Histopathological analysis of early hydatidiform mole

超声在诊断和处理胎儿宫内死亡中的广泛应用导致葡萄胎比以前更早排出。为明确早期部分性葡萄胎(PM)的临床病理特点，对早期(小于或等于)和晚期(<12周)部分性葡萄胎的形态和DNA倍体进行了研究。分析了80例早孕和20例晚孕(1981-90年37例，1991-98年63例)。早孕组平均孕周为9.6周，晚孕组为14.8周。早期PM在1991-98年(57/63，90%)比1981-90年(23/37，62%)更常见。葡萄胎的疏散前诊断只有4例早期葡萄胎和1例晚期葡萄胎。除早期绒毛较小、晚期间质纤维化外，早、晚期PMS的组织学无明显差异。80例早期PM中70例为三倍体，20例晚期PM中19例为三倍体，5例早期PM为非整倍体，5例早期PM和1例晚期PM为二倍体。45例早期早孕患者和11例晚期三倍体早孕患者中无一例发生持续性妊娠滋养细胞疾病。早期PM现在比以前更普遍。这可能是由于人们对PM的实体有了更多的认识，病理学家对PM的认识增加，以及超声在诊断和处理胎儿宫内死亡方面的广泛使用。PM的诊断应以病理检查为基础，因为大多数PM仍未被临床发现。DNA倍体分析在评估问题病例中是有用的。在经前综合征早期患持续性疾病的风险似乎非常低。

The widespread use of ultrasound in the diagnosis and management of intrauterine fetal death has resulted in moles being evacuated earlier than before. In order to clarify clinicopathologic features of early partial mole (PM), morphology and DNA ploidy of early (【less than or equal】12 gestational weeks) and late (>12) partial PM were studied. Eighty early and twenty late PMs (37 from 1981-90 ; 63 from 1991-98) were analyzed. Mean gestational weeks were 9.6 in early PMs and 14.8 in late PMs. Early PM was more common in 1991-98 (57/63, 90%) than in 1981-90 (23/37, 62%). Preevacuation diagnosis of hydatidiform mole was made only in four early and one late PMs. There was no significant difference in histology between early and late PMs except smaller villi in early PMs and extensive stromal fibrosis in late PMs. Seventy of 80 early PMs and 19 of 20 late PMs were tridiploid,five early PMs were aneuploid,and five early and one late PM were diploid. None of 45 patients with early PM and one of 11 with late triploid PM developed persistent gestational trophoblastic disease. Early PM is now more prevalent than it was previously. This may be a result of greater awareness of the entity of PM, its increased recognition by pathologists and the widespread use of ultrasound in the diagnosis and management of intrauterine fetal death. The diagnosis of PM should be based on pathologic examination since most PMs still escape clinical detection. DNA ploidy analysis is useful in the evaluation of problem cases. The risk of persistent disease in early PMs seems to be very low.