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Molecular Diagnosis of Gestational Trophoblastic Disease

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Part of the book series: Current Clinical Pathology ((CCPATH))

Abstract

Among gestational trophoblastic disorders, hydatidiform moles are the most common in the daily practice of gynecological pathology and frequently diagnostically challenging. While histological diagnosis of well-developed complete hydatidiform mole is generally reliable (see Chaps. 5 and 6), an early evacuated complete mole often presents with minimal histological abnormalities and is easily mistaken as a hydropic abortus or a normal pregnancy by both clinicians and pathologists (Adv Anat Pathol 12(3):116-25, 2005). Partial hydatidiform moles have been proven the most diagnostically difficult. At present time and even with available ancillary studies, pathologists cannot reliably classify a partial mole from its many mimics with both under- and over-diagnosis in a significant percentage of the cases.

This chapter is an update based on Expert Rev. Mol. Diag. 10(8), 1023–1034 (2010) with permission from Expert Reviews Ltd.

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References

  1. Hui P, Martel M, Parkash V. Gestational trophoblastic diseases: recent advances in histopathologic diagnosis and related genetic aspects. Adv Anat Pathol. 2005; 12(3):116–25.

    Article  PubMed  Google Scholar 

  2. Berkowitz RS, Goldstein DP. Clinical practice. Molar pregnancy. N Engl J Med. 2009;360(16):1639–45.

    Article  PubMed  CAS  Google Scholar 

  3. Genest DR. Partial hydatidiform mole: clinicopathological features, differential diagnosis, ploidy and molecular studies, and gold standards for diagnosis. Int J Gynecol Pathol. 2001;20(4):315–22.

    Article  PubMed  CAS  Google Scholar 

  4. Feltmate CM, Growdon WB, Wolfberg AJ, Goldstein DP, Genest DR, Chinchilla ME, et al. Clinical characteristics of persistent gestational trophoblastic neoplasia after partial hydatidiform molar pregnancy. J Reprod Med. 2006;51(11):902–6.

    PubMed  Google Scholar 

  5. Fukunaga M, Katabuchi H, Nagasaka T, Mikami Y, Minamiguchi S, Lage JM. Interobserver and intraobserver variability in the diagnosis of hydatidiform mole. Am J Surg Pathol. 2005;29(7):942–7.

    Article  PubMed  Google Scholar 

  6. Howat AJ, Beck S, Fox H, Harris SC, Hill AS, Nicholson CM, et al. Can histopathologists reliably diagnose molar pregnancy? J Clin Pathol. 1993; 46(7):599–602. PMCID: 501384.

    Google Scholar 

  7. Javey H, Borazjani G, Behmard S, Langley FA. Discrepancies in the histological diagnosis of hydatidiform mole. Br J Obstet Gynaecol. 1979;86(6): 480–3.

    Article  PubMed  CAS  Google Scholar 

  8. Kajii T, Ohama K. Androgenetic origin of hydatidiform mole. Nature. 1977;268(5621):633–4.

    Article  PubMed  CAS  Google Scholar 

  9. Bifulco C, Johnson C, Hao L, Kermalli H, Bell S, Hui P. Genotypic analysis of hydatidiform mole: an accurate and practical method of diagnosis. Am J Surg Pathol. 2008;32(3):445–51.

    Article  PubMed  Google Scholar 

  10. McConnell TG, Murphy KM, Hafez M, Vang R, Ronnett BM. Diagnosis and subclassification of ­hydatidiform moles using p57 immunohistochemistry and molecular genotyping: validation and prospective analysis in routine and consultation practice settings with development of an algorithmic approach. Am J Surg Pathol. 2009;33(6):805–17.

    Article  PubMed  Google Scholar 

  11. Hui P. Molecular diagnosis of gestational trophoblastic disease. Expert Rev Mol Diagn. 2010;10(8): 1023–34.

    Article  PubMed  CAS  Google Scholar 

  12. Lipata F, Parkash V, Talmor M, Bell S, Chen S, Maric V, et al. Precise DNA genotyping diagnosis of hydatidiform mole. Obstet Gynecol. 2010;115(4):784–94.

    Article  PubMed  Google Scholar 

  13. Buza N, Hui P. Gestational trophoblastic disease: histopathological diagnosis in the molecular era. Diagnostic histopathology. In Press.

    Google Scholar 

  14. Szulman AE, Surti U. The syndromes of hydatidiform mole. I. Cytogenetic and morphologic correlations. Am J Obstet Gynecol. 1978;131(6):665–71.

    PubMed  CAS  Google Scholar 

  15. Szulman AE. Syndromes of hydatidiform moles. Partial vs. complete. J Reprod Med. 1984;29(11): 788–91.

    PubMed  CAS  Google Scholar 

  16. Jacobs PA, Angell RR, Buchanan IM, Hassold TJ, Matsuyama AM, Manuel B. The origin of human triploids. Ann Hum Genet. 1978;42(1):49–57.

    Article  PubMed  CAS  Google Scholar 

  17. Jacobs PA, Szulman AE, Funkhouser J, Matsuura JS, Wilson CC. Human triploidy: relationship between parental origin of the additional haploid complement and development of partial hydatidiform mole. Ann Hum Genet. 1982;46(Pt 3):223–31.

    Article  PubMed  CAS  Google Scholar 

  18. Fisher RA, Khatoon R, Paradinas FJ, Roberts AP, Newlands ES. Repetitive complete hydatidiform mole can be biparental in origin and either male or female. Hum Reprod. 2000;15(3):594–8.

    Article  PubMed  CAS  Google Scholar 

  19. Helwani MN, Seoud M, Zahed L, Zaatari G, Khalil A, Slim R. A familial case of recurrent hydatidiform molar pregnancies with biparental genomic contribution. Hum Genet. 1999;105(1–2):112–5.

    Article  PubMed  CAS  Google Scholar 

  20. Hayward BE, De Vos M, Talati N, Abdollahi MR, Taylor GR, Meyer E, et al. Genetic and epigenetic analysis of recurrent hydatidiform mole. Hum Mutat. 2009;30(5):E629–39.

    Article  PubMed  Google Scholar 

  21. Van den Veyver IB, Al-Hussaini TK. Biparental hydatidiform moles: a maternal effect mutation affecting imprinting in the offspring. Hum Reprod Update. 2006;12(3):233–42.

    Article  PubMed  Google Scholar 

  22. Hodges MD, Rees HC, Seckl MJ, Newlands ES, Fisher RA. Genetic refinement and physical mapping of a biparental complete hydatidiform mole locus on chromosome 19q13.4. J Med Genet. 2003;40(8):e95. PMCID: 1735575.

    Google Scholar 

  23. Kajii T, Ferrier A, Niikawa N, Takahara H, Ohama K, Avirachan S. Anatomic and chromosomal anomalies in 639 spontaneous abortuses. Hum Genet. 1980;55(1):87–98.

    Article  PubMed  CAS  Google Scholar 

  24. Wake N, Fujino T, Hoshi S, Shinkai N, Sakai K, Kato H, et al. The propensity to malignancy of dispermic heterozygous moles. Placenta. 1987;8(3):319–26.

    Article  PubMed  CAS  Google Scholar 

  25. Wake N, Seki T, Fujita H, Okubo H, Sakai K, Okuyama K, et al. Malignant potential of homozygous and heterozygous complete moles. Cancer Res. 1984;44(3):1226–30.

    PubMed  CAS  Google Scholar 

  26. Davis JR, Surwit EA, Garay JP, Fortier KJ. Sex assignment in gestational trophoblastic neoplasia. Am J Obstet Gynecol. 1984;148(6):722–5.

    PubMed  CAS  Google Scholar 

  27. Fisher RA, Lawler SD. Heterozygous complete hydatidiform moles: do they have a worse prognosis than homozygous complete moles? Lancet. 1984; 2(8393):51.

    Article  PubMed  CAS  Google Scholar 

  28. Baasanjav B, Usui H, Kihara M, Kaku H, Nakada E, Tate S, et al. The risk of post-molar gestational trophoblastic neoplasia is higher in heterozygous than in homozygous complete hydatidiform moles. Hum Reprod. 2010;25(5):1183–91.

    Article  PubMed  CAS  Google Scholar 

  29. Genest DR, Ruiz RE, Weremowicz S, Berkowitz RS, Goldstein DP, Dorfman DM. Do nontriploid partial hydatidiform moles exist? A histologic and flow cytometric reevaluation of nontriploid specimens. J Reprod Med. 2002;47(5):363–8.

    PubMed  Google Scholar 

  30. Redline RW, Hassold T, Zaragoza MV. Prevalence of the partial molar phenotype in triploidy of maternal and paternal origin. Hum Pathol. 1998;29(5): 505–11.

    Article  PubMed  CAS  Google Scholar 

  31. Uchida IA, Freeman VC. Triploidy and chromosomes. Am J Obstet Gynecol. 1985;151(1):65–9.

    PubMed  CAS  Google Scholar 

  32. Lage JM, Mark SD, Roberts DJ, Goldstein DP, Bernstein MR, Berkowitz RS. A flow cytometric study of 137 fresh hydropic placentas: correlation between types of hydatidiform moles and nuclear DNA ploidy. Obstet Gynecol. 1992;79(3):403–10.

    Article  PubMed  CAS  Google Scholar 

  33. Lage JM, Bagg A. Hydatidiform moles: DNA flow cytometry, image analysis and selected topics in molecular biology. Histopathology. 1996;28(4): 379–82.

    Article  PubMed  CAS  Google Scholar 

  34. Lage JM, Popek EJ. The role of DNA flow cytometry in evaluation of partial and complete hydatidiform moles and hydropic abortions. Semin Diagn Pathol. 1993;10(3):267–74.

    PubMed  CAS  Google Scholar 

  35. Gschwendtner A, Neher A, Kreczy A, Muller-Holzner E, Volgger B, Mairinger T. DNA ploidy determination of early molar pregnancies by image analysis: comparison to histologic classification. Arch Pathol Lab Med. 1998;122(11):1000–4.

    PubMed  CAS  Google Scholar 

  36. Zaragoza MV, Surti U, Redline RW, Millie E, Chakravarti A, Hassold TJ. Parental origin and phenotype of triploidy in spontaneous abortions: predominance of diandry and association with the partial hydatidiform mole. Am J Hum Genet. 2000;66(6): 1807–20. PMCID: 1378061.

    Google Scholar 

  37. Esteban JM, Sheibani K, Owens M, Joyce J, Bailey A, Battifora H. Effects of various fixatives and fixation conditions on DNA ploidy analysis. A need for strict internal DNA standards. Am J Clin Pathol. 1991; 95(4):460–6.

    PubMed  CAS  Google Scholar 

  38. Cheville JC, Greiner T, Robinson RA, Benda JA. Ploidy analysis by flow cytometry and fluorescence in situ hybridization in hydropic placentas and gestational trophoblastic disease. Hum Pathol. 1995;26(7): 753–7.

    Article  PubMed  CAS  Google Scholar 

  39. Yver M, Carles D, Bloch B, Bioulac-Sage P. Martin Negrier ML. Determination of DNA ploidy by fluorescence in situ hybridization (FISH) in hydatidiform moles: evaluation of FISH on isolated nuclei. Hum Pathol. 2004;35(6):752–8.

    Article  PubMed  CAS  Google Scholar 

  40. Maggiori MS, Peres LC. Morphological, immunohistochemical and chromosome in situ hybridization in the differential diagnosis of Hydatidiform Mole and Hydropic Abortion. Eur J Obstet Gynecol Reprod Biol. 2007;135(2):170–6.

    Article  PubMed  Google Scholar 

  41. Lescoat D, Jouan H, Loeuillet-Olivo L, Le Calve M. Fluorescent in situ hybridization (FISH) on paraffin-embedded placental tissues as an adjunct for understanding the etiology of early spontaneous abortion. Prenat Diagn. 2005;25(4):314–7.

    Article  PubMed  CAS  Google Scholar 

  42. Surti U, Szulman AE, O’Brien S. Complete (classic) hydatidiform mole with 46, XY karyotype of paternal origin. Hum Genet. 1979;51(2):153–5.

    Article  PubMed  CAS  Google Scholar 

  43. Ohama K, Kajii T, Okamoto E, Fukuda Y, Imaizumi K, Tsukahara M, et al. Dispermic origin of XY hydatidiform moles. Nature. 1981;292(5823):551–2.

    Article  PubMed  CAS  Google Scholar 

  44. Ohama K, Okamoto E, Nomura K, Fujiwara A, Fukuda Y. Genetic studies of hydatidiform mole with 46, XY karyotype (author’s transl). Nippon Sanka Fujinka Gakkai Zasshi. 1981;33(10):1664–8.

    PubMed  CAS  Google Scholar 

  45. Fisher RA, Povey S, Lawler SD, Martin CA, Abeliovich D. The human chorionic gonadotrophin alpha subunit gene in gestational trophoblastic disease. 1. Restriction fragment length polymorphisms in hydatidiform moles. Dis Markers. 1987;5(4):237–45.

    Google Scholar 

  46. Ko TM, Hsieh CY, Ho HN, Hsieh FJ, Lee TY. Restriction fragment length polymorphism analysis to study the genetic origin of complete hydatidiform mole. Am J Obstet Gynecol. 1991;164(3):901–6.

    PubMed  CAS  Google Scholar 

  47. Wallace DC, Surti U, Adams CW, Szulman AE. Complete moles have paternal chromosomes but maternal mitochondrial DNA. Hum Genet. 1982; 61(2):145–7.

    Article  PubMed  CAS  Google Scholar 

  48. Lawler SD, Pickthall VJ, Fisher RA, Povey S, Evans MW, Szulman AE. Genetic studies of complete and partial hydatidiform moles. Lancet. 1979;2(8142):580.

    Article  PubMed  CAS  Google Scholar 

  49. Fan JB, Surti U, Taillon-Miller P, Hsie L, Kennedy GC, Hoffner L, et al. Paternal origins of complete hydatidiform moles proven by whole genome single-nucleotide polymorphism haplotyping. Genomics. 2002;79(1):58–62.

    Article  PubMed  CAS  Google Scholar 

  50. Zhivotovsky LA, Bennett L, Bowcock AM, Feldman MW. Human population expansion and microsatellite variation. Mol Biol Evol. 2000;17(5):757–67.

    PubMed  CAS  Google Scholar 

  51. Collins PJ, Hennessy LK, Leibelt CS, Roby RK, Reeder DJ, Foxall PA. Developmental validation of a single-tube amplification of the 13 CODIS STR loci, D2S1338, D19S433, and amelogenin: the AmpFlSTR Identifiler PCR Amplification Kit. J Forensic Sci. 2004;49(6):1265–77.

    Article  PubMed  CAS  Google Scholar 

  52. Abeln EC, Cornelisse CJ, Dreef EJ, Kuipers-Dijkshoorn NJ, Hogendoorn PC. Molecular identification of a partial hydatidiform mole. Diagn Mol Pathol. 1997;6(1):58–63.

    Article  PubMed  CAS  Google Scholar 

  53. Bell KA, Van Deerlin V, Addya K, Clevenger CV, Van Deerlin PG, Leonard DG. Molecular genetic testing from paraffin-embedded tissue distinguishes nonmolar hydropic abortion from hydatidiform mole. Mol Diagn. 1999;4(1):11–9.

    Article  PubMed  CAS  Google Scholar 

  54. Lai CY, Chan KY, Khoo US, Ngan HY, Xue WC, Chiu PM, et al. Analysis of gestational trophoblastic disease by genotyping and chromosome in situ hybridization. Mod Pathol. 2004;17(1):40–8.

    Article  PubMed  CAS  Google Scholar 

  55. Fukuyama R, Takata M, Kudoh J, Sakai K, Tamura S, Shimizu N. DNA diagnosis of hydatidiform mole using the polymerase chain reaction. Hum Genet. 1991;87(2):216–8.

    Article  PubMed  CAS  Google Scholar 

  56. Fisher RA, Newlands ES. Rapid diagnosis and classification of hydatidiform moles with polymerase chain reaction. Am J Obstet Gynecol. 1993;168(2): 563–9.

    PubMed  CAS  Google Scholar 

  57. Popiolek DA, Yee H, Mittal K, Chiriboga L, Prinz MK, Caragine TA, et al. Multiplex short tandem repeat DNA analysis confirms the accuracy of p57(KIP2) immunostaining in the diagnosis of complete hydatidiform mole. Hum Pathol. 2006; 37(11):1426–34.

    Article  PubMed  CAS  Google Scholar 

  58. Murphy KM, McConnell TG, Hafez MJ, Vang R, Ronnett BM. Molecular genotyping of hydatidiform moles: analytic validation of a multiplex short tandem repeat assay. J Mol Diagn. 2009;11(6):598–605. PMCID: 2765760.

    Google Scholar 

  59. Van Deerlin VM, Leonard DG. Bone marrow engraftment analysis after allogeneic bone marrow transplantation. Clin Lab Med. 2000;20(1):197–225.

    PubMed  Google Scholar 

  60. Nollet F, Billiet J, Selleslag D, Criel A. Standardisation of multiplex fluorescent short tandem repeat analysis for chimerism testing. Bone Marrow Transplant. 2001;28(5):511–8.

    Article  PubMed  CAS  Google Scholar 

  61. Fisher RA, Nucci MR, Thaker HM, Weremowicz S, Genest DR, Castrillon DH. Complete hydatidiform mole retaining a chromosome 11 of maternal origin: molecular genetic analysis of a case. Mod Pathol. 2004;17(9):1155–60.

    Article  PubMed  Google Scholar 

  62. McConnell TG, Norris-Kirby A, Hagenkord JM, Ronnett BM, Murphy KM. Complete hydatidiform mole with retained maternal chromosomes 6 and 11. Am J Surg Pathol. 2009;33(9):1409–15.

    Article  PubMed  Google Scholar 

  63. Baergen RN, Kelly T, McGinniss MJ, Jones OW, Benirschke K. Complete hydatidiform mole with a coexistent embryo. Hum Pathol. 1996;27(7):731–4.

    Article  PubMed  CAS  Google Scholar 

  64. Wax JR, Pinette MG, Chard R, Blackstone J, Do Cartin A. A. Prenatal diagnosis by DNA polymorphism analysis of complete mole with coexisting twin. Am J Obstet Gynecol. 2003;188(4):1105–6.

    Article  PubMed  Google Scholar 

  65. Makrydimas G, Sebire NJ, Thornton SE, Zagorianakou N, Lolis D, Fisher RA. Complete hydatidiform mole and normal live birth: a novel case of confined placental mosaicism: case report. Hum Reprod. 2002;17(9):2459–63.

    Article  PubMed  CAS  Google Scholar 

  66. Sebire NJ, Foskett M, Paradinas FJ, Fisher RA, Francis RJ, Short D, et al. Outcome of twin pregnancies with complete hydatidiform mole and healthy co-twin. Lancet. 2002;359(9324):2165–6.

    Article  PubMed  Google Scholar 

  67. Hoffner L, Dunn J, Esposito N, Macpherson T, Surti U. P57KIP2 immunostaining and molecular cytogenetics: combined approach aids in diagnosis of morphologically challenging cases with molar phenotype and in detecting androgenetic cell lines in mosaic/chimeric conceptions. Hum Pathol. 2008;39(1):63–72.

    Article  PubMed  CAS  Google Scholar 

  68. Gupta N, Mittal S, Misra R, Vimala N, Das AK. Placental site trophoblastic tumor originating in a tubal ectopic pregnancy. Eur J Obstet Gynecol Reprod Biol. 2006;129(1):92–4.

    Article  PubMed  Google Scholar 

  69. Su YN, Cheng WF, Chen CA, Lin TY, Hsieh FJ, Cheng SP, et al. Pregnancy with primary tubal placental site trophoblastic tumor–A case report and literature review. Gynecol Oncol. 1999;73(2):322–5.

    Article  PubMed  CAS  Google Scholar 

  70. Kuo KT, Chen MJ, Lin MC. Epithelioid trophoblastic tumor of the broad ligament: a case report and review of the literature. Am J Surg Pathol. 2004; 28(3):405–9.

    Article  PubMed  Google Scholar 

  71. El Hag IA, Ramesh K, Kollur SM, Salem M. Extrauterine placental site trophoblastic tumour in association with a lithopedion. Histopathology. 2002;41(5):446–9.

    Google Scholar 

  72. Xu ML, Yang B, Carcangiu ML, Hui P. Epithelioid trophoblastic tumor: comparative genomic hybridization and diagnostic DNA genotyping. Mod Pathol. 2009;22(2):232–8.

    Article  PubMed  CAS  Google Scholar 

  73. Zhao J, Xiang Y, Wan XR, Feng FZ, Cui QC, Yang XY. Molecular genetic analyses of choriocarcinoma. Placenta. 2009;30(9):816–20.

    Article  PubMed  CAS  Google Scholar 

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Hui, P. (2012). Molecular Diagnosis of Gestational Trophoblastic Disease. In: Hui, P. (eds) Gestational Trophoblastic Disease. Current Clinical Pathology. Springer, New York, NY. https://doi.org/10.1007/978-1-61779-394-3_11

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