الفهرس 
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Abstract
SUMMARY
Gestational trophoblastic diseases represent a spectrum of
disorders that range from benign lesions (partial moles; complete moles)
to malignant neoplasms (choriocarcinomas).The discriminationbetween
these two categories of lesions and their separation from cases of abortion
is very important because the latter has no important sequalae, while up to
10% of cases of partial moles and 30% of cases of complete moles can
develop persistent trophoblastic disease and even choriocarcinoma.
This study aims at clinical, histopathological, and DNA (ploidy)
studies followed by cellular morphometric study on cases of partial moles,
complete moles, and choriocarcinomas taking cases of abortion as a
control.
DNA studies used the CAS 200 cell image analyzer and compared their
results with the clinical and histopathological data to reach the proper
diagnosis for cases of molar pregnancy and their separaration from cases of
abortion to avoid misdiagnosis and subsequently, inadequate therapy; also
to reach a proper specific criteria for diagnosis of molar pregnancy as a
partial mole or complete mole.
Cases were collected in the period from 1992 to 1998.
Specimens included partial moles (11 cases), complete moles (16 cases),
choriocarcinoma (9 cases) and spontaneous abortion (6 cases) that were
taken as a control.
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Specimens were examined by:-
1) Hematoxyline and Eosin stain for the routine histopathological
examination;
2) Feulgen stain for quantitative DNA analysis(ploidy) using the CAS
200 cell image analyzer system;
3) Cellular morphometry was done for the examined cases to determine the
villus and the nuclear areas as an assistant measure that help to confirm
diagnosis.
Clinical studies showed that small and large for date uterine criteria
for cases of complete and partial moles respectively should not consider
specific for their diagnosis as small for date uteri were found in 27% of
partial moles, 65% of complete moles, and in 10% of cases of
choriocarcinomas. On the other hand, large for date uteri were found in the
rest percentage of cases. So, both large and small for date uteri can be
found in any case of molar pregnancy and choriocarcinoma.
Histopathological studies showed that the traditional criteria used for
diagnosis of partial moles and their differentiation from cases of complete
moles by presence of intravillus fetal blood vessels(IVFBV) in cases of
partial moles and their complete absence in cases of complete moles is not
accurate as IVFBV were not found in 27% of partial moles cases.
DNA studies showed that one case of the examined cases of
abortion (case no.2) could be considered as molar pregnancy as it showed
DI 0.95 and had diploid proliferating histogram and high PA (36% of cells
were in S- phase).
Three cases of complete moles could be considered as malignant
gestational trophoblastic disorders with malignant change as they showed
aneuploid histograms with mean DI around 2 and more than 45% of cells
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were in S- phase (cases no. 22,30,31) although these cases were in the
villus form and no malignant criteria were detected in the nucleus by their
histopathological examination.
Three of the examined cases of choriocarcinomas (cases no. 32, 38, 39)
showed much higher proliferative activity that reached 52% of cells were
in S- phase of the cell cycle while in the other examined cases,
proliferative activity was less than this level and not exceeded 45% of
cells in the S- phase. These criteria can be considered one of the
parameters used to evaluate the cases with poor prognosis as supported
by many other studies done over malignantneoplasia and found that high
proliferative activity can successfully considers a sign for poor prognosis .
These criteria for poor prognosis is an important guide for the subsequent
plan of therapy that must be recommended for these cases as regard the
type, the dose given, and the duration of the choosen chemotherapeutic
agent.
These results indicated that DNA analysis is a good diagnostic and
prognostic technique for molar pregnancy and choriocarcinoma and their
subsequent therapy. It should be added to the routine clinical,
histopathological criteria and coupled with measuring the villus area and
the nuclear area as a confirmatorymeasure for an accurate diagnosis and
propper therapy to reach the optimal cure level
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