MOLECULAR AND IMMUNOHISTOCHEMICAL CHARACTERISTICS OF COMPLETE HYDATIDIFORM MOLES
Kubelka-Sabit KB1,*, Prodanova I2, Jasar D1, Bozinovski G3, Filipovski V1, Drakulevski S1, Plaseska-Karanfilska D3
*Corresponding Author: Dr. Katerina B. Kubelka-Sabit, Clinical Hospital Acibadem Sistina, Skupi 5a, 1000 Skopje, Republic of Macedonia. Tel: +389-70-365-338. Fax: +389-23-099-599. E-mail: catkubelka@ yahoo.co.uk; katerina.kubelka@acibademsistina.mk
page: 27

INTRODUCTION

Molar pregnancy is a gestational trophoblastic disease that belongs to the category of precancerous lesions. On the other end of the spectrum are gestational trophoblastic neoplasms such as invasive mole, choriocarcinoma, placental site trophoblastic tumor and epithelioid trophoblastic tumor, which are considered malignant tumors. Each of these conditions can perforate the uterine wall, metastasize and lead to death if left untreated. Approximately 50.0% of them arise from molar pregnancy and derive from placental villous, and extra-villous trophoblast [1]. Molar pregnancy has the highest incidence of all trophoblastic diseases, estimated at 0.57 to 2/1000 pregnancies [2-5]. Higher incidences occur in Southeast Asia and Japan and lower in Australia, New Zealand, as well as Europe and North America (0.6-1.1 per 1000 pregnancies) [6,7]. Based on defined histopathological criteria, molar pregnancy is divided into partial and complete hydatidiform mole. The risk of persistent trophoblastic disease is higher in complete hydatidiform mole, compared with partial mole. For comparison, choriocarcinoma rarely occurs after partial mole, but occurs in 2.0-5.0% of cases of complete hydatidiform mole [2,8]. Therefore, the exact diagnosis of the products of conception is extremely important. Histomorphological diagnostic criteria for molar pregnancy are clearly defined in the literature. Vesicular stromal edema and trophoblastic surface proliferation are the most prominent features. However, in early spontaneous abortions, the differences between classical pathological changes in hydropic abortion and various types of molar pregnancy are subtle. Especially in the case of early complete mole, the diagnosis can be quite challenging. In those cases, additional molecular methods can be of use to differentiate between partial molar pregnancy, complete molar pregnancy and hydropic abortion. On the other hand, immunohistochemical analyses using certain antibodies such as p57 can differentiate between hydropic abortion and partial molar pregnancy on one side and complete molar pregnancy on the other. Moreover, when molecular methods and additional immunohistochemical analyses were used, considerable variations in the diagnosis of hydropic abortion and molar pregnancy was observed [2-4,9,10]. The aim of this study was to assess the importance of additional molecular and immunohistochemical methods to accurately diagnose complete hydatidiform mole and to stress the importance of correct diagnosis and close follow-up of these patients.



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