MRI of the placenta - a short review.

While ultrasound is still the gold standard method of placental investigation, magnetic resonance imaging (MRI) has certain benefits. In advanced gestational age, obese women, and posterior placental location, MRI is advantageous due to the larger field of view and its multiplanar capabilities. Some pathologies are seen more clearly in MRI, such as infarctions and placental invasive disorders. The future development is towards functional placental MRI. Placental MRI has become an important complementary method for evaluation of placental anatomy and pathologies contributing to fetal problems such as intrauterine growth restriction.

[Clinical analysis of patients with lung metastasis of invasive mole before evacuation of hydatidiform mole].

OBJECTIVE: To investigate the clinical characteristics, management and outcome of patients with lung metastasis of invasive mole (IM) before evacuation of hydatidiform mole (HM). METHODS: Clinical data of patients with hydatidiform mole (HM) and lung metastasis of IM who were diagnosed and treated at Peking Union Medical College Hospital from Jan 2004 to Jan 2006 were analyzed retrospectively. Firstly, clinical characteristics of patients with lung metastasis of IM before evacuation of HM (positive group) were compared with that of patients without lung metastasis before evacuation of HM (negative group); secondly, management and outcome of patients with lung metastasis of IM before evacuation of HM were compared with that of patients as lung metastasis of IM diagnosed in postevacuation follow-up of HM (control group). RESULTS: A total of 37 cases with HM underwent CT scan of the chest before evacuation, 11 cases of which were diagnosed as lung metastasis, accounting for 30%. Compared with negative group, significant increases in positive group were found in gestational age of week [(15.0 +/- 4.0) versus (10.0 +/- 2.5) weeks, P = 0.026], and proportion of complete HM (91% versus 50%, P = 0.027). Between positive group and negative group, no significant differences were found in age, uterine size greater than expected for gestational age, large theca lutein cyst and pre-evacuation serum human chorionic gonadotropin-beta subunit (beta-hCG) level (P > 0.05). Compared with control group, significant decrease in positive group was found in the interval from first evacuation of HM to resolution of serum beta-hCG level, (83 +/- 18) days versus (126 +/- 31) days (P < 0.01). Also, no statistically significant differences between positive group and control group were noted in the complete resolution rate achieved, the average courses of resolution of serum beta-hCG level and disappearance or marked absorption of lung metastasis needed, and the total chemotherapy courses (P > 0.05). CONCLUSIONS: Once HM is diagnosed, evacuation should be performed as soon as possible, the later the evacuation begins, the higher the risks of lung metastasis and chemotherapy are. It is not necessary to worry about lung metastasis before evacuation of HM, the outcome of post-chemotherapy is very good.

[Sensitivity, specificity, predictive positive and negative value of the main clinical signs and symptoms of hydatiform mole]. / Sensibilità, specificità, valore predittivo positivo e negativo dei principali segni clinici e sintomi della mola idatidea.

AIM: Especially in the first weeks of pregnancy, complete and partial hydatiform moles are not easily detected by sonography, symptoms and clinical signs. Due to the rarity of moles, it is possible that they may be confused with abortive pregnancies until the pathological examination. The aim of this study is to identify the sensitivity, specificity, predictive positive and negative value of the main symptoms and clinical signs of molar pregnancies. METHODS: Thirteen molar pregnancies have been detected after pathological examination from January 2003 to July 2005 in Perugia. Their main clinical signs and symptoms are compared with those recorded in 288 abortive pregnancies, 56 ectopic pregnancies and 27 Hyperemesis gravidarum, observed in the same period. RESULTS: Vaginal bleeding and pelvic pain are the most sensitive symptoms and have the highest predictive negative values. The size of the uterus greater for date is the most specific sign. Pelvic pain with hyperemesis, and uterus size greater for date have the highest predictive positive values, but the lowest sensitivity. CONCLUSIONS: A mole should be excluded in patients with hyperemesis and pelvic pain, and in patients with uterus size greater for date. In the first case, a hyperemesis gravidarum may be diagnosed and, in the second one, a twin pregnancy may be confirmed with a sonographic scan.

Cell proiferative actitiy and mutation of P53 suppressor gene in human gestational trophoblastic disease

Cell proliferative activity and the over accumulation of P53 suppressor gene were evaluated in 26 cases of gestational trophoblastic disease and five cases with normal placentae. Formalin-fixed, paraffin-embedded histological sections were used for immunohistochemistry, utilizing the avidin-biotin-peroxidase technique and antibodies to PCNA (proliferative cell nuclear antigen) and to P53 (product of suppressor gene). Positive reactions for PCNA were graded from 1+ to 3+ (1+ - less than 10 per cent of cells; 2+ - 10 - 50 per cent ; 3+ - more than 50 per cent ). Eight of 10 cases of choriocaricinoma (80 per cent ) showed moderate to strong reactivity for PCNA (2+ and 3+). All 9 cases with hydatidiform mole and 6 of 7 cases with partial mole also demonstrated 2+ and 3+ reactions for PCNA. There was minimal or no PCNA straining in the trophoblastic cells of normal placentae. Five of 10 cases with choriocarcinoma (50 per cent ) exhibited P53 overaccumulattion as did 7 of 9 cases with hydatidiform mole (78 per cent ). In hydatidiform moles, P53 staining was limited to the areas of trophoblastic proliferation separate from chorionic villi. None of the partial moles or normal placentae showed P53 overaccumlation. It is concluded that the cell proliferative activity of choriocarcinomas as well as complete and partial hydatidiform moles are comparable. On the other hand, the mutation of P53 suppressor gene, as demonstrated by the overaccumulation of P53 protein, is seen only in true trophoblastic neoplasms, namely choriocarcinomas and hydatidiform moles.

Mola y preeclampsia: una presentación clínica atípica / Mola and preeclampsia: an atypical clinical presentation

Se presenta un caso clínico de mola invasora y preeclampsia, la cual tuvo una presentación atípica, involucrando, por lo difícil del diagnóstico inicial, a los servicios de medicina interna y ginecología-obstetricia. Se analiza el caso, su fisiopatología y su adecuado tratamiento