Expression of inhibin/activin subunits, sialyl-lewis A (CA 19-9, sLea) and sialyl-Lewis X (sLex) carbohydrate antigens in a hydatidiform mole with persistent polymorphic trophoblastic hyperplasia.
The persistence of polymorphic trophoblastic hyperplasia in a hydatidiform mole is an extremely rare condition. Its early diagnosis is essential since such cases can transform into invasive tumours.


METHODS
The paraffin-embedded biopsies were routinely stained with HE. Immunohistochemical staining reactions were performed with monoclonal antibodies against inhibin-alpha, inhibin-betaA and inhibin-betaB subunits. Additional immunohistochemical reaction was performed with, Sialyl-Lewis A and Sialyl-Lewis X and glycodelin.


RESULTS
Large villi and hydatidiform villi with ranging syncyctio- and cytotrophoblasts were seen. Intervillous proliferating trophoblasts showed cell- and nuclear polymorphy with invasion of the myometrium wall. The immunohistochemistry exhibited strong positivity for inhibin-alpha, inhibin-betaA and inhibin-betaB subunits in trophoblastic tissue, while the decidua was negative. Sialyl-Lewis A and Sialyl-Lewis X showed no or minimal focal immunohistochemical reaction.


CONCLUSIONS
A complete hydatidiform mole with hyperplasia and proliferation presents a high risk of developing a persistent (eventually metastatic) trophoblastic disorder and, in up to 15% of the cases, an invasive mole. In 2.5% of the cases it can transform into a choriocarcinoma. Since the inhibin/activin subunits reacted positively with trophoblastic tissue, they might be a useful diagnostic marker for hydatidiform mole with persistence of polymorphic trophoblastic hyperplasia.
Mylonas
I
I
Ludwig-Maximilians University Munich, 1st Department of Obstetrics and Gynecology, Maistrasse 11, 80337 Munich, Germany. ioannis.mylonas@fk-i.med.uni-muenchen.de
Makovitzky
J
J
Vogel
M
M
Shabani
N
N
Jeschke
U
U
Friese
K
K
D028341:Activins / Q000378:metabolism*; D000328:Adult; D018395:CA-19-9 Antigen / Q000276:immunology*; D005260:Female; D006801:Humans; D006828:Hydatidiform Mole / Q000276:immunology / Q000378:metabolism*; D006965:Hyperplasia / Q000276:immunology / Q000378:metabolism*; D007150:Immunohistochemistry; D007265:Inhibins / Q000378:metabolism*; D009844:Oligosaccharides / Q000276:immunology*; D011247:Pregnancy; D000080506:Sialyl Lewis X Antigen; D014327:Trophoblasts / Q000276:immunology / Q000378:metabolism*
D018395:CA-19-9 Antigen; D009844:Oligosaccharides; D000080506:Sialyl Lewis X Antigen; D028341:Activins; D007265:Inhibins