Histopathological analysis of early hydatidiform mole

超声在宫内胎儿死亡诊断和处理中的广泛应用，导致胎痣比以前更早被排出。为了明确早期部分痣（PM）的临床病理特征，我们研究了早期（≤12孕周）和晚期（≤12孕周）部分痣的形态和DNA倍体。80例早期pm和20例晚期pm（1981-90年37例，1991-98年63例）被分析。经前期平均妊娠周9.6周，经后期平均妊娠周14.8周。早期PM在1991-98年（57/ 63,90%）比1981-90年（23/ 37,62%）更常见。仅在4例早期和1例晚期pm中进行了葡萄胎的预抽液诊断。除了早期pm的绒毛较小和晚期pm的广泛间质纤维化外，早期pm和晚期pm的组织学无显著差异。80个早期PM中有70个是三倍体，20个晚期PM中有19个是三倍体，5个是非整倍体，5个早期PM和1个晚期PM是二倍体。45例早期PM患者和11例晚期三倍体PM患者中均无持续性妊娠滋养细胞疾病。早PM现在比以前更普遍了。这可能是由于对PM的认识提高，病理学家对PM的认识增加，超声在宫内胎儿死亡的诊断和处理中的广泛应用。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倍性分析在问题病例的评估中是有用的。早期经前期持续疾病的风险似乎很低。

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.