The villous stromal constituents of complete hydatidiform mole differ histologically in very early pregnancy from the normally developing placenta

Histologic distinction between complete hydatidiform moles and nonmolar abortuses in early pregnancy is often extremely difficult. This study details the chronologic changes that occur in normal placenta, especially in the villous stroma during gestational weeks 4 to 12 and compares the findings in 63 normal placentas and 73 early complete moles. Over time, the chorionic villi in normal placenta showed gradual but recognizable alterations, from basophilic/hypocellular and nonvascular stroma to basophilic/cellular stroma containing angiogenic cell cords (immature blood vessels), and then to loose, edematous/reticular stroma with mature blood vessels containing vascular lumina and hematopoietic components. A basophilic stroma, which was frequently seen in early complete moles, was a constant feature of chorionic villi younger than week 7 in normal placenta, but had disappeared after week 8, except in the newly branched sprouts. Trophoblastic proliferation was virtually unrecognizable in 59% of early complete moles, whereas circumferential trophoblastic sprouts during weeks 4 to 6 of normal placenta can be mistaken as that of complete moles. Few or no mature blood vessels and excessive stromal karyorrhexis are characteristic features of early complete moles, even in the absence of trophoblastic proliferation, but they are occasionally found in normal placenta younger than week 7. Although many features of normal and molar placenta were similar during the earliest weeks (5 to 6) including basophilic stroma, angiogenic cell cords (immature blood vessels), and often circumferential trophoblastic sprouts and proliferation, already by that time early moles showed significantly greater percentages of stromal cells undergoing karyorrhexis and apoptosis compared with normal placenta (37.6% vs. 5.4%). These results indicate the histologic features do exist early on in pregnancy to differentiate normal from molar pregnancy. Further, it points out that complete hydatidiform mole in addition to being disease of trophoblastic proliferation is also associated with defects in vasculogenesis and maturation of villous stromal constituents.     

Diagnostic reproducibility of hydatidiform moles: ancillary techniques (p57 immunohistochemistry and molecular genotyping) improve morphologic diagnosis

Distinction of hydatidiform moles (HMs) from nonmolar specimens (NMs) and subclassification of HMs as complete hydatidiform moles (CHMs) and partial hydatidiform moles (PHMs) are important for clinical practice and investigational studies; yet, diagnosis based solely on morphology is affected by interobserver variability. Molecular genotyping can distinguish these entities by discerning androgenetic diploidy, diandric triploidy, and biparental diploidy to diagnose CHMs, PHMs, and NMs, respectively. Eighty genotyped cases (27 CHMs, 27 PHMs, and 26 NMs) were selected from a series of 200 potentially molar specimens previously diagnosed using p57 immunostaining and genotyping. Cases were classified by 3 gynecologic pathologists on the basis of H&E slides (masked to p57 immunostaining and genotyping results) into 1 of 3 categories (CHM, PHM, or NM) during 2 diagnostic rounds; a third round incorporating p57 immunostaining results was also conducted. Consensus diagnoses (those rendered by 2 of 3 pathologists) were determined. Genotyping results were used as the gold standard for assessing diagnostic performance. Sensitivity of a diagnosis of CHM ranged from 59% to 100% for individual pathologists and from 70% to 81% by consensus; specificity ranged from 91% to 96% for individuals and from 94% to 98% by consensus. Sensitivity of a diagnosis of PHM ranged from 56% to 93% for individual pathologists and from 70% to 78% by consensus; specificity ranged from 58% to 92% for individuals and from 74% to 85% by consensus. The percentage of correct classification of all cases by morphology ranged from 55% to 75% for individual pathologists and from 70% to 75% by consensus. The κ values for interobserver agreement ranged from 0.59 to 0.73 (moderate to good) for a diagnosis of CHM, from 0.15 to 0.43 (poor to moderate) for PHM, and from 0.13 to 0.42 (poor to moderate) for NM. The κ values for intraobserver agreement ranged from 0.44 to 0.67 (moderate to good). Addition of the p57 immunostain improved sensitivity of a diagnosis of CHM to a range of 93% to 96% for individual pathologists and 96% by consensus; specificity was improved from a range of 96% to 98% for individual pathologists and 96% by consensus; there was no substantial impact on diagnosis of PHMs and NMs. Interobserver agreement for interpretation of the p57 immunostain was 0.96 (almost perfect). Even with morphologic assessment by gynecologic pathologists and p57 immunohistochemistry, 20% to 30% of cases will be misclassified, and, in particular, distinction of PHMs and NMs will remain problematic.     

人正常胚胎和葡萄胎绒毛中纤蛋白溶酶原激活与抑制因子及其尿激酶受体的表达

本研究应用原位杂交技术检测人正常胚胎及葡萄胎绒毛中纤蛋白溶酶原激活与抑制因子（ｔＰＡ,ｕＰＡ,ＰＡＩ－１）及其尿激酶受体（ｕＰＡ－Ｒ）的表达。结果表明,人正常胚胎绒毛的合体滋养层和细胞滋养层细胞中均含有ｔＰＡ、ｕＰＡ、ＰＡＩ－１及ｕＰＡ－ＲｍＲＮＡ,葡萄胎绒毛中ｔＰＡ、ＰＡＩ－１及ｕＰＡ－ＲｍＲＮＡ表达明显增强。提示：（１）ＰＡ－ＰＡＩ的协同作用在维持妊娠期间正常的纤蛋白溶解可能是重要的;（２）纤溶激活与抑制在葡萄胎的发展过程中可能起作用     

早早孕人子宫蜕膜及绒毛膜凝集素的组化分析

以凝集素作为组化探针研究早早孕期人子宫蜕膜、绒毛膜表面糖复合物的变化。结果表明：６种凝集素在早早孕期与子宫蜕膜及绒毛膜结合显示不同变化。其中刀豆凝集素（ＣｏｎＡ）、花牛凝集素（ＰＮＡ）、双花藕豆凝集素（ＤＢＡ）与子宫蜕膜结合随妊娠无数增加着色逐渐减弱。荆豆凝集素（ＵＥＡ－Ⅰ）与子宫蜕膜未见着色。麦胚凝集素（ＷＧＡ）、蓖麻凝集素（ＲＣＡ－Ⅰ）与子宫内膜在早早孕期着色程度未见有变化。ＰＮＡ、ＣｏｎＡ在与绒毛滋养层细胞结合随妊娠天数增加着色逐渐增强。ＵＥＡ－Ⅰ和ＤＢＡ与滋养层细胞在各期中未见结合。     

Luminex液相蛋白芯片用于研究着床窗期子宫内膜和早孕蜕膜基质细胞的细胞因子的表达谱

目的探索着床窗期子宫内膜和早孕期蜕膜基质细胞的细胞因子谱表达及其对胚胎着床和早期妊娠的可能影响。方法获取着床窗期子宫内膜基质细胞(ESC)和早孕期蜕膜基质细胞(DSC)进行体外培养,采用Luminex液相蛋白芯片技术检测细胞培养上清液中15种细胞因子:肿瘤坏死因子(TNF-α)、干扰素-γ(IFN-γ)、白细胞介素(IL)-1β、IL-2、IL-4、IL-6、IL-8、IL-10、IL-12、颗粒-巨噬细胞集落刺激因子(GM-CSF)、颗粒细胞集落刺激因子(G-CSF)、巨噬细胞炎症蛋白-1α(MIP-1α)、单核细胞趋化蛋白因子-1(MCP-1)、受调节激活的正常T细胞排泌的因子(RANTES)和γ干扰素诱导蛋白10(IP-10)的含量变化,比较两者表达的差异。结果DSC分泌多种细胞因子,与ESC相比,其中TNF-α、IFN-γ、IL-1β、IL-6、IL-8、IL-10、IP-10、GM-CSF、G-CSF、MIP-1α、RANTES表达下调,有极显著差异(P<0.001);IL-4表达上调,有显著差异(P<0.01);MCP-1、IL-2和IL-12表达无明显变化。不同时期表达的细胞因子之间存在复杂的相关关系。结论从着床窗期子宫内膜到早孕期蜕膜基质细胞表达的细胞因子谱的水平发生变化,可能对调控胚胎着床和维持早期妊娠起着重要作用。     

完全性葡萄胎绒毛凋亡与基因表达的相关研究

目的 :探讨完全性葡萄胎绒毛凋亡、增殖活性与 Bcl-2、Bax、Fas、Fas-L及增殖细胞核抗原 ( PCNA)基因表达的相关性。方法 :收集正常早孕绒毛标本及近一年归档的完全性葡萄胎绒毛蜡块 ,原位末端标记法 ( TUNEL)进行细胞凋亡的组织学检测 ,免疫组织化学法测定 Bcl-2、Bax、Fas、Fas-L、PCNA的分布与含量 ,原位杂交法测定 Fas、Fas-Lm RNA的分布与含量。结果 :正常早孕绒毛有少量凋亡细胞 ,主要分布于合体滋养细胞 ,Bcl-2、PCNA蛋白仅在细胞滋养细胞表达且含量丰富 ,Bax、Fas、Fas-L蛋白在合体滋养细胞表达且含量低下。完全性葡萄胎绒毛合体滋养细胞凋亡较正常早孕明显增多 ,Fas、Fas-L 蛋白及其 m RNA不仅在合体滋养细胞而且在细胞滋养细胞表达均明显增强 ,Bcl-2、Bax蛋白在两种细胞中表达也增强 ;PCNA蛋白仅见于细胞滋养细胞 ,含量丰富。结论 :完全性葡萄胎绒毛凋亡细胞增多 ,主要经 Fas/ Fas-L 转录与翻译水平介导 ,表现为高凋亡与高增殖共存现象 ,可能与其无控生长的特性相关。     

短串联重复序列多态性分析在鉴别妊娠早期葡萄胎和水肿性流产中的临床应用

目的探讨短串联重复序列(STR)多态性分析在鉴别妊娠早期葡萄胎(HM)和水肿性流产(HA)中的临床应用价值。方法收集2015年9月至2016年11月于北京妇产医院计划生育科行高危流产手术、疑似HM的17例患者为研究对象,常规取材固定后分别采用传统组织病理学方法及STR分析方法进行分析。评价STR方法在HM和HA鉴别中的效果。结果 17例可疑HM病例,经组织病理学检查发现9例符合HM[其中完全性HM(CHM)6例,部分性HM(PHM)3例],8例符合HA。STR基因分型结果为10例HM,其中6例CHM(单精纯合型CHM 4例,双精杂合型CHM 2例),4例PHM(均为双精杂合型);7例符合HA。组织病理学诊断中有1例PHM漏诊,1例双精杂合型PHM被误诊为HA。结论STR多态性分析可以作为一种快速、简洁、精准的方法,有效用于妊娠早期HM和HA的鉴别诊断。     

早中孕期标准颅脑超声切面诊断胎儿颅内畸形

目的：探讨早中孕期标准颅脑超声切面对胎儿颅内畸形的诊断价值。方法：回顾性分析3800例2011年11月至2013年6月孕11～14周的孕妇常规颅脑超声切面检查所得的胎儿颅内超声图像,并与病理结果相对照。结果：3800例孕妇通过早中孕期颅脑超声切面检查共发现颅脑畸形61例,其中包括无脑儿13例,露脑畸形8例,脊柱裂4例,全前脑11例,脑膜脑膨出13例,颈部水囊瘤12例,漏诊颅脑畸形8例,脊柱裂漏诊2例。结论：通过早中孕期标准颅脑超声切面对胎儿颅内超声成像,可早期诊断胎儿颅内畸形,具有重要的临床意义。     

Protein restriction in pregnancy is associated with increased apoptosis of mesenchymal cells at the start of rat metanephrogenesis

BACKGROUND: In rats, offspring born to mothers supplied low protein diets during pregnancy have fewer glomeruli than normal. We hypothesized that such nephron deficits are associated with altered cell turnover in the metanephros, the embryonic precursor of the adult kidney. METHODS: Wistar rats were supplied with one of three isocaloric diets from day 0 of pregnancy: control (18% protein) or low protein (9% or 6%) diets. All had a normal chow after birth. Groups were compared by multilevel statistical modeling. RESULTS: At two weeks postnatally, when nephrogenesis has finished, controls had 16.8 x 103 +/- 0.7 x 10(3) (mean +/- SEM) glomeruli/kidney, whereas offspring exposed to 9% diet had 5.1 x 10(3) +/- 1.2 x 10(3) fewer and those exposed to 6% diet had 6.9 x 10(3) +/- 1.7 x 10(3) fewer glomeruli/kidney (P < 0.001, both diets). At embryonic day 13 (E13), when the metanephros has just formed, control metanephroi contained 2.35 x 10(4) +/- 0.15 x 10(4) cells, with no significant differences in low protein groups. At E15, when mesenchyme begins forming primitive nephrons but glomeruli are still absent, controls had 2.00 x 10(6) +/- 0.13 x 10(6) cells. E15 embryos exposed to 9% protein had 1.09 x 10(6) +/- 0.36 x 10(6) fewer cells/metanephros than controls, while those exposed to 6% diet had 1.45 x 10(6) +/- 0.37 x 10(6) fewer (P < 0.01, both diets). Apoptotic cells were detected by molecular (in-situ end-labeling) and morphological (propidium iodide staining) techniques. In all diets, apoptosis was noted in condensing mesenchyme (nephron precursors) and loose mesenchyme (interstitial precursors). Control E13 metanephroi had 63 +/- 7 apoptotic cells/mm2, whereas those exposed to 9% diet had an increase of 77 +/- 26 cells/mm2 (P < 0.01) and those exposed to 6% diet had an increase of 55 +/- 26 cells/mm2 (P < 0.05). By E15, apoptosis was similar in all groups but metanephric mitosis was significantly increased in the 6% protein diet group. No change was found in the level of apoptosis in E13 mesonephroi. CONCLUSIONS: Maternal low protein diets reduce final numbers of glomeruli in association with enhanced deletion of mesenchymal cells at the start of kidney development. Whether aberrant nephrogenesis is a direct effect from deletion of nephron precursors, or an indirect effect from loss of supportive interstitial precursors, requires further investigation.     

米非司酮对早孕胎盘绒毛诱导型一氧化氮合酶和细胞凋亡的影响

目的了解米非司酮对早孕绒毛诱导型一氧化氮合酶（iNOS）及滋养层细胞凋亡的影响,进一步探讨米非司酢早孕药物流产机理。方法选择40例早孕药物流产患者（实验组）,采用原位杂交及免疫组化方法检测绒毛中iNOS的表达,细胞凋亡采用3＇-OH末端缺口标记法（TUNEL）显示绒毛滋养细胞中原位凋亡细胞的表达。利用计算机图象分析系纺（CMIAS）,iNOS表达指标以数密度（N／S）及阳性单位（Pu）计算,细胞凋亡以每个统计场凋亡细胞个数（N）、凋亡细胞平均噘光度（OD）、凋亡细胞面密度（凋亡细胞面积／统计场面积,DS／TS）表示,并与40例正常人工流产的绒毛和蜕膜组织（对照组：比较。结果实验组绒毛组织iNOS原位杂交结果显示N／S、Pu分别为0．12±0．010、15．3±2．6,对照组分别为0．02±0．003、3．1±0．5,两组有极显著性差异（P〈0．01）;免疫组化结果显示实验组和对照组N／s、Pu分别为0．09±0．01、10．24±1．55及0．016±0．002、1．26±0．33,差异有显著性。实验组绒毛滋养细胞凋亡指数显著增高,各指标两组比较差异显著。结论米非司酮早孕药物流产与绒毛组织iNOS活性及滋养细胞凋亡有关。     

Surgical repair of incomplete cleft sternum and cardiac anomalies in early infancy

Congenital cleft sternum is a rare congenital anomaly due to lack of fusion of the lateral mesodermal plates. We report two cases of incomplete superior cleft sternum associated with cardiac anomalies that underwent successful complete surgical correction.     

原癌基因c-kit在胃肠道间质瘤中的表达及其临床意义

目的　通过检测胃肠道间质瘤 (gastrointestinalstromaltumor ,GIST)中原癌基因c kit蛋白表达 ,探讨c kit在GIST中的诊断及预后意义。　方法　应用免疫组织化学技术EnVision微波二步法检测了 12 2例GIST(良性 5 4例 ,潜在恶性 13例 ,恶性 5 5例 )中的c kit蛋白的表达情况 ,并与平滑肌瘤、神经鞘瘤进行对照研究。不着色或仅细胞核着色者为阴性 ,凡肿瘤细胞浆内或 (和 )细胞膜上有棕黄色颗粒者为阳性。　结果　GIST中c kit的阳性表达率为 97% (118/ 12 2 ) ,阳性信号定位准确。其中 ,良性组、潜在恶性组及恶性组c kit的阳性率分别为 98% (5 3/ 5 4 )、93% (12 / 13)、96 % (5 3/ 5 5 )。与良性组相比 ,转移或复发病例c kit蛋白着色较淡 ,但 3组之间c kit的表达水平差异无显著意义 (χ2 =1 16 7,P >0 0 5 )。平滑肌瘤和神经鞘瘤c kit阴性表达。　结论　c kit作为一种胃肠道间质瘤特异而敏感的标记物 ,对GIST的诊断及鉴别诊断有重要的意义 ,但其不能作为GIST分化程度的指标     

基质金属蛋白酶在胃间质瘤中的表达及其临床意义

目的研究基质金属蛋白酶（MMP）在胃间质瘤（GST）中的表达及其临床意义。方法采用免疫组化方法检测44例GST组织中的MMP-2、MMP-9的表达情况,并分析其与GST临床病理之间的关系。结果GST组织中的MMP-2、MMP-9阳性率分别为84．1％、81．8％,MMP-2、MMP-9随着GST恶性程度增高,其表达出现递增趋势（P〈0．05）,与肿瘤良恶性、生长方式、肿瘤大小、肿瘤中心有无坏死亦有明显关系（P均〈0．05）。MMP-2与MMP-9在GST中的表达阳性率呈明显正相关关系（r=0．6523,P〈0．05）。MMP-2、MMP-9阳性表达者5年生存率显著低于阴性表达者（P均〈0．05）。结论MMP-2、MMP-9在GST中的表达可以作为判断其性质、恶性程度、转移及预后的客观指标。     

Bcl-2和survivin蛋白在胃肠道间质瘤的表达与意义

目的探讨Bcl-2和生存素(survivin)蛋白在胃肠道间质瘤(GIST)的表达及临床意义。方法应用免疫组化SP法和病理图像分析系统检测85例胃肠道间质瘤(良性28例,潜在恶性16例,恶性41例)中Bcl-2和survivin的表达情况,结合临床病理学资料分组比较并进行统计学分析。结果 85例GIST中Bcl-2和survivin表达的平均灰度值在良性组、潜在恶性组、恶性组中依次递减,阳性表达水平逐渐增高。3组两两比较,各组的平均表达水平差异存在统计学意义(P0.05)。在41个恶性病例中,有浸润或转移的亚组的Bcl-2和survivin表达水平显著高于无浸润转移亚组的表达水平(P0.05)。GIST中Bcl-2和survivin表达有显著的正相关性(rs=0.43)。结论 Bcl-2和survivin高表达能够协同促进GIST的恶变和向外浸润转移,检测这两个指标也许有助于判断GIST的良恶性以及预测肿瘤的预后。     

Total intravenous anesthesia for evacuation of a hydatidiform mole and termination of pregnancy in a patient with thyrotoxicosis

Clinical hyperthyroidism is found in approximately 5% of women with a hydatidiform mole, as human chorionic gonadotropin secreted by molar tissue is structurally similar to thyroid-stimulating hormone. A hydatidiform mole occasionally presents with a co-existing viable fetus. Surgical evacuation may be indicated for significant hemorrhage or preeclampsia. Perioperative management in the presence of hyperthyroidism may be complicated by a thyroid storm. We report a case of total intravenous anesthesia with propofol and remifentanil, combined with an esmolol infusion, to control sympathetic hyperactivity during surgery.     

Diagnostic and therapeutic significance of arthroscopy in distal radius fracture

Non-operative and minimal-invasive treatment of distal radius fractures have still a poor outcome. Although bony structures often heal acceptable, additional lesions of intraarticular ligamentous structures cause persistent pain and disability. Aim of the study was to present the diagnostic and therapeutic possibilities of arthroscopically assisted treatment of distal radius fractures. Diagnostic wrist arthroscopy found in 6 of 30 patients with distal radius fractures (23 AO type C fractures) a scapho-lunate ligament tear (20%) of which 3 had to be stabilized operatively. 18 patients (60%) presented with tears of the triangular fibrocartilage complex [Palmer classification: 1A (1); 1B (5); 1D (2); 1A, 1B (2); 1A, 1D (6); 1B, 1D (2)], which were repaired by arthroscopic shaving (n = 12), Kirschner wire stabilization of ulna head (n = 2) or arthroscopic suture (n = 3). Fractures were stabilized in most cases by combinations of canulated titan screws (3.0 mm) and Kirschner wires (n = 12). In 27 patients, the radial joint surface and the distal radio-ulnar joint could be reconstructed without any specific complications. Arthroscopic reduction of distal radius fractures allows minimal-invasive reconstruction of the joint surface, diagnoses relevant ligamentous tears and should applied with incongruencies of the joint surface greater than 2 mm and in widely dislocated fractures.     

CTA对小肠间质瘤的诊断价值

目的 评价螺旋CT与螺旋CT血管造影(MSCTA)对小肠间质瘤的诊断价值.方法 回顾性分析19例经手术病理证实小肠间质瘤的螺旋CT扫描与MSCTA结果.结果 19例中良性12例,恶性7例;肿瘤大小约2～15 cm.19例中CT及MSCTA发现病灶有16例,即定性诊断准确率为84.21%.根据手术中探查结果,CT及MSC...