J Pathol Transl Med.  2017 Jul;51(4):381-387. 10.4132/jptm.2017.04.28.

Morphological Features and Immunohistochemical Expression of p57Kip2 in Early Molar Pregnancies and Their Relations to the Progression to Persistent Trophoblastic Disease

• Khashaba M
• Arafa M
• Elsalkh E
• Hemida R
• Kandil W

• KMID: 2392578
• DOI: http://doi.org/10.4132/jptm.2017.04.28

Abstract

BACKGROUND
Although the morphological features characteristic of products of conception specimens including molar pregnancies are well described, substantial histopathological similarities are observed between the different entities, especially in cases of early pregnancies. Furthermore, there are no current solid criteria that could predict cases with progression to persistent gestational trophoblastic disease. In this study, we aimed to determine the most specific histopathological and immunohistochemical features required for accurate diagnosis that can reliably predict the clinical behavior.
METHODS
Sixty-five cases of products of conception were reviewed clinically and pathologically, and any progression to persistent gestational trophoblastic disease (GTD), if present, was noted. Pathological assessment of the archival material included re-cut sections of 5 μm in thickness, routine staining with hematoxylin and eosin and immunohistochemical staining of p57Kip2.
RESULTS
Certain histopathological criteria were found to be significant in differentiation between complete hydatidiform mole (CHM) and partial hydatidiform mole including villous shape and outline, villous trophoblast hyperplasia, and atypia in extravillous trophoblasts. There were no significant differences in any morphological or immunohistochemical features between cases with or without subsequent development of GTD.
CONCLUSIONS
Histopathological diagnosis of molar pregnancy remains problematic especially in early gestation. Their diagnosis should be stated after a constellation of specific histopathological criteria in order not to miss CHM. p57Kip2 immunohistochemistry is of great value in diagnosis of cases that had equivocal morphology by histopathological examination. However, there were no significant features to predict cases that subsequently developed persistent GTD.

Keyword

Hydatidiform mole; Complete hydatidiform mole, early; p57Kip2 immunohistochemistry

MeSH Terms

Diagnosis
Eosine Yellowish-(YS)
Female
Fertilization
Gestational Trophoblastic Disease
Hematoxylin
Hydatidiform Mole*
Hyperplasia
Immunohistochemistry
Molar*
Pregnancy
Trophoblasts*
Eosine Yellowish-(YS)
Hematoxylin

Figure

• 

  Fig. 1. (A) Complete hydatidiform mole (CHM): irregular villous outline (club shaped) with villous stromal karyorrhectic debris. (B) Partial hydatidiform mole (PHM). Two villous populations; large edematous villi with irregular outline and normal appearing nondistended ones. (C) Hydropic abortion (HA): distended villi with hydropic change. (D) CHM: trophoblastic inclusion (arrow). (E) CHM: cistern formation. (F) CHM: multifocal villous trophoblastic hyperplasia. (G) HA: positive p57Kip2 nuclear staining in intermediate trophoblast as positive internal control (asterisk). Positive p57Kip2 nuclear staining in villous cytotrophoblasts (CT) (short arrow) and villous stromal cells (long arrow) (immunoperoxidase). (H) CHM p57Kip2 immunohistochemistry: negative nuclear staining in villous CT (short arrow) and villous stromal cells (long arrow); positive p57Kip2 nuclear staining in intermediate trophoblast as positive internal control (asterisk) (immunoperoxidase). (I) PHM: positive p57Kip2 nuclear staining in villous CT (short arrow) and villous stromal cells (long arrow) (immunoperoxidase).

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