Abstract
Placental site trophoblastic tumor (PSTT) consists of a neoplastic proliferation of intermediate or extravillous trophoblast (also known as X cells). Pregnancy-associated major basic protein (pMBP) is a marker for placental intermediate trophoblast. We compared the distribution of pMBP and human placental lactogen (hPL) in 24 PSTT and 3 exaggerated placental site (EPS) specimens using two distinct immunohistologic methods. Statistical analyses were used to compare staining intensities in metastatic and nonmetastatic lesions. By immunofluorescence, 77% of the PSTT specimens and 100% of the EPS specimens stained with antibodies to pMBP, and the pMBP was localized in intermediate trophoblast and surrounding extracellular areas. By immunohistochemistry, 78% of the PSTT specimens and 100% of the EPS specimens stained for pMBP with a pattern comparable with that of immunofluorescence. Likewise, by immunohistochemistry, hPL stained 96% of the PSTT specimens and 100% of the EPS specimens. Immunohistochemical staining intensities for pMBP and hPL correlated (r2 = +.24; P = .013), but hPL staining was mainly confined to intermediate trophoblast and was more intense. Anti-pMBP tended to stain metastatic PSTT weakly. Thus, pMBP is a useful marker for intermediate trophoblast tumors and could help distinguish these from other forms of trophoblastic disease.
Highlights
The 60kD heat shock protein is a highly conserved protein and a dominant antigen of most pathogenic bacteria
Occlusion of the fallopian tubes subsequent to a chlamydial infection has been attributed to an immune response to the chlamydial hsp60.4,1z Among women undergoing in vitro fertilization (IVF) the presence of cervical IgA antibodies to chlamydial hsp[60] was associated with a failure of implantation after embryo transfer. 13
As an immunological marker for detection of cervical IgA antibodies to chlamydial hsp[60], peptide 260-271 antibodies had a sensitivity of 87.5%, a specificity of 93.9%, a positive predictive value of 77.8% and a negative predictive value of 96.8%
Summary
The 60kD heat shock protein (hsp60) is a highly conserved protein and a dominant antigen of most pathogenic bacteria. In women undergoing in vitro fertilization (IVF), the presence of cervical IgA antibodies reactive with the C. trachomatis hsp[60] correlated with implantation failure after embryo transfer. In subsequent studies of women not undergoing IVF, cervical IgA antibodies to the human hsp[60] were identified in 13 of 91 reproductive age women This antibody was most prevalent in those women with a history of primary infertility (p 0.003). Immune sensitization to epitopes expressed by the human hsp[60] may reduce the probability of a successful pregnancy outcome due to reactivation of hsp60-reactive lymphocytes, induction of a pro-inflammatory cytokine response and interference with early embryo development and/or implantation. Occlusion of the fallopian tubes subsequent to a chlamydial infection has been attributed to an immune response to the chlamydial hsp60.4,1z Among women undergoing in vitro fertilization (IVF) the presence of cervical IgA antibodies to chlamydial hsp[60] was associated with a failure of implantation after embryo transfer. Occlusion of the fallopian tubes subsequent to a chlamydial infection has been attributed to an immune response to the chlamydial hsp60.4,1z Among women undergoing in vitro fertilization (IVF) the presence of cervical IgA antibodies to chlamydial hsp[60] was associated with a failure of implantation after embryo transfer. 13
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