p53在妊娠滋养细胞和肿瘤中的表达

目的：分析Ｐ５３过度表达与葡萄胎、恶性葡萄胎（恶葡）、绒毛膜癌（绒癌）的恶性程度及预后关系。方法：采用单克隆抗体免疫组化技术，对正常胎盘绒志及妊娠滋养细胞肿瘤组织，进行肿瘤抑制基因Ｐ５３表达检测。其中包括早期妊娠１０例，中期妊娠１０例，晚期妊娠１３例，葡萄胎４０例，恶葡９例，绒癌２０例；结果：正常胎盘Ｐ５３异常表达阴性，葡萄胎、恶葡、绒癌阳性表达率分别为４２．５％（１７／４０）、５５．５％（５／９     

Persistent gestational trophoblastic disease is rarely, if ever, derived from non-molar first-trimester miscarriage

Traditional epidemiologic data suggest that persistent gestational trophoblastic disease (pGTD), may follow, and be derived from, either molar pregnancy, non-molar term pregnancy or first-trimester non-molar miscarriage. We examined a database of cases of possible or probable hydatidiform moles and proven pGTD derived from the Regional Trophoblastic Disease Unit, Charing Cross Hospital, London. There were 424 cases (6%), in whom the initial registered diagnosis was that of PHM or CHM but central histopathological review diagnosed a definite non-molar hydropic abortion (HA). In eight of the 424 (2%), although the histology of the most recent index pregnancy was that of non-molar miscarriage, there was a previous history of pregnancy affected by hydatidiform mole; two of these developed subsequent pGTD. Of a further 86 cases referred for a histopathological opinion prior to registration which demonstrated definite non-molar HA, none developed pGTD (zero of 510 (0%, 95% CI 0-0.7%)). During the same period there were 352 cases with pGTD requiring chemotherapy. In 31 cases, the only known pregnancy was the preceding apparent non-molar HA. However, of these, there were only three cases in whom the preceding histological products of conception had been centrally reviewed and were suggestive of non-molar pregnancy. However, in all three of these cases, the specimens were inadequate for definite exclusion of molar pregnancy. In one case in whom no material was available for review, molecular genetic analysis using restriction fragment length polymorphisms was carried out, and the choriocarcinoma was genetically derived from a previous molar pregnancy rather than the preceding HA. There were therefore no cases identified on the database of the trophoblastic disease unit of pGTD requiring treatment in whom the trophoblastic tumour could be genetically proven to have arisen from the preceding first trimester non-molar HA. We suggest that the risk of pGTD developing from a histologically confirmed non-molar HA is less than 1 in 50,000 and that the majority of pGTD cases previously reported to have been caused by a non-molar miscarriage probably represent disease due to an unrecognised early molar pregnancy.     

Telomerase activity in gestational trophoblastic disease

AIMS: To investigate the pattern of telomerase activity in hydatidiform mole as compared with normal placenta and choriocarcinoma, and to determine the prognostic significance of telomerase activity in hydatidiform mole. METHODS: Telomerase activity in 35 cases of hydatidiform mole, 35 normal placentas, one choriocarcinoma sample, and two choriocarcinoma cell lines (JAR, JEG3) was determined using the sensitive polymerase chain reaction based telomeric repeat amplification protocol (TRAP) assay. Two cases of breast carcinoma and two cases of ovarian carcinoma were also included as positive controls in the telomerase assay. RESULTS: Telomerase activity was detected in 11 of 30 early placentas (36.7%), one of five term placentas (20%), five of 27 hydatidiform moles which regressed spontaneously (18.5%), and six of eight hydatidiform moles which developed persistent trophoblastic disease (75%) (including three which developed metastases). Hydatidiform moles which subsequently developed persistent disease, especially those which metastasised, were more likely to express telomerase activity (p < 0.01). However, there was no significant difference in the frequency of telomerase activity between early placentas and hydatidiform mole. Strong telomerase activity was observed in choriocarcinoma tissue, choriocarcinoma cell lines, and ovarian and breast carcinomas. CONCLUSIONS: Telomerase activation occurs in hydatidiform mole with a similar incidence to early normal placentas. This supports the concept that hydatidiform mole is essentially an abnormal conceptus. There is an association between telomerase activation and the development of persistent trophoblastic disease. Further study is warrant to confirm the prognostic significance of telomerase activity in hydatidiform mole.     

早孕绒毛及妊娠滋养细胞疾病中癌基因表达的研究

目的:研究癌基因c-myc和N-ras在早孕绒毛及GTD中的表达。方法:地高辛标记的c-myc、N-ras裸核探针与石腊包埋的18例早孕绒毛及54例GTD组织进行原位杂交。结果:c-myc mRNA在早孕绒毛、葡萄胎、侵蚀性葡萄胎和绒癌中阳性表达率分别为27.8%、44.4%、55.5%和84.4%。N-ras mRNA在早孕绒毛、葡萄胎、侵蚀性葡萄胎和绒癌组织中阳性表达率分别为83.8%、88.9%、77.8%和44.4%。Ⅲ-Ⅳ期GTT中c-myc阳性表达率高于Ⅰ期。c-myc和N-ras在GTT组织中共同表达率为47.2%。结论:c-myc与GTD病变的发展及临床分期有关,N-ras为GTT发生的早期事件。     

Pulmonary disease in gestational trophoblastic neoplasms.

Gestational trophoblastic neoplasms can present as pulmonary nodules without significant disease of the reproductive organs. This article describes a case of metastatic gestational trophoblastic disease to the lungs. This entity must be considered in the differential diagnosis in any female of reproductive age who presents with multiple pulmonary nodules. Thoracotomy has a limited role in the initial evaluation of patients with this disease. However, it may be needed in patients who have evidence of persistent pulmonary disease, despite appropriate therapy.     

Abnormal expression of plasminogen activator inhibitors in patients with gestational trophoblastic disease.

We previously reported significantly elevated levels of plasminogen activator inhibitor type 1 (PAI-1) in plasma and placenta from pregnant women with severe pre-eclampsia, and pre-eclampsia is a frequent problem in molar pregnancies. As increases in PAI-1 may contribute to the placental alterations that occur in pre-eclampsia, we have begun to investigate changes in PAI-1 as well as PAI-2 and several other components of the fibrinolytic system in patients with trophoblastic disease. Significant increases in plasma PAI-1 and decreases in plasma PAI-2 levels were observed in molar pregnancies when compared with the levels in normal pregnant women of similar gestational age. PAI-1 antigen levels also were increased, and PAI-2 levels were decreased in placenta from women with molar pregnancies compared with placenta obtained by spontaneous abortion. Immunohistochemical analysis revealed strong positive and specific staining of PAI-1 in trophoblastic epithelium in molar pregnancies and relatively weak staining of PAI-2. No association between the distribution of PAI-1 and vitronectin was found, and no specific signal for tissue type PA, urokinase type PA, tumor necrosis factor-alpha, or interleukin-1 was detected. In situ hybridization revealed an increase in PAI-1 but not PAI-2 mRNAs in placenta from molar pregnancies in comparison with placenta from abortions. These results demonstrate increased PAI-1 protein and mRNA in trophoblastic disease and suggest that localized elevated levels of PAI-1 may contribute to the hemostatic problems associated with this disorder.     

Diagnosis of gestational trophoblastic disease in early pregnancy

Most pregnancies affected by complete or partial hydatidiform mole are now evacuated in early pregnancy. In the majority of cases, confident diagnosis is possible on the basis of morphological analysis of products of conception with routine haematoxylin and eosin stained sections. In early pregnancy however, the diagnostic criteria are subtly different from the classical pathological features, often still described in textbooks, which were derived from studies of molar tissue evacuated at later gestational age. In the first trimester, complete moles are characterized by moderate, patchy villus hydrops, prominent ‘budding’ of the villus outline, myxoid stromal degeneration with stromal karyorrhectic debris and collapsed blood vessels, scattered trophoblastic pseudoinclusions, and moderate trophoblast hyperplasia with pleomorphic extravillus trophoblast sheets. Partial moles demonstrate an irregular or ‘dentate’ villus outline with patchy mild-to-moderate hydrops, stromal blood vessels (collapsed or containing nucleated red blood cells), stromal fibrosis, mild focal villus trophoblast hyperplasia, scattered trophoblastic pseudoinclusions and often the presence of amnion or fetal tissue.     

Constitutional trisomy 8 mosaicism and gestational trophoblastic disease

Concurrence of congenital trisomy 8 mosaicism and gestational trophoblastic disease in a 42-year-old gravida IV, para IV female is described in the present report. In contrast to other cases described in the literature, our patient had no known additional confounding chromosomal abnormalities other than trisomy 8. The finding of trisomy 8 mosaicism in yet another type of cancer provides further support for the hypothesis of an increased predisposition to cancer in tissues with constitutional genomic imbalance, which can manifest itself as numerical chromosomal abnormalities (e.g., trisomies) or structural chromosomal abnormalities (e.g., translocations).

To the best of our knowledge, this is the only report in the English literature of constitutional trisomy 8 mosaicism associated with gestational trophoblastic disease, a rare gynecologic disease entity in itself.     

PCNA和Caspase-3在妊娠滋养细胞疾病中的表达及意义

目的研究PCNA和Caspase-3在妊娠滋养细胞疾病中的表达变化及意义,为妊娠滋养细胞疾病早期诊断、预后判断提供理论依据。方法收集滋养细胞疾病标本50例,其中葡萄胎10例(均为完全性葡萄胎),侵蚀性葡萄胎20例,绒毛膜癌20例。正常早孕绒毛标本10例为对照组。应用免疫组织化学技术检测PCNA和Caspase-3在早孕绒毛、葡萄胎、侵蚀性葡萄胎、绒毛膜癌组织中的表达情况。结果 PCNA在正常早孕绒毛、葡萄胎、侵蚀性葡萄胎和绒癌中的表达分别为10.24%、20.70%、50.92%、53.65%,各组差异有统计学意义(P0.05)。Caspase-3在正常早孕绒毛、葡萄胎、侵蚀性葡萄胎和绒癌中的表达先升高又降低,分别为1.25%、2.60%、6.40%、1.90%,各组差异有统计学意义(P0.05)。结论 PCNA及Caspase-3表达异常,增殖/凋亡失衡是引起GTT的重要因素。     

Hepatocyte growth factor in human placenta and trophoblastic disease.

The hepatocyte growth factor (HGF) is an acidic protein with a strong mitogenic effect on hepatocytes. Hepatocyte growth factor mRNA recently was cloned from a placental cDNA library. Here we demonstrate the purification of HGF from human placenta with heparin-agarose chromatography and TSK-heparin high-pressure liquid chromatography and describe the distribution of placental HGF by immunohistochemistry using a polyclonal antibody to HGF. The yield of HGF from the placenta was approximately 100 to 200 times greater than that previously obtained from human plasma. Placental HGF was expressed strongly in the villous syncytium, extravillous trophoblast, and amnionic epithelium, and, to a lesser degree in endothelial cells and villous mesenchyme. Hepatocyte growth factor also was identified in the trophoblast of complete hydatidiform moles, choriocarcinomas, and a case of blighted ovum. The presence of HGF in an organ characterized by rapid cell proliferation during gestation and in trophoblastic tumors strongly suggests that the growth-regulating effect of HGF is not limited to hepatocytes.     

Incidence and outcome of gestational trophoblastic disease in lower Egypt

BackgroundGestational trophoblastic disease (GTD) defines a spectrum of proliferative disorders of trophoblastic epithelium of the placenta. Incidence, risk factors, and outcome may differ from one country to another.ObjectiveTo describe incidence, patient characteristics, treatment modalities, and outcome of GTD at Mansoura University which is a referral center of Lower Egypt.MethodsAn observational prospective study was conducted at the GTD Clinic of Mansoura University. The patients were recruited for 12 months from September 2015 to August 2016. The patients'' characteristics, management, and outcome were reported.ResultsWe reported 71 clinically diagnosed GTD cases, 62 of them were histologically confirmed, 58 molar (33 CM and 25 PM) in addition to 4 initially presented GTN cases. Mean age of the studied cases was 26.22 years ± 9.30SD. Mean pre-evacuation hCG was 136170 m.i.u/ml ±175880 SD. Most of the cases diagnosed accidentally after abnormal sonographic findings (53.2%). Rate of progression of CM and PM to GTN was 24.2% and 8%, respectively.ConclusionThe incidence of molar pregnancy and GTN in our locality was estimated to be 13.1 and 3.2 per 1000 live births respectively. We found no significance between CM and PM regarding hCG level, time to hCG normalization, and progression rate to GTN.     

妊娠滋养细胞病变中FHIT和PTEN蛋白的表达

目的　探讨抑癌基因FHIT、PTEN蛋白表达在妊娠滋养细胞疾病发生、发展中的作用及临床病理意义。方法　采用免疫组化S P法分别检测了 30例完全性葡萄胎、15例侵袭性葡萄胎、15例绒毛膜细胞癌中FHIT、PTEN的蛋白表达。结果　完全性葡萄胎中FHIT蛋白表达低于正常早孕绒毛 (P <0 0 1) ,FHIT蛋白表达与葡萄胎滋养细胞增生呈负相关关系。侵袭性葡萄胎和绒毛膜细胞癌中FHIT蛋白表达均低于完全性葡萄胎 (P <0 0 5 ,P <0 0 1)。侵袭性葡萄胎和绒毛膜细胞癌中核PTEN蛋白表达均低于完全性葡萄胎 (P <0 0 1,P <0 0 1)。绒毛膜细胞癌中核PTEN蛋白表达与临床分期呈负相关关系。结论　FHIT和PTEN蛋白表达下降或缺失可能参与了妊娠滋养细胞疾病的发生、发展过程。     

MM P-2/TI MP-2及VEG F在滋养细胞疾病中的表达及意义

目的 检测不同滋养细胞疾病组织中MMP-2/TIMP-2及VEGF的表达情况,观察比较它们的表达特点,分析与滋养细胞疾病发生、发展的相关性.方法 收集30例正常绒毛;40例葡萄胎组织,30例手术切除的恶性葡萄胎组织,采用单克隆抗体免疫组化SP法对其染色,光镜下分别观察以上不同组织中MMP-2、TIMP-2、VEGF的阳性表达情况.结果 (1)从正常绒毛→良性葡萄胎→恶性葡萄胎,MMP-2的阳性率有升高趋势,差异有统计学意义(P＜0.05).VEGF的表达与MMP-2正相关.(2)TIMP-2的阳性表达在滋养细胞疾病内部不同分组间两两比较,差异均无统计学意义(P＞0.05).(3)MMP-2/TIMP-2组合同时阴性表达在良性葡萄胎中占65%(26/40),在恶性葡萄胎中占16.67%(5/30),两者比较有显著性差异(P＜0.01).MMP-2阳性表达伴TIMP-2阴性表达在良性葡萄胎中占2.5%(1/40),在恶性葡萄胎中占56.67%(17/30),两者比较有显著性差异(P＜0.01).结论 (1)MMP-2和VEGF共同参与了滋养细胞疾病的发生和发展.(2)MMP-2/TIMP-2两者联合检测对鉴别良、恶性滋养细胞疾病有重要价值.     

滋养细胞疾病的超声诊断

文章论述了滋养细胞疾病的多普勒超声特征和有关学者的研究结果，包括多普勒超声在诊断葡萄胎及恶性滋养细胞肿瘤方面的应用状况、有关黄素化囊肿问题、经阴道多普勒超声诊断检查及存在的局限性、临床价值和超声随访的意义等5个部分。     

Detection of mitochondrial DNA mutations in gestational trophoblastic disease

Mitochondrial DNA (mtDNA) mutations have been implicated in a wide range of human disease. However, its role in gestational trophoblastic disease remains unclear. In this study, the entire mitochondrial genome of 10 hydatidiform moles (HM) and one choriocarcinoma were examined by automated DNA sequencing after amplification by polymerase chain reaction. MtDNA sequences obtained separately from disease tissues (HM and choriocarcinoma) and patients' tissues were compared. Of the 133 neutral sequence variants identified, 41 have not been reported to date. Large or small-scale deletion or insertion was not detected in any of the samples studied. A total of six (five in the D-loop and one in the 16S rRNA gene) somatic point mutations were detected in the choriocarcinoma sample, in contrast to none being detected in the HM samples. Somatic mtDNA instability was detected in the D-loop region in three cases of HM as well as in the choriocarcinoma sample. Somatic mtDNA instability appeared in the same nucleotide position, from 303 to 309, within the Conserved Sequence Block II resulting in alteration in length of the homopolymorphic C-tract, reflecting microsatellite instability. The results suggest that mtDNA instability may be an early event occurring at a premalignant stage. Occurrence of multiple somatic mtDNA mutations in choriocarcinoma suggests that mtDNA mutations might play an important role in the molecular pathogenesis of invasive gestational trophoblastic disease.     

Trophoblastic gestational disease: a placental site trophoblastic tumor and an epithelioid trophoblastic tumor

Placental site trophoblastic tumor and epithelioid trophoblastic tumor are rare gestational trophoblastic tumors. They both appear in the same context and follow the same course. We report two cases in patients aged 44 and 20 years. These lesions usually affect young women with a history of multiple gestations. Clinical manifestations include vaginal bleeding, uterine mass, and moderate elevation of serum beta human chorionic gonadotrophin levels. These morphologically distinct trophoblastic proliferations usually have a favorable course if complete excision is performed.     

Apoptosis in gestational trophoblastic disease is correlated with clinical outcome and Bcl-2 expression but not Bax expression.

Apoptosis has been found to play a crucial role in the pathogenesis and prognosis of many human diseases. The pathogenesis of gestational trophoblastic disease (GTD), which encompasses hydatidiform moles (HMs) and choriocarcinomas (CCAs), is not fully understood. Prognostic indicators of HM have also been scanty. In this study, we investigated apoptotic activity and the expression of two apoptosis regulatory genes, Bcl-2 and Bax, in an attempt to determine the role of apoptosis in GTD. Formalin-fixed paraffin-embedded tissue of 33 normal placentas, 14 spontaneous abortions, 14 partial moles, 34 complete moles, and eight CCAs were examined. Apoptotic activity was assessed by the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling (TUNEL) method. Quantitative assessment of apoptotic index (AI) was calculated as a percentage of TUNEL-positive nuclei. Expression of Bcl-2 and Bax were assessed immunohistochemically. Extensive apoptosis was located in syncytiotrophoblasts, cytotrophoblasts, and villous stromal cells in all HM cases. Apoptosis was detected at a much lower level in spontaneous abortions and normal placentas. Moreover, in normal placentas, TUNEL positive nuclei were exclusively found in syncytiotrophoblasts. AIs were significantly different among various categories of trophoblastic lesions (P < .001) in an ascending order: normal placentas less than spontaneous abortions less than CCAs less than HMs. Furthermore, AIs of those cases that spontaneously regressed was statistically higher than those that developed persistent trophoblastic disease requiring chemotherapy. AIs of trophoblastic lesions in general inversely correlated with Bcl-2 expression (P < .001), but no significant correlation was found between AI and Bax expression (P > .5). We conclude that AI may be a useful prognostic marker for clinical progress of HMs. Bcl-2 expression is probably regulating apoptosis in normal placentas and GTD, whereas Bax expression is not. The difference in AI and Bcl-2 expression between non-molar placentas and HMs offers a potential adjunctive diagnostic tool to distinguish the two entities.