Immunohistochemical analysis of c-erbB-2, Bcl-2, p53, p21WAF1/Cip1, p63 and Ki-67 expression in hydatidiform moles

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, p21^WAF1/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, p21^WAF1/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). p21^WAF1/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.     

Expression of p53 protein and proliferating cell nuclear antigen in human gestation trophoblastic disease

Objective: To study the relationship between p53 protein, proliferating cell nuclear antigen (PCNA) expression and benign or malignant gestational trophoblastic disease (MGTD). Methods: The histotomic sections of 48 patients with gestational trophoblastic disease and 24 patients of normal chorionic villi were stained using immunohistochemistry. The monoclonal antibodies were used to determine p53 protein and PCNA. Results: The frequency of p53 and PCNA positive expression were significantly different among the chorionic villi of normal pregnancy, hydratidiform mole (HM) and MGTD. But neither p53 nor PCNA has any relation with the clinical staging or metastasis of MGTD. Conclusion: Both P53 and PCNA are valuable in diagnosis of human gestational trophoblastic disease.     

Gestational Trophoblastic Disease Diagnosis and Treatment： An Analysis of 56 Cases

Objective To investigate the diagnosis and treatment of gestational trophoblastic disease （GTD）. Methods A retrospective review was conducted on 56 patients with GTD who under- went treatment in Ruijin hospital from January 2007 to December 2012. Their infor- mation of diagnosis, treatments, follow-up and efficacy were collected and analyzed Results Misdiagnosis rate was 41.1% （23/56）for the first time. Of 56 patients, 31 had direct curettage, 19 had curettage after trichosanthis （TCS） treatment, 3 had curettage after intervention treatment and 3 did not have curettage. Twenty patients with gesta- tional trophoblastic neoplasia （GTN） took fluorouracil＋vincristine＋dactinomycin （VCR ＋KSM＋5-FU） chemotherapy, but 2 of them changed to etoposide＋methotrexate＋acti- nomycetes streptozotocin-D＋cyclophosphamide＋vincristine （EMA-CO） chemo- therapy due to drug resistance. Three patients＂ with GTN took EMA-CO chemotherapy. Two patients with placental site trophoblastic tumor （PSTT） required surgeries, one took hysterectomy, another got mass and adnexectomy. Apart from 1 case who gave up treatment and was dead, all the other women went into remission from their diseases. Conclusion The diagnosis of trophoblastic disease rely on a comprehensive analysis. A reasonable choice of TCS or intervention can be effective and safe in treating GTD. Most patients with GTN could get complete remission by selecting the appropriate chemotherapy and surgery.     

妊娠滋养细胞肿瘤发病机制的研究进展

妊娠滋养细胞肿瘤是一类严重威胁女性生殖健康的疾病,随着分子生物学技术的发展,研究发现多种因素参与其发病过程.本文从癌基因、抑癌基因、细胞因子、细胞增殖相关基因、细胞凋亡基因等多方面综述其浸润、转移机制的研究进展.     

胎盘异铁蛋白在异常妊娠中作用的研究进展

胎盘异铁蛋白是一种免疫抑制因子 ,主要抑制妊娠过程中母体淋巴细胞对胎儿的同种异体免疫 ,使妊娠得以顺利进行 ,其低水平表达 ,不仅与一些肿瘤发生有关 ,而且与许多异常妊娠 ,如早产、流产、异位妊娠、胎儿宫内发育迟缓、妊高征、滋养细胞肿瘤以及多种妊娠合并症关系密切。对胎盘异铁蛋白的研究将促进妇产科多种疾病的诊治进展。     

中药治疗腰椎退行性骨关节炎42例

目的:观察中药治疗腰椎退行性骨关节炎的临床疗效。方法:将本院2013年3月—2015年5月收治的腰椎退行性骨关节炎患者84例随机分为对照组和观察组42例,对照组采用整脊手法治疗,观察组采用中药汤剂治疗,比较两组患者临床疗效。结果:观察组治疗后VAS评分、FFD评分及JOA评分等均较治疗前明显改善,组间比较差异具有统计学意义;观察组有效率为97.62%,明显高于对照组的76.19%,组间比较差异具有统计学意义。结论:中药治疗腰椎退行性骨关节炎疗效显著,可明显改善患者的临床症状。     

彩色多谱勒超声在妊娠滋养细胞疾病诊断和治疗中的应用

目的 评价妊娠滋养细胞疾病血流多谱勒特点、血流特点与血β-hCG值相互关系以及病人预后.方法 检测41例妊娠滋养细胞疾病病人治疗前后子宫肌层血流多谱勒波形中阻力指数（RI）;放射免疫定量测定病人治疗前后血β-hCG值;彩色多谱勒监测病人治疗前后病变部位及大小.结果 妊娠滋养细胞疾病病人治疗前血流多谱勒波形中阻力指数较低（0.16-0.45）,且血β-hCG含量较高（300-600ng/ml）;治疗后阻力指数升高（0.52-0.85）,且血β-hCG含量降低（50-100ng/ml）,治疗前后阻力指数的升高与血β-hCG含量的降低存在明显相关性.葡萄胎,侵蚀性葡萄胎及绒癌间血流多谱勒波形中阻力指数及血β-hCG含量无显著性差异.可根据彩色多谱勒监测到病变部位、大小及阻力指数（RI）而诊断妊娠滋养细胞疾病并观察治疗效果.结论 彩色多谱勒超声较血β-hCG值在诊断妊娠滋养细胞疾病方面具有更大的价值;彩色多谱勒超声也可以监测妊娠滋养细胞疾病的治疗和跟踪妊娠滋养细胞疾病的预后.     

Placental site trophoblastic tumour

Placental site trophoblastic tumour (PSTT) is a very rare and unique form of gestational trophoblastic disease (GTD). This tumour represents a neoplastic transformation of intermediate trophoblastic cells that normally play a critical role in implantation. PSTT can occur after a normal pregnancy, abortion, term delivery, ectopic pregnancy or molar pregnancy. It displays a wide clinical spectrum, and when metastatic, can be difficult to control even with surgery and chemotherapy. Unlike other forms of GTD, PSTT is characterized by low beta-hCG levels because it is a neoplastic proliferation of intermediate trophoblastic cells. Expression, however, of human placental lactogen (hPL) is increased on histologic section as well as in the serum. The most common presenting symptoms of PSTT are vaginal bleeding and amenorrhoea. Diagnosis is confirmed by dilatation and curettage (D and E) and hysterectomy but meticulous evaluation of metastasis is mandatory. Most cases are confined to the uterus but pelvic involvement, lung and other organ metastasis has been reported. Unlike other forms of GTD, the WHO prognostic score is of little help. For the PSTT patient, surgery is the primary treatment of choice. For patients desiring future childbearing, D and C and adjuvant chemotherapy is an option. Because these tumours tend to be less sensitive than other types of GTD to chemotherapy, the most successful regimen to date has been with EMA/CO or EMA/EP. Good prognosis is anticipated in cases localized to the uterus, and when the interval between antecedent pregnancy and treatment is less than 2 years. In cases with distant metastasis or delayed treatment, the outcome is dismal.Advances in chemotherapeutic regimens have improved clinical reponse in metastatic disease.     

Is there a relationship between treatment for infertility and gestational trophoblastic disease?

BACKGROUND: The aim of the study was to record the incidence of treatment for infertility prior to development of gestational trophoblastic disease (GTD). METHODS AND RESULTS: A retrospective analysis was undertaken of 231 consecutive women receiving chemotherapy for persistent GTD at Weston Park Hospital, Sheffield, from 1991 to 2001. Three patients in this group had received treatment for infertility prior to their molar pregnancy. In a control group of 226 patients not requiring treatment for persistent GTD, four had had treatment for infertility just before their molar pregnancy, and in a further control group of 208 'normal' pregnancies, eight patients had had treatment for infertility prior to conception. CONCLUSION: We conclude that we can demonstrate no relationship between infertility treatment and subsequent development of GTD.