblast and syncytiotrophoblast were 5.5% and 2.5%. In c-erbB-2 positive membranous stained cytotrophoblast the cut off was 12.5%. Conclusions Our data suggests that over expression of p53 and c-erbB-2 is associated with malignant progression of molar pregnancy. We encountered that high expression of p53 and c-erbB-2 in trophoblastic cells could predict gestational trophoblastic neoplasia during the early stages.
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Affiliation(s)
- Malihe Hasanzadeh
- Department of Obstetrics and Gynecology, Women Health Research Center, Qaem Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Norrie Sharifi
- Department of Pathology, Qaem Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Marjaneh Farazestanian
- Women Health Research Center, Qaem Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
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Zhou X, Duan Z. Doppler ultrasonography reveals blood flow signals within the masses of invasive moles in subjects with normal hCG levels after chemotherapy: Three case reports. Oncol Lett 2013; 6:950-952. [PMID: 24137443 PMCID: PMC3796410 DOI: 10.3892/ol.2013.1474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 06/19/2013] [Indexed: 11/06/2022] Open
Abstract
A consensus has formed that patients with invasive moles should continue with one to three cycles of chemotherapy after human chorionic gonadotropin (hCG) levels have decreased to a normal level. However, the management plan has not been agreed for cases where Doppler ultrasonography (DU) indicates blood-flow signals within the tumor mass after one to three cycles of chemotherapy when the hCG concentration has returned to normal. The present study describes the clinical and therapeutic courses of three patients with invasive moles with confirmed blood-flow signals (by DU) after their hCG levels had normalized. One patient underwent surgery to remove the mass within the uterine muscle, while the other two patients decided to cease chemotherapy and were managed by follow-up appointments; all three patients had good outcomes. These data illustrate that patients with invasive moles should be followed up if DU indicates blood-flow signals in the tumor mass after one to three cycles of chemotherapy when the hCG level has decreased back to a normal level.
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Affiliation(s)
- Xi Zhou
- Reproductive Research Center, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China ; Department of Radiation Oncology, The First Affiliated Hospital of the Medical College, Xi'an Jiaotong University, Xi'an, Shaanxi 710004, P.R. China
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Khooei A, Atabaki Pasdar F, Fazel A, Mahmoudi M, Nikravesh MR, Khaje Delui M, Pourheydar B. Ki-67 expression in hydatidiform moles and hydropic abortions. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:590-4. [PMID: 24396579 PMCID: PMC3871747 DOI: 10.5812/ircmj.5348] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Revised: 05/16/2013] [Accepted: 05/28/2013] [Indexed: 11/16/2022]
Abstract
Background Differential diagnosis of hydatidiform moles from non-molar specimens as well as their sub-classification such as complete and partial hydatidiform moles are important for clinical management and accurate risk assessment for persistent gestational trophoblastic disease, but diagnosis based solely on histomorphology suffers from poor interobserver and intraobserver reproducibility. Objectives This study was undertaken to determine whether the expression of Ki-67 protein could differentiate these entities. Materials and Methods We performed Ki-67 immunohistochemical staining in 19 molar (8 partial and 11 complete moles) and 10 non-molar (hydropic abortions) formalin-fixed, paraffin-embedded tissue samples. Ploidy analysis using flow cytometry had confirmed diploidy in hydropic abortions and complete moles and triploidy in partial moles. Results Ki-67 immunoreactivity was assessed in villous cytotrophoblasts, syncytiotrophoblasts and stromal cells. Positive cells were found to be restricted mostly to the villous cytotrophoblasts, while syncytiotrophoblasts showed an absence of immunostaining for Ki-67, and occasional weak nuclear staining was seen in the stromal cells. There was a significant difference in Ki-67 immunoreactivity of cytotrophoblastic cells between hydropic abortions and complete moles (P < 0.001), hydropic abortions and partial moles (P = 0.002) and also between complete and partial moles (P < 0.001). On the other hand, there is significant overlap in the Ki-67 immunoreactivity between complete and partial moles (++ staining category) and between partial moles and hydropic abortions (+ staining category). Conclusions Despite the significant differences , Ki-67 immunostaining could not be helpful in distinguishing molar placentas from hydropic abortions as well as partial from complete hydatidiform moles, because there are considerable overlaps between results in different categories.
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Affiliation(s)
- Alireza Khooei
- Department of Pathology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Fatemeh Atabaki Pasdar
- Department of Anatomical Sciences, Urmia University of Medical Sciences, Urmia, IR Iran
- Corresponding author: Fatemeh Atabaki Pasdar, Department of Anatomical Sciences, Urmia University of Medical Sciences, Urmia, IR Iran. Tel: +98-4413444352, Fax: 98-4412780801, E-mail:
| | - Alireza Fazel
- Department of Anatomy and Cell Biology, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mahmoud Mahmoudi
- Immunology Research Center, Bu Ali Research Institute, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mohammad Reza Nikravesh
- Department of Anatomy and Cell Biology, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mohammad Khaje Delui
- Department of Medical Ethics, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Bagher Pourheydar
- Department of Anatomical Sciences, Urmia University of Medical Sciences, Urmia, IR Iran
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Down-regulation of poly(rC)-binding protein 1 correlates with the malignant transformation of hydatidiform moles. Int J Gynecol Cancer 2013; 22:1125-9. [PMID: 22801034 DOI: 10.1097/igc.0b013e3182606ac3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To analyze the expression patterns of poly(rC)-binding protein 1 (PCBP1) in complete hydatidiform moles (HMs) and to determine the predictive value of PCBP1 during postmolar follow-up after uterine evacuation. MATERIALS AND METHODS The PCBP1 protein expression profile was investigated in 10 complete moles that remained benign, 10 complete moles that underwent malignant transformation, and 10 choriocarcinoma tissues using Western blot analysis. The PCBP1 protein expression patterns in complete HM samples gathered from 69 patients were also detected by immunohistochemical analysis. The association of PCBP1 protein expression with the progression in HMs was subsequently assessed. RESULTS The expression of PCBP1 was significantly lower in malignant-transformed moles than benign moles. The PCBP1 expression level was negatively associated with malignant transformation and serum human chorionic gonadotropin levels. Logistic regression analysis indicated that complete moles with high PCBP1 expression levels had a significantly lower risk of progression to gestational trophoblastic tumors (odds ratio, 0.22; 95% confidence interval, 0.07-0.67). CONCLUSIONS These observations suggest that PCBP1 may be important in the pathogenesis of gestational trophoblastic tumors. In addition to the β-fraction of human chorionic gonadotropin, decreased expression of PCBP1 protein may be a strong predictor of the malignant transformation of complete moles.
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Hasanzadeh M, Sharifi N, Esmaieli H, Daloee MS, Tabari A. Immunohistochemical expression of the proliferative marker Ki67 in hydatidiform moles and its diagnostic value in the progression to gestational trophoblastic neoplasia. J Obstet Gynaecol Res 2012; 39:572-7. [DOI: 10.1111/j.1447-0756.2012.01981.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Cheung ANY, Zhang HJ, Xue WC, Siu MKY. Pathogenesis of choriocarcinoma: clinical, genetic and stem cell perspectives. Future Oncol 2009; 5:217-31. [PMID: 19284380 DOI: 10.2217/14796694.5.2.217] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Choriocarcinoma is a unique malignant neoplasm composed of mononuclear cytotrophoblasts and multinucleated syncytiotrophoblasts that produce human chorionic gonadotrophin. Choriocarcinoma can occur after a pregnancy, as a component of germ cell tumors, or in association with a poorly differentiated somatic carcinoma, each with distinct clinical features. Cytogenetic and molecular studies, predominantly on gestational choriocarcinoma, revealed the impact of oncogenes, tumor suppressor genes and imprinting genes on its pathogenesis. The role of stem cells in various types of choriocarcinoma has been studied recently. This review will discuss how such knowledge can enhance our understanding of the pathogenesis of choriocarcinoma, enable exploration of novel anti-choriocarcinoma targeted therapy and possibly improve our insight on embryological and placental development.
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Affiliation(s)
- Annie N Y Cheung
- Department of Pathology, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
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