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Article
A Prospective Study of Gestational Trophoblastic Disease in Al-Mosul City

Author: Zhraa Abd-Alkader Taboo
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 2 Pages: 268-276
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

BACKGROUND: Gestational trophoblastic tumors comprise a wide spectrum of neoplastic disorders that arise fromplacental trophoblastic epithelium after abnormal fertilization which is characterized bytrophoblastic hyperplasia and overgrowth of placental villi. There are several histologically distincttypes of gestational trophoblastic diseases GTD: hydatiform mole (complete or partial),persistant/invasive gestational trophoblastic neoplasia (GTN), choriocarcinoma and placenta sitetrophoblastic tumors. OBJECTIVE: Of the present study is to determine the incidence, clinical presentation and some of its relevantfactors among women admitted to Al-Batool Hospital in Mosul- Iraq. METHODS: The study was conducted in Al-Batool Hospital, Department of Gynecology and Obstetrics, Iraq,Mosul city, from April 2009 to January 2011 as prospective study 9500 patients were analyzedregarding their history, clinical examination, investigations, risk factor. RESULTS: During the analysis, the peak incidence of age is between 21 – 25 years (31.2%). The mostcommon clinical presentation bleeding per vaginal (100%). The peak incidence of the disease iswith para two (36%). Complete hydatidiform mole forming (80%). Partial hydatidiform moleforming (18.4%). Invasive mole forming (1.6%). The mean level of B-hCGin partial mole beforeevacuation is between 3000-4000 mIU/ml. the mean level of B-hCG in complete mole beforeevacuation is between 7000-10000 mIU/ml. CONCLUSION: Frequency of GTD was higher compared to national and international studies. The disease wascommon in young ages, low para and grand multiparous women. Hydatidiform mole was thecommonest type of trophoblastic disease in these patients. Most common presenting complaint wasbleeding per vagina followed by pain in lower abdomen. It appears that the ultrasound ismoderately sensitive in the diagnosis of hydatiform mole pregnancy


Article
Immunoexpression of P53 protein in trophoblastic diseases
أبانة مناعية لبروتين P53 في أمراض ورم الأرومة الغاذية

Authors: Sanarya M. Ali --- Nadya Y. Ahmedi --- Tara M. Shalal --- Tenya T. Abdulhameed
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2017 Volume: 21 Issue: 1 Pages: 1629-1635
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objective: Trophoblastic diseases constitute a spectrum of tumors and tumor- like conditions characterized by proliferation of pregnancy associated trophoblastic tissue of progressive malignant potential. This study aimed to assess the value of p53 protein immunoexpression in the diagnosis of hydatidiform molar pregnancy and the differential diagnosis of its subtypes (complete and partial) from abortions.Methods: A cross-sectional study of tissue sections from 68 formalin-fixed, paraffin- embedded specimens of products of conception, including 1st trimester abortion (n=15), partial hydatidiform mole PHM (n=24), complete hydatidiform CHM (n=24) and full term placenta (n=5), all were examined at the Histopathology Department of Maternity Teaching Hospital in Erbil, Iraq during the period of Jan.2013-Jun.2013. Immunohistochemistry was performed using p53 antibody and the standard streptavidin-biotin immunoperoxidase method. The labeling index (number of positive nuclei/total number of nuclei) for villous cytotrophoblasts, syncytiotrophoblasts and stromal cells were evaluated separately. Statistical analysis was carried out by one way ANOVA and Fisher’s exact tests, statistical significance was determined at P ≤0.05.Results: All villous trophoblastic lesions showed higher p53 immunoexpression in all villous components especially cytotrophoblasts, being the highest in complete hydatidiform mole (>50%) and partial hydatidiform mole (>20%). A statistically significant difference was found in immunoexpressins of p53 that was useful in separating abortion from complete hydatidiformmole, P <0.001, and partial hydatidiform mole, P <0.0002. It was also useful in separating between the complete hydatidiform mole and partial hydatidiform mole (P <0.001).Conclusion: p53 immunoexpression was valuable in differentiation between molar and non molar pregnancies and between subtypes of molar pregnancies.


Article
Malignant gestational trophoblastic disease: a review of seventeen cases

Authors: Haifa Z. Beker هيفاء --- Aasem M. AL-Chalabi عاصم الجلبي --- Yosra T. Jarjees يسرى طاهر جرجيس
Journal: Annals of the College of Medicine Mosul مجلة طب الموصل ISSN: 00271446 23096217 Year: 2006 Volume: 32 Issue: 1&2 Pages: 23-28
Publisher: Mosul University جامعة الموصل

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Abstract

Objective: (a) To describe the demographic characteristics of malignant gestational trophoblasic disease (GTD) in Mosul. (b) To evaluate the classification system that stratifies the treatment of the malignant GTD. (c) To know the incidence of malignant changes of mole to malignant GTD.
Design: retrospective clinical case series study done over a period of 5 years.
Setting: Al-Batool Maternity Teaching Hospital and Ibn Seena Teaching Hospital.
Participants: The records of a series of 17 consecutively treated patients who had been diagnosed to have malignant GTD were reviewed. The records of these 17 patients were studied for their age, parity, and mode of presentation. All patients underwent staging studies which included chest x-ray and abdominal ultrasound and were classified as good prognosis group 8 patients (47%) and poor prognosis group 9 patients (53%).
Intervention(s): The good prognosis group was treated with courses of intramuscular methotrexate (50 mg on alternative days 1,3,5,7) with folinic acid rescue (7.5 mg orally on alternative days 2,4,6,8) .The poor prognosis group was treated with methotrexate (10 mg/m2 /day) intravenously (iv), dactinomycin (0.3 mg/m2 /day) iv, and cyclophosphamide (110 mg/m2 /day) iv, for three-day course. Both courses were repeated according to patients’ response.
Results: The mean age incidence of malignant GTD was 37.2 years; the mean parity was 4.6, equally presented from rural and urban areas. The presenting symptom of malignant GTD was vaginal bleeding in 47%, cough and shortness of breath in 41.1%, cough and hemoptysis in11.7%. The blood group was O+ve in 64.7%, A+ve in 17.5%, B+ve in 11.7% and AB+ve in 5.9%. The antecedent pregnancy for malignant GTD was complete mole in 88.2 % (the entire good prognosis group), term pregnancy in 5.9% and abortion in 5.9% (both of them in the poor prognosis group). The mean duration between the antecedent pregnancy and treatment of malignant GTD was 5.7 months. Complete response rate without recurrence was 75% for the good prognosis group and 44.4% for the poor prognosis group. The mortality rate was 0% for the good prognosis group and 33.3% for the poor prognosis group giving an overall cure rate of 58.8%. Hysterectomy was needed in 2 patients (22.2%) of the poor prognosis group. The ratio of changes from complete mole to malignant GTD was about one to nine.
Conclusion: Malignant GTD usually complicated complete mole and presented as poor prognosis type in nearly half of the patients. Classification into good and poor prognosis groups is a successful way for treatment selection.

Key words: Gestational trophoblastic disease, hydatidiform mole, neoplasm staging.


Article
P57Kip2 immunostaining, a diagnostic marker in differentiating complete hydatidiform mole from its mimics
P57Kip2 المناعية ، علامة تشخيصية في التمييز بين الخلد المائي الكامل من مقلداته

Author: Ava T. Ismael
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2016 Volume: 20 Issue: 2 Pages: 1316-1322
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objective: The distinction of hydatidiform mole from hydropic abortion remains a problem because of interobserver and intraobserver variability. This study aimed to determine the utility of p57Kip2 as a diagnostic marker in differentiating complete hydatidiform mole from its mimics.Methods: A total of 97 formalin fixed paraffin embedded material including forty cases of complete hydatidiform mole, 36 cases of partial hydatidiform mole and 21 cases of hydropic abortion were selected randomly from the files of histopathology laboratory of Maternity Teaching Hospital in Erbil. The samples were reviewed by two pathologists, afterward; immunohistochemical staining was performed by using a p57Kip2 marker. We considered p57Kip2 positive only if nuclear p57Kip2 staining was identified in at least 10% or more of all in a tissue section. Results: Negative immunostaining was seen in 77.5% of the complete hydatidiform mole in both villous cytotrophoblast and stromal cells. In contrast, 86.1% of partial hydatidiform mole showed positive immunostaining for p57Kip2. All cases of hydropic abortion 100% were positive for p57Kip2 immunostaining. In all gestations, p57Kip2 was strongly expressed in decidua which served as internal positive control. The concordance between the initial histological diagnosis and p57Kip2 immunostaining was statistically significant (P <0.001). Conclusions: p57Kip2 immunostaining is a highly sensitive and specific marker for diagnosis and classification of hydatidiform mole. p57Kip2 staining has the advantage of differentiating hydropic abortuses from the complete hydatidiform mole.


Article
Histological Study of Molar Pregnancy by using some of the Special Stains
دراسة نسيجية للحمل العنقودي باستخدام صبغات نسيجية خاصة

Authors: Tuqa Yousif Sharef تقى يوسف شريف --- Prshang Tawfiq برشانك توفيق فرطاس --- Toqa J Chkhaim تقى جبار جكهام
Journal: Diyala Journal of Medicine مجلة ديالى الطبية ISSN: 97642219 Year: 2019 Volume: 16 Issue: 2 Pages: 72-82
Publisher: Diyala University جامعة ديالى

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Abstract

Background: Molar pregnancy (hydatidiform mole HM) is an abnormal form of pregnancy in which a non-viable fertilized egg implants in the uterus and will fail to come to term. A molar pregnancy is a gestational trophoblastic disease which grows into a mass in the uterus that has swollen chorionic villi. These villi grow in clusters that resemble grapes. A molar pregnancy can develop when a fertilized egg does not contain an original maternal nucleus. The diagnosis of HM is based on its morphology. In classic cases, the abnormally large villi have a vesicular or a grape like appearance. Histologically, HM presents variable degrees of circumferential trophoblastic hyperplasia and epithelial atypia. Distinguish between complete mole (CM) and partial mole (PM) is difficult especially with early diagnosis and evacuation of molar pregnancies, however, the criteria are subjective and show considerable inter-observer variability. Unfortunately in our country the histological diagnosis is depend only on routine stain (H&E) which is not giving a clear results in some cases because of that, the study design to find the similarities and differences between the two types of molar pregnancy by using some of special stains which surely distinguish between complete and partial moles samples using immunohistochemical marker P57KIP2. Objective: To detecting if the special stain can be helpful to distinguish between the two types of molar pregnancy also to find the accuracy of the routine diagnosis of hydatidiform mole comparing with P57 immunohistochemistry stain.Patients and Methods: The study conducted at the maternal teaching hospital in Erbil city. Thirty cases of Molar Pregnancy diagnosed, 15 of them were complete and the others were partial mole. All the samples studied histologically using H&E and some of special stains including: PAS stain, Congo red, and Trichrom, to describe the morphological differences between the two types of mole. Also immunohistological P57 stain was used in this study to confirm the type of mole.Results: The study result shows the morphological variation between complete and partial hydatidiform through using the routine H&E stain and special stains. The complete hydatidiform mole sections showed vesicular swelling of chorionic villi and circumferential trophoblastic hyperplasia, the trophoblastic proliferation grade varying in complete samples, most samples showed grade II (46.6%) of trophoblastic proliferation, while few of samples showed grade III (13.3%). The cases of partial hydatidiform mole showed scattered hydropic villi with irregular scalloped villous outlines and mild trophoblastic hyperplasia, trophoblastic distribution elucidate that the majority (60%) of samples show zonal distribution and high percentage (73.3%) of focal trophoblastic proliferation. The vessels in the villous stroma of most of partial molar samples (80%) was obviously seen also the cistern appear clearly in 73.33% of the samples and all partial molar pregnancy samples showed presence of fetal part in contrast to complete mole. The PAS stain show no different between the two types of molar pregnancy samples while the Congo red stained the partial molar samples intensely comparing with complete samples opposite to the trichrome stain which showed highly color intensity in complete than in partial samples. In this study the most important noticed results was high percentage (26.66) of positive result of P57 in complete diagnosed sample by routine way. Conclusion: The special stains can be helpful in diagnosis of hydatidiform mole and The study of p57 immunohistochemistry stain indicate present of misread in routine diagnoses of complete hydatidiform due to mimic morphological characters.Keywords: Molar pregnancy, Hydatidiform mole, Special stains, Complete mole, Partial mole

خلفية الدراسة: الحمل العنقودي هو شكل غير طبيعي من اشكال الحمل الناتجة من بويضة مخصبة ليس لها القدرة في تكوين جنين واتمام فترة الحمل . و يعتبر الحمل العنقودي احد اشكال الامراض الارومية (ورم غير سرطاني ) للحمل ،حيث تنمو المشيمة لتكون مجموعة اكياس تشبه الحويصلات و كتل منتفخة من الزغابات المشيمية تشبه عناقيد العنب. يحدث الحمل العنقودي عندما لاتحتوي البيويضة المخصبة على نواة الام الاصلية و يستند تشخيص هذا النوع من الحمل على التغيرات النسيجية للخزع ( العينات النسيجية) التي يحدثها الحمل العنقودي من تضخم و انتشار للحويصلات الزغبية بالاضافة الى وجود او عدم وجود الانسجة الجنينية . يعتبر وجود الانسجة الجنينية اساس التشخيص و التميز بين نوعي الحمل العنقودي . حيث ينقسم الحمل العنقودي اعتمادا على وجود او عدم وجود الانسجة الجنينية الى نوعين ، الحمل العنقودي الكامل والذي لا يحتوي على انسجة مشيمة سليمة بتاتا و لايحتوي على جنين ايضا . و الحمل العنقودي الجزئي الذي يتميز بوجود القليل من الانسجة المشيمية بالاضافة الى انسجة الجنين.اهداف الدراسة: التشخيص النسيجي الروتيني للعينات يعتمد على صبغة الهيماتوكسلين – ايوسين لهذا صممت الدراسة للعثور على اوجه التشابه و الاختلاف بين نوعي الحمل العنقودي بأستخدام اصباغ نسيجية خاصة .المرضى والطرائق: اجريت الدراسة في المستشفى التعليمية للولادة في مدينة اربيل ،تم استخدام 30 حالة مشخصة من حالات الحمل العنقودي تضمنت 15 حالة حمل عنقودي كامل و 15 حمل عنقودي جزئي . جميع العينات تم دراسة مظهرها و صفاتها النسيجية بأستخدام الصبغة الروتينية و صبغات نسيجية خاصة بالاضافة الى صبغة مناعية خاصة لتشخيص الدقيق للحمل العنقودي Immunohistological stain P57.النتائج: اظهرت نتائج الداسة الاختلافات المورفولوجية ( الشكلية ) بين نوعي الحمل العنقودي الكامل و الجزيئي من حيث طريقة الانتشار و التضخم و فرط التنسج الارومي و انتظام و عدم انتظام الحواف النسيجية و تواجد الانسجة الجنينية . اظهرت النتائج ان معظم الانتشار و فرط التنسج الارومي لعينات الحمل العنقودي الكامل كان من النوع الثاني 46.6% في حين ان النوع الثالث كان اقل درجة انتشار بين العينات 13.3% . اما الحمل العنقودي الجزئي فقد اتسم بوجود زغابات مائية مبعثرة غير منتظمة الحواف كانت معظمها 60% zonal distribution and 73.3%focal trophoblastic proliferation .اما الصبغات الخاصة فقد اظهرت تباين في شدة تصبيغ العينات النسيجية ، حيث اظهرت النتائج ان صبغة PAS تتشابه في عملها مع الصبغة الروتينية المستخدمة في التشخيص على عكس صبغة كونجو الحمراء التي اظهرت شدة تصبغ واضحة لعينات الحمل العنقودي الجزئي مقارنة بشدة التصبغ لعينات الحمل العنقودي الكامل وهذه النتيجة مخالفة لنتائج التصبغ بصبغة الترايكروم التي اظهرت النتائج شدة تصبيغها لعينات الحمل العنقودي الكامل مقارنة بتصبغ عينات الحمل العنقودي الجزئي . ان اهم النتائج التي توصل اليها البحث هي النسبة العالية للتشخيص الخاطيء لنوع الحمل العنقودي بالطريقة الروتينية المتبعة بالمستشفى ، حيث اشارت نتائج الكشف الدقيق لنوع الحمل العنقودي بأستعمال الصبغة النسيجية المناعية الخاصة وجود نسبة 26.66% حمل عنقودي جزئي بين عينات الحمل العنقودي الكامل Imminohistochemical stain P57 المشخص بالطريقة الروتينية . الاستنتاجات : تتلخص نتائج البحث بأن الصبغات النسيجية الخاصة قد تكون مفيدة في تشخيص نوع الحمل العنقودي الا ان الصبغة المناعية هي افضل طريقة لتجنب الاخطاء الناتجة عن التشابهات او التماثلات الشكلية لنوعي الحمل العنقودي لهذا تنصح الدراسة P47 بأعتماد الصبغة المناعية لتشخيص الحمل العنقودي في جميع المستشفيات المختصة بالحمل و الرعاية بدل الصبغة الروتينية لتجنب الاخطاء.

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