Histopathological analysis of early hydatidiform mole

超声波在诊断和处理宫内胎儿死亡中的广泛应用，导致痣比以前更早被清除。为探讨早期部分性葡萄胎（PM）的临床病理特征，对早期（≤ 12孕周）和晚期（>12孕周）部分性PM的形态学和DNA倍体进行了研究。对80例早期和20例晚期PM（1981-90年37例; 1991-98年63例）进行了分析。早期PM的平均孕周为9.6周，晚期PM为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中进行了葡萄胎的排空前诊断。早期和晚期PMs的组织学差异无统计学意义，但早期PMs的绒毛较小，晚期PMs的间质纤维化广泛。80个早期PM中有70个和20个晚期PM中有19个为三二倍体，5个早期PM为非整倍体，5个早期PM和1个晚期PM为二倍体。45例早期PM患者和11例晚期三倍体PM患者均未发生持续性妊娠滋养细胞疾病。早期PM现在比以前更普遍。这可能是由于对PM的认识提高，病理学家对其的认识增加以及超声在诊断和管理宫内胎儿死亡中的广泛使用。PM的诊断应基于病理检查，因为大多数PM仍然逃避临床检测。DNA倍体分析在问题病例的评估中是有用的。早期PM中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.