Incidence of postmolar gestational trophoblastic disease in androgenetic moles and the morphological features associated with low risk postmolar gestational trophoblastic disease
Incidence of postmolar gestational trophoblastic disease in androgenetic moles and the morphological features associated with low risk postmolar gestational trophoblastic disease
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DOI：
10.1111/j.1349-7006.2010.01602.x
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发表时间：
2010-07-01
期刊：
影响因子：
5.7
通讯作者：
Wake, Norio
中科院分区：
文献类型：
--
作者：
Kaneki, Eisuke;Kobayashi, Hiroaki;Wake, Norio
在本研究中，我们评估了磨牙妊娠后滋养细胞疾病（GTD）的发生率。我们还根据日本妇产科学会（JSOG）的分类验证了宏观诊断。根据DNA多态性将297份水绒毛分为雄性源性痣、分散三倍体和双亲本二倍体（水性流产），临床分别对应完全葡萄胎（CHM）、部分葡萄胎（PHM）和水性流产。这些样本也根据JSOG分类进行形态学分类。对后磨牙GTD的发生率进行了随访研究。对符合检测条件的267个样本进行分析并诊断为雄性痣（232例）、分散三倍体（20例）和双亲本二倍体（15例）。大多数宏观诊断的CHM病例在遗传上起源于雄激素。PHM病例包括30个雄性痣和12个分散的三倍体。我们回顾了200例患者的结局（178例雄激素性痣，13例分散三倍体，9例双亲本二倍体）。28例（16%）雄激素源性痣发生磨牙后GTD。分散性三倍体患者均未发生后磨牙GTD。在28例发生后磨牙GTD的患者中，最大水绒毛的最短直径明显长于未发生后磨牙GTD的患者。在最短直径小于2 mm的雄激素性痣患者中，无一例发生后磨牙GTD。对于分散性三倍体患者，后磨牙GTD的风险极低。雄激素源性痣伴小绒毛积水的患者发生磨牙后GTD的风险也很低。基于水绒毛形态的JSOG分类对CHM的诊断是可靠的，但对PHM或“微观”痣的诊断不准确。（癌症科学2010）。
In the present study, we evaluated the incidence of postmolar gestational trophoblastic disease (GTD) in molar pregnancy. We also validated the macroscopic diagnosis based on the Japan Society of Obstetrics and Gynecology (JSOG) classification. A total of 297 samples of hydropic villi were classified according to DNA polymorphisms as androgenetic moles, dispermic triploids, or biparental diploids (hydropic abortion), clinically corresponding to complete hydatidiform mole (CHM), partial hydatidiform mole (PHM), and hydropic abortion, respectively. These samples were also classified morphologically based on the JSOG classification. A follow-up study was performed to investigate the incidence of postmolar GTD. A subset of 267 samples eligible for testing were analyzed and diagnosed as androgenetic moles (232 cases), dispermic triploids (20 cases), and biparental diploids (15 cases). Most of the macroscopically diagnosed CHM cases were genetically androgenetic in origin. The PHM cases consisted of 30 androgenetic moles and 12 dispermic triploids. We reviewed the outcomes of 200 patients (178 cases of androgenetic mole, 13 cases of dispermic triploids, and nine cases of biparental diploids). Twenty-eight cases (16%) of androgenetic moles developed postmolar GTD. None of the patients with dispermic triploids developed postmolar GTD. Among the 28 patients who developed postmolar GTD, the shortest diameter of the largest hydropic villi was significantly longer than that of patients not developing postmolar GTD. None of the patients with androgenetic moles who had hydropic villi < 2 mm in their shortest diameter developed postmolar GTD. For the patients with dispermic triploids, the risk of postmolar GTD is extremely low. The risk of postmolar GTD is also low in patients with androgenetic moles with small hydropic villi. The JSOG classification based on the morphology of hydropic villi is reliable for the diagnosis of CHM, but inaccurate for the diagnosis of PHM or "microscopic" moles. (Cancer Sci 2010).