title: Prognostic value of trophoblastic proliferation in complete hydatidiform moles in predicting persistent disease.
abstract: The clinical outcome of patients with complete hydatidiform moles (CHM) is variable. The correlation between trophoblastic proliferation and development of persistent disease was evaluated. A hundred and fifty-one cases with the initial diagnosis of CHM were re-evaluated histopathologically. The need for chemotherapy and occurrence of metastatic disease was correlated with the histologic grade using a three-level score. Twelve out of 151 cases were re-evaluated as hydropic abortion, partial moles, or were insufficient for morphologic examination, representing a diagnostic agreement of 92%. A total of 63.4% of the CHM presented with low trophoblastic proliferation with focal areas of slight hyperplasia (grade 1), and 23.7% with moderate proliferation with slight anaplasia and medium-sized sheets of free trophoblast in between the villies (grade 2). In all, 12.9% of the cases showed marked hyperplasia with marked anaplasia and involvement of nearly all villies, as well as a large amount of intervillous trophoblastic sheets (grade 3). Twenty-six of the CHM (19%) required chemotherapy. Grade 3, on histology, showed a positive correlation with the necessity of chemotherapy (p=0.04), but not with the occurrence of metastatic disease. Histomorphology might predict the risk of persistent disease, indicating the necessity for closer a follow-up, but further studies are required.
authors.affiliation: Institute of Pathology, Division of Perinatal and Gynecologic Pathology, Leipzig University, Liebigstrasse 26, Leipzig D-04103, Germany. hornl@medizin.uni-leipzig.de
authors.forename: L-C
authors.initials: LC
authors.lastname: Horn
authors.forename: J
authors.initials: J
authors.lastname: Kowalzik
authors.forename: K
authors.initials: K
authors.lastname: Bilek
authors.forename: C E
authors.initials: CE
authors.lastname: Richter
authors.forename: J
authors.initials: J
authors.lastname: Einenkel
mesh_terms: D000293:Adolescent; D000328:Adult; D049109:Cell Proliferation; D006063:Chorionic Gonadotropin / Q000378:metabolism; D003937:Diagnosis, Differential; D018450:Disease Progression; D005260:Female; D006801:Humans; D006828:Hydatidiform Mole / Q000175:diagnosis* / Q000473:pathology; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000473:pathology; D011247:Pregnancy; D011379:Prognosis; D014327:Trophoblasts / Q000473:pathology*
chemical_list: D006063:Chorionic Gonadotropin