Hydropic Abortion Research Articles

Diagnosis of hydatidiform moles using p57 immunohistochemistry and chromogenic insitu hybridization: A retrospective study

Background: Chromogenic in situ hybridization (CISH) and immunohistochemistry analysis for p57 are ancillary studies discriminating partial hydatidiform mole (PHM), complete hydatidiform mole (CHM), and non-molar hydropic abortion (HA). Objective: It aimed to study CISH with a probe to chromosome 17 (CISH17) and chromosome 2 (CISH2) discriminating chromosomal ploidy of PHM, CHM, and HA; in addition, their surrogacy value in the evaluation of triploid and diploid in product of conception specimens (POCs) was evaluated. Materials and Methods: 44 statistically significant POCs were selected retrospectively. The Kappa agreement coefficients, sensitivity, specificity, and accuracy with 95% confidence interval (95% CI) were reported. Results: PHM, CHM, and HA were diagnosed to be 23, 17, and 3 cases based on both CISH2 and CISH17 resulting in their complete discrimination between PHM and HA (23 vs. 3). The Kappa agreement coefficient was 95.4% (p < 0.001) when diagnosing the PHM (23), CHM (20), and HA (1). In addition, the accuracy, sensitivity, and specificity were 95.26% (95% CI: 84.25–99.38), 100% (95% CI: 85.18–100), and 95% (95% CI: 76.18–99.88), respectively. The power analysis on CISH2 and CISH17 tests discriminating between triploid and diploid in POCs was estimated to be 100%. Conclusion: Based on the current finding, CISH2 and CISH17 enjoyed perfect agreement in diagnosing chromosomal ploidy; in addition, their absolute power discriminating between triploid and diploid revealed that they could be used as surrogate markers for ploidy. Prospective studies on fresh specimens are suggested comparing the CISH method’s accuracy with flow cytometry karyotyping and fluorescence in situ hybridization. Key words: Hydatidiform mole, CISH protein, Human, Pathology, Clinical.

Comprehensive Proteomic Analysis Reveals Distinct Features and a Diagnostic Biomarker Panel for Early Pregnancy Loss in Histological Subtypes

Early pregnancy loss (EPL) is a common event in human reproduction and is classified into histological subtypes such as hydropic abortion (HA) and hydatidiform moles (HMs), including complete hydatidiform moles (CHMs) and partial hydatidiform moles (PHMs). However, accurate diagnosis and improved patient management remain challenging due to high rates of misdiagnosis and diverse prognostic risks. Therefore, diagnostic biomarkers for EPL are urgently needed. Our study aimed to identify biomarkers for EPL through comprehensive proteomic analysis. Ten CHMs, six PHMs, ten HAs and ten normal control (NC) products of conception (POC) were used to obtain a proteomic portrait. Parallel reaction monitoring (PRM)-targeted proteomic and regression analyses were used to verify and select the diagnostic signatures. Finally, 14 proteins were selected and a panel of diagnostic classifiers (DLK1, SPTB/COL21A1, and SAR1A) was built to represent the CHM, PHM, and NC groups (auROC=0.900, 0.804/0.885, and 0.991, respectively). This high diagnostic power was further validated in another independent cohort (n = 148) by immunohistochemistry (IHC) (n = 120) and western blot (WB) analyses (n = 28). The protein SPTB was selected for further biological behaviour experiments in vitro. Our data suggest that SPTB maintains trophoblast cell proliferation, angiogenesis, cell motility and the cytoskeleton network. This study provides a comprehensive proteomic portrait and identifies potential diagnostic biomarkers. These findings enhance our understanding of EPL pathogenesis and offer novel targets for diagnosis and therapeutic interventions.

Single-nucleotide polymorphism array and fluorescence in situ hybridization analysis to decode the cytogenetic profile of atypical partial hydatidiform moles diagnosed by short tandem repeat polymorphism analysis.

Accurate diagnosis of partial hydatidiform moles (PHMs) is crucial for improving outcomes of gestational trophoblastic neoplasia. The use of short tandem repeat (STR) polymorphism analysis to distinguish between PHM and hydropic abortuses is instrumental; however, its diagnostic power has not been comprehensively assessed. Herein, we evaluated the diagnostic efficacy of STR in differentiating between PHM and hydropic abortus, thus providing an opportunity for early measurement of human chorionic gonadotropin for PHMs. We reviewed charts of STR polymorphism analysis performed on fresh villous specimens and patient blood samples using a commercial kit for 16 loci. The genetic classification of 79 PHMs was confirmed. STR was reliable in differentiating PHMs when at least 15 loci were available. Typically, PHMs are characterized by their triploidy, including two paternal and one maternal haploid contribution. In our sample, seven PHMs lacked the three-allelic loci, requiring fluorescence in situ hybridization (FISH) analysis to investigate imbalanced biparental conceptus and single-nucleotide polymorphism array analysis to reveal cytogenetic details. Of these PHMs, two, three, and one were identified as androgenetic/biparental mosaics (diploids), monospermic diandric monogynic triploids, and a typical dispermic diandric monogynic triploid, respectively. The remaining case was monospermic origin, but its ploidy details could not be available. Therefore, STR differentiated PHM from a biparental diploid abortus in most cases. However, PHM diagnosis may be compromised when STR is used as the sole method for cases displaying distinct cytogenetic patterns lacking the three-allelic loci, including androgenetic/biparental mosaicism. Therefore, FISH should be considered to confirm the diagnosis.

Evaluation of Combined p57KIP2 Immunohistochemistry and Fluorescent in situ Hybridization Analysis for Hydatidiform Moles Compared with Genotyping Diagnosis.

Immunostaining with p57KIP2 is a widely used diagnostic technique to differentiate complete hydatidiform moles (CHMs) from partial hydatidiform moles (PHM) and non-molar hydropic abortion. However, distinguishing between PHMs and non-molar hydropic abortions using histopathology alone is often challenging. This study aimed to evaluate the technical validity and additional benefits of using fluorescence in situ hybridization (FISH) in combination with p57KIP2 immunostaining to diagnose molar and non-molar conceptuses. The study involved 80 specimens, which underwent genetic diagnosis using short tandem repeat analysis, including 44 androgenetic CHMs, 20 diandric monogynic PHMs, 14 biparental non-molar hydropic abortions, 1 monoandric digynic triploid abortion, and 1 vaginal specimen of gestational trophoblastic neoplasia. Two pathologists independently diagnosed the cases based on morphology and p57KIP2 immunostaining while the clinical information was masked. FISH analysis was performed using 3 probes (CEP17, CEPX, and CEPY), which revealed that all androgenetic CHM and biparental diploid non-molar hydropic abortion specimens were diploid. Among the 20 diandric monogynic PHM cases examined by analyzing short tandem repeat polymorphisms, 18 were triploid, and the remaining 2 were diploid. These two specimens were possibly androgenetic/biparental mosaics based on FISH analysis, where the three-signal ratios counting 50 cells were clearly within the diploid ranges. Eight of the 20 genetic PHMs and 2 of the 14 genetically confirmed non-molar hydropic abortions that were falsely diagnosed based on morphology and immunohistochemistry by at least 1 pathologist were correctly diagnosed as PHM and non-molar hydropic abortion, respectively, by FISH analysis. However, 1 monoandric digynic villus was classified as triploid by FISH analysis, leading to a false PHM diagnosis. In conclusion, the combination of FISH analysis with p57KIP2 immunostaining helps in diagnosing molar and non-molar conceptuses in numerous cases; nevertheless, exceptional cases should be considered.

To Determine the Degree of Agreement between Ki67 and Histopathology to Differentiate between Hydatidiform Mole

Aim: To determine the degree of agreement between Ki67 and histopathology to differentiate between hydatidiform mole and hydropic abortus. Methods: Descriptive, Cross Sectional Survey was conducted in the Department of Pathology, Fatima Memorial Hospital, Lahore during 6 months (May 11, 2016 to Nov 11, 2016). Using non-probability consecutive sampling, 105 cases were included in this study as per the inclusion and exclusion criteria. 10% buffered formalin was used to fix the sepecimens. Gross examination and staining with Hematoxylin and Eosin was done. The cases were diagnosed by a histopathologist. IHC staining Ki67 was performed, assessed by histopathologist and the data was recorded on the proforma. Results: The mean age was 27.79±5.81 years with minimum and maximum ages of 18 years and 42 years respectively. The histopathological findings showed hydatidiform mole in 41 (39%) women and hydropic abortus in 64(61%) women. The Ki67 was reported to be >25 in 41(39%) patients and less than or equal to 25 in 64(61%) patients. The agreement of differentiation in the two types for histopathology and Ki67 was found in 101(96.2%) patients. Kappa statistics showed 92% (p-value= 0.000) strength of agreement between histopathology and Ki67. Conclusion: There is high degree of agreement between Ki67 and histopathology for differentiation of hydatidiform mole and hydropic abortus. So Ki67 can be used as an adjacent in histopathologic diagnosis of hydatidiform mole in difficult cases. MeSh words: Hydatidiform Mole, Immunohistochemistry, Ki-67 Antigen

Histological analysis of the products of conception in first trimester spontaneous abortions

Aims: To evaluate the histopathological findings of products of conception in the first trimester spontaneous abortions.
 Methods: A hospital based descriptive cross sectional study conducted from March 2018 to March 2019, among the women admitted with diagnosis of first trimester spontaneous abortion at Paropakar Maternity and Women’s Hospital.
 Results: Among 80 cases of spontaneous abortions, incomplete abortion was the commonest type constituting 42.5% of the studied group. The majority of participants belonged to age group of 21-30 years (61.2%) with a mean age of 26.8±6.1 years. Histopathologic examination confirmed products of conception in 60 (75%) patients, partial molar pregnancy in 9 (11.25%) patients, decidual reaction in 9 (11.25%) patients and hydropic abortus in only 2 (2.5%) patients. The molar pregnancy was more prevalent among women of Tibeto-Nepalese ethnic group 26.5% (n=9). Partial hydatidiform mole was more common in primiparous (19.3%) than in multiparous (14.2%).
 Conclusions: The histopathological examination of the products of conception proved to be an important tool in detecting undiagnosed pathology like molar pregnancy and hydropic changes that necessitate special follow-up protocol and further management.

Differential expression of P63, P27, P57, Ki-67, and CD146 in hydropic and molar pregnancies.

To investigate the expressions of immunohistochemical markers P63, P27, P57, Ki-67 and CD146 in hydropic and molar specimens in order to explore their role in the pathogenesis of molar gestations. The retrospective study was conducted at the Kırıkkale Medical University, Turkey, and comprised data from 2011 to 2018 related to patients with a definitive pathological diagnosis of hydropic abortus, complete hydatidiform moles and partial hydatidiform moles. Immunoreactivity using antibodies against P63, P27, P57, Ki-67 and CD146 was scored by evaluating the percentage of distinctly stained cells. Data was analysed using SPSS 15. Of the 37 specimens, 10(27%) were hydropic abortus, 17(46%) partial hydatidiform moles and 10(27%) complete hydatidiform moles. Patients with complete hydatidiform moles severe cytologic atypia in CD146-positive extravillous trophoblastic column and florid syncytiotrophoblast proliferation. P57 immunostaining was negative in 9(90%) patients with complete hydatidiform moles, whereas all patients in the two other groups showed positive immunostaining, and they also showed P63 and Ki-67 overexpression in cytotrophoblasts. P27 was expressed in differentiated, non-dividing syncytiotrophoblasts but did not yield any diagnostic aid. The proliferative activity location varied between molar and nonmolar pregnancies.

Role of the Immunohistochemical Marker (Ki67) in Diagnosis and Classification of Hydatidiform Mole

Introduction: Since the hallmark of gestational trophoblastic disease is trophoblastic proliferation, Ki67 is regarded as the best marker in studying hydatidiform mole.This study was conducted to evaluate the role of this proliferative marker in distinguishing among hydropic abortion, partial and complete hydatidiform mole. Materials and methods: This is a cross sectional study involving the application of Ki67 on a total of 90 histological samples of curetting materials from molar (partial and complete mole) and non molar hydropic abortion belong to Iraqi females, so three study groups were created. Immunohistochemical expression in villous cytotrophoblasts, syncytiotrophoblasts and stromal cells were recorded separately by three independent observers and the results were correlated statically. Results: The mean number of stained nuclei of villous cytotrophoblasts and stromal cells was the highest in complete mole and the lowest in non molar hydropic abortion. There is a significant statistical relationship regarding Ki67 labeling index in villous cytotrophoblasts between partial moles and hydropic abortion, complete mole and partial moles, hydropic abortion and complete mole. Regarding Ki67 labelling index in villous stromal cells, a significant statistical relationship achieved when the correlation done between partial mole and hydropic abortions, hydropic abortion and complete mole, while a non significant statistical relationship was achieved if the correlation done between partial and complete mole. All villous syncytiotrophoblasts showed negative results. Conclusion: Ki-67 labeling index in villous cytotrophblastic cells are useful in separating between partial moles and hydropic abortion, partial mole and complete mole, hydropic abortion and complete mole. While Ki-67 labeling index in villous stromal cells is only useful in separating between partial moles and hydropic abortion, hydropic abortion and complete mole.

P57-discordant villi in hydropic products of conception: a clinicopathological study of 70 cases

p57 immunostaining is performed on hydropic products of conception to diagnose hydatidiform moles (HMs), which can progress to gestational trophoblastic neoplasia. Partial hydatidiform mole (PHM) and hydropic abortion (HA) display positive staining in stromal and cytotrophoblastic cells, whereas complete hydatidiform mole (CHM) is characterized by loss of p57 expression in both cell types. In some cases, an aberrant pattern is observed, called discordant p57 expression, with positive cytotrophoblast staining and negative stromal staining, or vice versa. The aim of this study was to describe the clinical, biological, and pathological characteristics of p57-discordant villi (p57DV) and other associated populations in cases of divergent p57 expression and to compare the evolutions of p57DV-associated and classic CHMs. Seventy cases of p57DV diagnosed by referent pathologists were divided into two groups, G1: p57DV±non-CHM component (n=22) and G2: p57DV+CHM component (n=48). p57DV morphology was similar in the two groups. Observation of more than two populations and hybrid villi on p57 immunostaining were significantly more frequent in G2. The clinical, ultrasound, and biological presentations of p57DV-associated and classic CHMs were similar. The initial pathological diagnosis was more frequently incorrect, missing the CHM component, for the p57DV-associated CHMs. Molecular genotyping was informative in seven cases and identified as androgenetic/biparental mosaicism in four cases. These results show that p57DV are a diagnostic challenge for pathologists and that most are associated with a CHM component. However, the clinical management of p57DV-associated CHMs should be the same as that of classic CHMs.

Clinical application of short tandem repeat polymorphism analysis in the differential diagnosis of early hydatidiform mole and hydropic abortion

Objective: To determine the clinical differential diagnosis value of short tandem repeat polymorphism (STR) analysis in early hydatidiform moles (HMs) and non-molar gestations. Methods: Four hundred eighty-one patients with suspected HMs were examined using traditional pathology methods and STR analysis. The value of the STR method in distinguishing HMs from non-molar gestations was evaluated. Results: Among 481 patients with suspected HMs, 177 were diagnosed with HMs and 304 with non-molar gestations based on histopathologic examination. The STR genotypic results show that 151 patients were diagnosed with HMs, including 63 complete HMs and 88 partial HMs. Three hundred thirty patients were diagnosed with non-molar gestations, including 43 patients with chromosome abnormalities. Among 63 complete HMs, 56 were monosyllabic and 7 were dispermic. All 88 partial HMs were dispermic. The histopathologic diagnoses in 84 patients were not in agreement with STR analyses. Among the 84 cases, 29 were incorrectly diagnosed with non-molar gestations and the others were incorrectly diagnosed with HMs by histopathologic examinations. The chi-test result demonstrated that the two methods were quite different. Conclusion: STR polymorphism analysis is a rapid, simple, and accurate method that can be utilized for accurate diagnosis of early HMs and hydropic abortions.

Expression of Pro-Apoptotic Bax and Anti-Apoptotic Bcl-2 Proteins in Hydatidiform Moles and Placentas With Hydropic Changes

Abstract- Morphologic examination still forms the main diagnostic tool in the differential diagnosis of molar placentas. However the criteria are subjective and show considerable inter-observer variability among pathologists. The aim of the present study was to investigate the role of Bcl-2 and Bax immunostaining in the differential diagnosis of molar placentas. Bax and Bcl-2 immunohistochemical staining were performed in 19 molars (8 partial and 11 complete hydatidiform mole) and 10 non-molar (hydropic abortion) formalin-fixed, paraffin-embedded tissue samples. Ploidy analysis using flow cytometry had confirmed diploidy in hydropic abortions and complete hydatidiform moles and triploidy in partial hydatidiform moles. Bcl-2 expression was observed only in syncytiotrophoblasts, No immunoreactivity was detected in Cytotrophoblasts, and stromal cells, the total score averages of Bcl-2 immunoexpression in partial hydatidiform moles and hydropic abortions were significantly higher than in complete hydatidiform moles, whereas no significant difference was observed between partial hydatidiform moles and hydropic abortions. Bax immunoreactivity was observed in cytotrophoblasts, stromal cells and occasionally in syncytiotrophoblasts. No statistically significant difference in Bax immunoexpression total score was observed among various groups. Based on the results of this study, Bcl-2 immunostaining offers a potential adjunctive diagnostic tool to distinguish complete hydatidiform mole from partial hydatidiform mole and hydropic abortion, but not partial hydatidiform mole from hydropic abortion, Bax immunostaining cannot be helpful in this regard.

P53 expression in various types of hydropic placentas (through ploidy analysis as a complementary tool in diagnosis of samples).

Background:Placentas characterized by hydropic swelling of chorionic villi occur in a spectrum of pathological conditions including hydropic abortion (HA), partial hydatidiform mole (PHM) and complete hydatidiform mole (CHM). The purpose of this study was to investigate whether the expression of p53 tumour suppressor protein could differentiate these various types of hydropic placentas.Methods:p53 immunohistochemical staining was performed in 19 molar (8 PHM and 11 CHM) and 10 non-molar (HA) formalin-fixed, paraffin-embedded tissue samples. Ploidy analysis using flow cytometry was performed as a complementary tool in diagnosis of samples.Results:DNA histograms obtained from all samples had confirmed diploidy in HAs and CHMs and triploidy in PHMs. p53 immunoreactivity was assessed in villous cytotrophoblasts, syncytiotrophoblasts and stromal cells. The p53 positive reaction was predominantly observed in the nuclei of cytotrophoblastic cells and rarely in stromal cells, no reaction was seen in syncytiotrophoblasts. The mean percentage of p53 positive cells were 6.10±3.75 for HA, 25.87±13.4 for PHM and 39.83±18.76 for CHM. There was a significant difference in P53 immunoreactivity of cytotrophoblastic cells between CHM and HA (P<0.001), and between PHM and HA (P=0.004). There was no significant difference in immunohistochemical reactivity between CHM and PHM (P=0.068).Conclusion:This study confirms that p53 immunostaining may be helpful in distinguishing complete and partial hydatidiform mole from hydropic abortion, but not complete hydatidiform mole from partial hydatidiform mole.

Differential expression of cyclin E, p63, and Ki-67 in gestational trophoblastic disease and its role in diagnosis and management: A prospective case-control study.

Gestational trophoblastic disease (GTD) constitutes a spectrum of tumors and tumor-like conditions, characterized by proliferation of pregnancy-associated trophoblastic tissue of progressive malignant potential. It is very difficult to differentiate these complex groups of lesions basing on histomorphology alone. Immunohistochemistry (IHC) with cyclin E, P63, and Ki-67 has a definite role in the identification of different trophoblasts and entities of GTD and also in the determination of biological behavior. The aim of this study is to find the differential expression of cyclin E, p63, and Ki-67 in normal placenta, hydropic abortus (HA), and various entities of GTD. A prospective case-control study conducted in a government medical college. Total 96 cases, divided into Group A (48 histologically confirmed cases of GTD) and Group B (controls comprising 8 HA and 40 normal placentas of different trimesters), were studied. The histological samples were subjected to IHC using cyclin E, Ki-67, and p63. Results were analyzed using SPSS statistical method. Among the three immunomarkers used, Cyclin E and Ki-67 show statistically significant difference (P < 0.05) when compared between GTD and control groups, but it was insignificant for p63 (P = 0.369). Strong staining intensity of cyclin E and Ki-67 is seen in complete moles, choriocarcinoma, and placental site trophoblastic tumor. This study was done to evaluate the role of cell cycle regulatory proteins such as cyclin E and p63 and proliferation marker Ki-67 in the detection of various trophoblasts and differential diagnosis of the lesions associated with them.

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, p21WAF1/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, p21WAF1/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). p21WAF1/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.

The Utility of P53, P63, P57 and Ki67 Immunohistochemistry in the Differentiation between Hydropic Abortion and Molar Pregnancy (Immunohistochemical Study)

The Utility of P53, P63, P57 and Ki67 Immunohistochemistry in the Differentiation between Hydropic Abortion and Molar Pregnancy (Immunohistochemical Study)

The Utility of P53, P63, P57 and Ki67 Immunohistochemistry in the Differentiation between Hydropic Abortion and Molar Pregnancy (Immunohistochemical Study)

The Utility of P53, P63, P57 and Ki67 Immunohistochemistry in the Differentiation between Hydropic Abortion and Molar Pregnancy (Immunohistochemical Study)

Clinical application of STR genotyping diagnosis for hydatidiform mole and nonmolar gestation

Objective: To investigate the value of short tandem repeat (STR) genotyping in the diagnostic workup of molar and non-molar gestations with correlation of histological characteristics. Methods: Six hundred and fifty-six cases were selected based on clinically suspected hydropic abortion and/or molar pregnancy from July 2015 to September 2017 at Beijing Obstetrics and Gynecology Hospital. DNA was extracted from dissected chorionic villi and paired maternal endometrial FFPE tissue samples by Simplex OUP™ FFPE DNA Tissue Kit. STR genotyping was performed by PowerPlex 16 HS system. Results: DNA genotyping was informative in 649 of 656 cases, leading to identification of 215 hydatidiform mole gestations and 434 non-molar gestations. Most of non-molar gestations (375 cases, 86.4%) were diploid hydropic abortion. Various trisomy syndromes were found (53 cases, 12.2%), including trisomy 2, 3, 4, 7, 8, 13, 16 and 21. Only 2(0.5%) digynic triploid gestations were detected. Moreover, 4 cases (0.9%) of uniparental disomies (homologous or heterologous) were found. There were 196 cases with histologic diagnostic suspicious of hydatidiform moles were accurate sub-classified. Among them, 59 cases hydatidiform moles were under-diagnosed as diploid hydropic abortions, and 28 cases diploid hydropic abortions were over-diagnosed as hydatidiform moles.Compared with partial moles(PHM), there were no specific histomorphological features between the various types of non-molar gestations and partial moles for definitive diagnostic separation. There was no significant difference in the expression of p57(kip2) among PHM, trisomy and diploid hydropic abortions group (P=0.247). Conclusions: STR genotyping can distinguish non-molar gestations from early hydatidiform moles, and efficiently avoid misdiagnosis based only on histological evaluation. Therefore, using STR genotyping, not only can the overdiagnosis of non-molar pregnancy be avoided, but also individualized management can be offered to patients including monitoring of serum hCG.

Diagnostic Utility of Twist1, Ki-67, and E-Cadherin in Diagnosing Molar Gestations and Hydropic Abortions.

This study aims to assess whether the expression of Twist1, Ki-67, and E-cadherin can guide the differential diagnosis of complete hydatidiform mole (CHM), partial hydatidiform mole (PHM), and hydropic abortion (HA). Differential expression of Twist1, Ki-67, and E-cadherin was analyzed in gestational products from 55 cases of CHM, PHM, and HA using immunohistochemistry. Prior to analysis, the studied cases were confirmed for their diagnosis by flow cytometric assessment of DNA ploidy and p57 immunostaining. Twist1 expression can distinguish CHM from PHM and HA with 100% sensitivity, 100%, specificity, 100% positive predictive value (PPV), and 100% negative predictive value (NPV). Furthermore, combined Ki-67 and E-cadherin expression could differentiate PHM and HA with 100% sensitivity, 93.3% specificity, 92.3% PPV, and 100% NPV. Twist1 expression is a highly reliable marker for the diagnosis of CHM, where combined Ki-67 and E-cadherin immunoreactivity can distinguish PHM from nonmolar pregnancies.

Sonographic findings of hydropic abortion

Sonographic findings of hydropic abortion

P57 and Ki-67 expression in hydropic abortion and molar pregnancy

Background The histopathological diagnosis and differentiation between partial mole (PM) and complete mole (CM) bears difficulties. Hence, additional methods rather than morphology can be useful to reach the proper diagnosis. Immunohistochemical (IHC) analysis using antibodies such as p57 and Ki-67 can be used to solve this problem. This study was done to investigate the role of p57 and Ki-67 IHC in distinguishing between CM, PM, and hydropic abortion (HA). Patients and methods Twenty cases of molar pregnancies – 10 (CM) and 10 (PM) – and 10 HA diagnosed on histopathological criteria were studied histopathologically along with IHC using antibodies against p57 and Ki-67. The cases were collected in a retrospective manner from Pathology Lab, Faculty of Medicine, Mansoura University from January 2015 to December 2015. Results We found that CM demonstrated enlarged villi with circumferential trophoblastic hyperplasia. Villous stromal cells and cytotrophoblast were negative for p57. PM demonstrated hydropic, irregularly shaped villi with scalloped contours, trophoblastic inclusions, and mild circumferential trophoblastic hyperplasia. Villous stromal cells and cytotrophoblast were diffusely positive for p57. In all 10 CM cases, the Ki-67 proliferation index was relatively high (>26% of cells) with complete absence of p57 immunostaining in the cytotrophoblasts and villous stromal cells in comparison with PM cases with statistical significance (P Conclusion Our study further confirms the valuable role of p57 in the diagnosis of CM augmented by the traditional histopathological criteria. Ki-67 has a limited value in differentiating between some cases of PM and CM. The best possible use of Ki-67 is to differentiate between molar and nonmolar pregnancy along with other histological parameters, especially trophoblastic proliferation and villous enlargement.