Clinical Usefulness of Immunohistochemical Staining of p57 kip2 for the Differential Diagnosis of Complete Mole.

Shigeru Sasaki,Koichi Iino,Yoshihiro Kojima,Toshiaki Kunimura,Akihiko Sekizawa,Yasushi Sasaki

doi:10.1155/2015/905648

Abstract

Objective. Can polymer-based immunohistochemical staining of p57kip2 replace DNA analysis as an inexpensive means of differentiating complete mole from partial mole or hydropic abortion? Methods and Materials. Original paraffin-embedded tissue blocks from 14 equivocal cases were turned over to our laboratory and examined by immunohistochemical staining of p57kip2. Results. Four of the 14 cases showed clearly negative nuclear staining in cytotrophoblasts and villous stromal cells: these results were fully concordant with the control staining. The remaining 10 cases showed apparently positive staining in cytotrophoblasts and villous stromal cells. Without DNA analysis we are able to clearly differentiate the 4 cases of complete mole among the 14 equivocal cases. During follow-up, secondary low-risk gestational trophoblastic neoplasia (GTN) developed in 1 of the 4 cases of complete mole: the GTN was treated by single-agent chemotherapy. No subsequent changes were observed during follow-up in the other cases. Conclusion. Polymer-based immunohistochemical staining of p57kip2 (paternally imprinted gene, expressed from maternal allele) is a very effective method that can be used to differentiate androgenetic complete mole from partial mole and hydropic abortion. We might be able to avoid the cost of DNA analysis.

Highlights

Today, widespread use of ultrasonography and measurement of serum human chorionic gonadotropin can be used to detect blighted ovum in the very early stage of pregnancy
We report the results obtained by polymer-based immunohistochemical staining of p57kip2 in 14 equivocal cases
We performed standard streptavidinbiotin immunohistochemical staining of p57kip2 in our DNAestablished complete mole and hydropic abortion cases to know how effective the reported method is for differentiation of complete moles from hydropic abortion [5, 6]

Summary

Introduction

Widespread use of ultrasonography and measurement of serum human chorionic gonadotropin (hCG) can be used to detect blighted ovum in the very early stage of pregnancy. We, including pathologists, often face equivocal cases of complete mole versus partial mole that are difficult to diagnose histologically. In such cases, pathologists always notify us that complete mole cannot be ruled out and that strict clinical follow-up should be necessary. We proceed to DNA polymorphism analysis to obtain an accurate diagnosis in such cases. This requires both the patient’s consent and extra expenditures

Methods

Results

Conclusion