Talin1 is highly expressed in the fallopian tube and chorionic villi to promote trophoblast invasion in tubal pregnancy / 南方医科大学学报

OBJECTIVE@#To investigate the expression of Talin1 in the fallopian tube and chorionic villi in patients with tubal pregnancy and its role in regulating invasion and migration of trophoblasts.@*METHODS@#Immunohistochemistry and Western blotting were used to detect the localization and expression level of Talin1 in the fallopian tube and chorionic villi in patients with tubal pregnancy and in women with normal pregnancy. In the cell experiment, HTR-8/SVneo cells was transfected with Talin1 siRNA and the changes in cell invasion and migration were assessed using scratch assay and Transwell assay. The expressions of MMP-2, MMP-9, N-cadherin and Snail in the transfected cells were detected by qRT-PCR and Western blotting.@*RESULTS@#Positive expression of Talin1 was detected in both normal fallopian tube tissues and tissues from women tubal pregnancy, and its expression was localized mainly in the cytoplasm of cilia cells. The expression level of Talin1 was significantly higher in both the fallopian tube and chorionic villi in women with tubal pregnancy than in normal fallopian tube and chorionic villi samples (P < 0.01). In HTR-8/SVneo cells, transfection with Talin1 siRNA significantly inhibited cell invasion (P < 0.01) and migration (P < 0.05), down-regulated the expression of N-cadherin, MMP-2 and Snail (P < 0.05), and up-regulated the expression of MMP-9 in the cells (P < 0.05).@*CONCLUSION@#The expression of Talin1 in the fallopian tube and chorionic villi is significantly increased in women with tubal pregnancy, suggesting the association of Talin1-regulated trophoblast cell invasion with the occurrence of tubal pregnancy.

Síndrome de transfusão feto-fetal: revisão de literatura / Twin-twin transfusion syndrome: a literature review

A síndrome de transfusão feto-fetal é uma complicação das gestações gemelares monocoriônicas. Além de ocorrer comumente no segundo trimestre, apresenta elevada morbimortalidade fetal e neonatal, e taxas de incidência que variam de 10 a 15% dentre todas as gravidezes monocoriônicas. O objetivo deste estudo é realizar uma revisão de literatura a partir de levantamento bibliográfico acerca dos principais aspectos epidemiológicos, clínicos e terapêuticos da STFF. A base de dados PubMed foi consultada, uma vez que os termos de pesquisa utilizados foram "síndrome de transfusão feto-fetal", "diagnóstico" e "tratamento". Obtiveram-se sessenta e oito artigos de revisão de literatura e/ou revisão sistemática, sendo que apenas vinte e nove foram selecionados após aplicação dos critérios de elegibilidade. Em relação à fisiopatologia, a síndrome é explicada pela transferência sanguínea direta entre os fetos gemelares através de anastomoses arteriovenosas placentárias, conceitualmente determinando a existência de um feto receptor e outro doador. Embora as gestantes comumente se apresentam assintomáticas, as repercussões clínicas fetais costumam ser graves. O diagnóstico é exclusivamente ultrassonográfico e deve ser feito o mais precocemente possível, ressaltando-se a importância da detecção da corionicidade da gestação gemelar, além de acompanhamento ultrassonográfico seriado para rastreio do desenvolvimento da síndrome. Apesar de ainda não haver protocolo de tratamento bem estabelecido, a ablação dos vasos placentários a laser é tida como o padrão-ouro dentre as opções terapêuticas disponíveis. Apresenta elevada taxa de sobrevida de pelo menos um dos fetos e baixos índices de sequelas neurológicas neonatais, podendo ser realizada somente até a 26ª semana de gestação.

Twin-twin transfusion syndrome is a complication of monochorionic twin pregnancies. In addition to commonly occurring in the second trimester, it has high fetal and neonatal morbidity and mortality and incidence rates ranging from 10 to 15% among all monochorionic pregnancies. This study aims to perform a literature review based on a bibliographic survey about the main epidemiological, clinical and therapeutic aspects of TTTS. The PubMed database was consulted, as the search terms used were "twin-twin transfusion syndrome", "diagnosis", and "treatment". Sixty-eight literature review and systematic review articles were obtained, and only twenty-nine were selected after applying the eligibility criteria. About the pathophysiology, the syndrome is explained by direct blood transfer between the twin fetuses through placental arteriovenous anastomoses, determining the existence of a recipient fetus and another donor. Although pregnant women are usually asymptomatic, the clinical fetal repercussions are often severe. Diagnosis is exclusively ultrasonographic and must be made as early as possible, emphasizing the importance of detecting chorionicity in twin pregnancy, in addition to serial ultrasonographic follow-up to track the development of the syndrome. Although there is still no well-established treatment protocol, endoscopic laser ablation of vascular anastomoses is considered the gold standard among the available therapeutic options. It has a high survival rate for at least one of the fetuses and low rates of neonatal neurological sequelae and can only be performed until the 26th week of pregnancy.

Falta de evidencia de transmisión vertical y hallazgos histopatológicos en restos placentarios de pacientes con diagnóstico de Síndrome Respiratorio Agudo Severo por Coronavirus 2 (SARS-CoV-2) en Guatemala / Lack of evidence of vertical transmission and histopathological findings in placental remains of patients diagnosed with Severe Acute Respiratory Syndrome of Coronavirus 2 (SARS-CoV-2) in Guatemala

El primer caso de infección por el virus SARS-CoV-2, fue reportado en la ciudad de Wuhan, China en diciem-bre de 2019. Desde entonces la enfermedad se ha dispersado a más de 188 países, confirmándose más de 53 millones de casos a nivel mundial. El 13 de marzo de 2020 se reportó el primer caso de COVID-19 en Guatemala y, a mediados del mes de noviembre, se han reportado más de 116,000 casos, 4,000 fallecidos y 106,000 recu-perados; con una tasa de mortalidad de 23 por cada 100,000 habitantes y una letalidad del 3.4%. Hasta ahora, la literatura científica disponible abarca ciertos aspectos de salud reproductiva, mientras se continúa recopilando más información que permita conocer más de su impacto real durante el proceso infeccioso y las secuelas derivadas de éste. La presente es una revisión histopatológica de restos placentarios de tres mujeres con resultado positivo para SARS-CoV-2, ingresadas en un hospital privado de la Ciudad de Guatemala. El examen histopatológico del tejido placentario aporta información importante sobre la salud de la madre y del feto. Todos los casos revelaron signos macroscópicos y microscópicos de disfunción placentaria por mala perfusión vascular materna, con for-mación de infartos hemorrágicos y daño placentario asociado con efectos adversos en el embarazo. Agregando a esto, dos neonatos presentaron un resultado negativo para SARS-CoV-2 y uno falleció. Es de suma importancia el estudio de la placenta de madres positivas a SARS-CoV-2 para conocer el rol de esta durante el embarazo y también, indagar en la posibilidad de transmisión vertical.

The first infection caused by the SARS-CoV-2 virus, was reported in the city of Wuhan, China in December 2019. Since then, the disease has spread to more than 188 countries and territories, confirming more than 53 million cases worldwide. On March 13th 2020, the first case of COVID-19 was reported in Guatemala and by the middle of November, more than 116,000 cases have been reported, 4,000 deaths and 106,000 recovered; with a mortality rate of 23 per 100,000 inhabitants and a fatality of 3.4%. Until now, the available scientific literature covers certain aspects of reproductive health, whilst more information continues to be collected that allows us to know more about its real impact on the human body during the infectious process and the consequences derived from it. This is a histopathological report of placental tissue obtained from three women with a positive result for SARS-CoV-2, admitted to a private hospital in Guatemala City. Added to this, the histopathological examination of placental tissue obtained, provides important information about the health of the mother and fetus. All cases revealed macroscopic and microscopic signs of placental dysfunction due to poor maternal vascular perfusion, with evidence of hemorrhagic infarcts and placental damage that is associated with adverse effects in pregnancy. In addition, two newborns had a negative result for SARS-CoV-2 and one newborn died. The study of the placenta of newborns of SARS-CoV-2 positive mothers is of utmost importance to understand its role during pregnancy and also, investigate the possibility of vertical transmission..

Obstetrical Outcomes of Amniocentesis or Chorionic Villus Sampling in Dichorionic Twin Pregnancies

BACKGROUND: Under certain situations, women with twin pregnancies may be counseled to undergo invasive prenatal diagnostic testing. Chorionic villus sampling and amniocentesis are the two generally performed invasive prenatal diagnostic tests. Studies comparing procedure-related fetal loss between first-trimester chorionic villus sampling and second-trimester amniocentesis in twin pregnancies are limited. This study aimed to evaluate the procedure-related fetal loss and the obstetrical outcomes of these two procedures, chorionic villus sampling and amniocentesis in twin pregnancies. METHODS: The data from dichorionic-diamniotic twin pregnancies on which first-trimester chorionic villus sampling (n = 54) or second-trimester amniocentesis (n = 170) was performed between December 2006 and January 2017 in a single center were retrospectively analyzed. The procedure-related fetal loss was classified as loss of one or all fetuses within 4 weeks of procedure, and overall fetal loss was classified as loss of one or all fetuses during the gestation. The groups were compared with respect to the procedure-related and obstetrical outcomes. RESULTS: The difference in proportion of procedure-related fetal loss rate (1.9% for chorionic villus sampling vs. 1.8% for amniocentesis; P = 1.000) and the overall fetal loss rate (7.4% for chorionic villus sampling vs. 4.7% for amniocentesis; P = 0.489) between the two groups was not significant. The mean gestational ages at delivery were not statistically significant. CONCLUSION: Both the overall fetal loss rate and the procedure-related fetal loss rate of chorionic villus sampling and amniocentesis in dichorionic twin pregnancies had no statistical significance. Both procedures can be safely used individually.

Genetic testing of chorionic villi from abortuses during early pregnancy / 中华医学遗传学杂志

OBJECTIVE@#To explore the prevalence and characteristics of chromosomal abnormalities in abortuses during early pregnancy with single nucleotide polymorphism microarray (SNP-array).@*METHODS@#For 520 abortuses, copy number variations (CNVs) in chorionic villi were analyzed with SNP-array.@*RESULTS@#In 510 (98.1%) of the samples, the analysis was successful. Among these, 57.6% (294/510) of the samples were found to harbor clinically significant chromosomal abnormalities. 38.8% of the samples (198/510) had a normal result. 2.4% (12/510) of the samples harbored benign CNVs, and 1.2% (6/510) harbored variants of uncertain significance (VOUS). Aneuploidies, polyploidies, pathogenic CNVs and uniparental disomies (UPD) had accounted for 75.2% (221/294), 13.9% (41/294), 8.2% (24/294), and 2.7% (8/294) of the samples, respectively. 45,XO was the most common finding, which was followed by trisomy 16 and trisomy 22. 69,XXY was the most common polyploidy.@*CONCLUSION@#Chromosomal abnormalities are the main cause for early miscarriage, among which aneuploidies are most common. The prevalence of aneuploidies is significantly increased among women over 35. SNP-array analysis has the advantage of high success rate, high resolution and great accuracy, but the clinical significance of microdeletions/microduplications found by SNP-array can be difficult for interpretation.

Morphological features of the human placenta and its free chorionic villi in normal pregnancies and those with diabetes and high blood pressure: literature review / Características morfológicas de la placenta humana y sus vellosidades coriales libres en gestas normales y con diabetes e hipertensión arterial: revisión de la literatura

The most prevalent pathologies during pregnancy, such as hypertension, gestational diabetes mellitus (GDM), and intrauterine growth restriction (IUGR), can determine modifications in macro- and microscopic morphological features of the placenta and its free chorionic villi. In the fetus it may be accompanied by pathological manifestations, with the embryo's future quality of life, and even its viability, at risk. The aim of this work is to perform a review of the morphological alterations that the placenta exhibits in pregnancies with GDM. A search on the topic in the scientific literature and specialized textbooks was carried out. The terms "placenta", "diabetes mellitus gestational" and "gestational diabetes mellitus" were used to define the search. Among the morphological modifications it was found that the placental weight/fetal weight ratio is higher in GDM and is associated mainly with histological changes. The distance between maternal and fetal circulation is increased because of an increase in the chorionic villi on the surface as well as greater thickness of the syncytiotrophoblast basal membrane due to an increased type IV collagen deposition. The stroma between the villi is edematous, which modifies the metabolic and endocrinal function of these placentas. Moreover, the capillary surface is enlarged due to the phenomena of vascular neoformation and a greater penetration of these vessels within the villi. Low oxygen partial pressure (pO2) was detected, which would produce a compensatory hyperplasia of terminal chorionic villi. In GDM the placenta undergoes alterations in its formation, structure, and function. According to the review, these alterations are related to an oxygenation deficiency in the fetus and changes in the transplacental transport of nutrients and other alterations, causing fetal overgrowth by increasing their availability in addition to other consequences to the developing fetus. In the case of high blood pressure during pregnancy, this produces accelerated maturation and rapid aging of the chorionic villi, with the risk of inducing a placental abruption. In addition, placental circulation is reduced by a third, decreasing oxygen saturation in the umbilical vessels and placing the health of the fetus at risk.

Las patologías de la gestación más prevalentes, como hipertensión, diabetes mellitus gestacional (DMG) y restricción del crecimiento uterino, pueden determinar modificaciones en las características morfológicas macro y microscópicas de la placenta y sus vellosidades coriales libres,y en el feto se puede acompañar de manifestaciones patológicas, con riesgo para su calidad de vida futura, e incluso su viabilidad. El objetivo de este trabajo consiste en realizar una revisión acerca de las alteraciones morfológicas que presenta la placenta en gestaciones con DMG. Se llevó a cabo una búsqueda sobre la temática en literatura científica y libros de texto especializados. Se utilizaron los términos "placenta", "diabetes mellitus gestacional" y "gestational diabetes mellitus" para orientar la búsqueda. Entre las modificaciones morfológicas se encontró que la relación peso placentario/peso fetal está aumentado en la DMG y se asocia principalmente a cambios histológicos. La distancia entre la circulación materna y la fetal está aumentada debido a un aumento de la superficie entre las vellosidades coriales, así como al mayor grosor de la membrana basal del sincitiotrofoblasto por un depósito elevado de colágeno tipo IV. El estroma entre las vellosidades se encuentra edematoso lo que va a modificar la función metabólica y endocrina de estas placentas. También hay aumento de la superficie capilar por fenómenos de neoformación vascular y una mayor penetración de estos vasos dentro de las vellosidades. Se detectó baja presión parcial de oxígeno (pO2), que produciría una hiperplasia compensatoria de vellosidades coriónicas terminales. En la DMG la placenta experimenta alteraciones en su formación, estructura y función. Según lo revisado, estas alteraciones están relacionadas con déficit en la oxigenación del feto, cambios en el transporte transplacentario de los nutrientes y otras alteraciones, ocasionando sobrecrecimiento fetal por aumento de su disponibilidad, entre otras consecuencias al feto en desarrollo. Y en el caso de la hipertensión arterial durante la gestación produce una maduración acelerada y envejecimiento rápido de las vellosidades coriales, con el riesgo de inducir un desprendimiento prematuro de placenta. Además se reduce la circulación placentaria en un tercio, disminuyendo la saturación de oxígeno en los vasos umbilicales del, poniendo en riesgo la salud del feto.

Aspectos morfocuantitativos de las vellosidades coriales libres en gestas normales, con diabetes, hipertensión arterial y restricción del crecimiento intrauterino / Morphoquantitative characteristics of free corial vellosities in normal births, with diabetes, hypertension and restriction of intrauterine growth

Las patologías de la gestación como la hipertensión, diabetes mellitus gestacional, o restricción del crecimiento intrauterino, pueden determinar modificaciones en las características morfológicas macro y microscópicas de la placenta y sus vellosidades coriales libres, y en el feto se puede acompañar de manifestaciones patológicas, con riesgo para su calidad de vida futura, e incluso su viabilidad. El objetivo de este trabajo consistió en describir aspectos morfométricos e histológicos de las vellosidades coriales libres en gestas normales, con diabetes e hipertensión arterial. Se utilizaron 30 placentas humanas y fueron separadas, según presencia o ausencia de patologías en el embarazo, en tres grupos: Normal (N), Síndrome Hipertensivo del Embarazo (SHE), Diabetes (D) y Restricción del Crecimiento Intrauterino (RCIU). Se usó ficha para registrar peso placentario y del recién nacido Todas las muestras fueron fijadas en formalina tamponada al 10 %. De cada una fueron extraídas 5 muestras, obteniendo 25 cortes por cada placenta. Posteriormente, fueron teñidas con H&E, Azul Alcián y Tricrómico de Masson. Además, se efectuó el análisis histológico y morfométrico (ImageJ®) de las vellosidades coriales. El análisis estadístico fue realizado utilizando ANOVA. Entre los cambios morfológicos, se encontró una relación peso placentario/peso del recién nacido aumentada en la Diabetes Mellitus Gestacional asociada a cambios histológicos. No hubo cambios morfométricos significativos entre placentas N, SHE y D. Hubo un aumento en el número de vasos coriales en placentas del grupo D (P < 0,05) y de la superficie entre las vellosidades coriales. En el grupo SHE hubo aumento moderado de nudos sinciciales y presencia de fibrina en el estroma. Las placentas con Diabetes Mellitus Gestacional experimentan alteraciones histológicas, como consecuencia de cambios estructurales y funcionales. Además, el aumento de vasos sanguíneos en placentas con diabetes se produce por neoformación vascular y mayor penetración de vasos sanguíneos dentro de las vellosidades. En el caso del SHE las alteraciones placentarias se relacionan con la gravedad de la enfermedad.

Gestational pathologies such as hypertension, gestational diabetes mellitus and restriction of intrauterine growth can determine changes in the macro and microscopic morphological characteristics of the placenta and its free chorionic villi. In the fetus it can be accompanied by pathological manifestations with risk to its viability and future quality of life. The aim of this work was to describe morphometric and histological aspects of free chorionic villi in normal pregnancies associated with diabetes, hypertension and restriction of intrauterine growth. Thirty human placentas were used and were separated into three groups: Normal (N), Hypertensive Pregnancy Syndrome (SHE), Diabetes (D), and Restriction of Intrauterine Growth (RIG) according to evident pathologies or absence thereof during pregnancy. Tab was used to record placental and newborn weight. All samples were fixed in 10 % buffered formalin. From each, 5 samples were extracted, obtaining 25 cuts for each placenta. Subsequently, they were stained with H & E, Alcian Blue and Masson's Trichrome. In addition, histological and morphometric analysis (ImageJ®) of the chorion villus was carried out. Statistical analysis was performed using ANOVA. Among the morphological changes, an increased placental weight / weight ratio of the newborn was found in Gestational Diabetes Mellitus associated with histological changes. There were no significant morphometric changes between placentas N, SHE and D. There was an increase in the number of corial vessels in placentas of group D (P <0.05) and of the surface between the chorion villi. In the SHE group there was a moderate increase in syncytial nodes and presence of fibrin in the stroma. Placentas with Gestational Diabetes Mellitus experience histological alterations, as a consequence of structural and functional changes. In addition, the increase of blood vessels in placentas D is produced by vascular neoformation and increased penetration of blood vessels into the villi. In the case of SHE, placental alterations are related to the severity of the disease.

Histomorphological study of placenta in gestational diabetes mellitus / Estudio histomorfológico de la placenta en diabetes mellitus gestacional

Evidence from the literature shows that well-controlled glucose levels during pregnancy are usually associated with normal placental morphology. The aim of this study was to identify the lacental changes attributed to maternal hyperglycemia. A total of 20 placentae were selected for study from a tertiary care medical center in Makkah city, Saudi Arabia. Out of 20, 10 placentae were from patients diagnosed with GDM based on IADSPG criteria, and 10 placentae were from patients with normal pregnancies without GDM. The morphometric measurements were recorded. The mean weight of GDM placentae were more than the normal placentae. Upon histopathology, significant changes such as syncytial knots, cytotrophoblastic cell proliferation, fibrinoid necrosis, stromal fibrosis, and hyalinized villi were observed in GDM placentae. GDM produces significant morphological alterations in the placentae, which might affect the developing fetus.

La evidencia de la literatura muestra que niveles de glucosa bien controlados durante el embarazo generalmente se asocian con una morfología placentaria normal. El objetivo de este estudio fue identificar los cambios placentarios atribuidos a la hiperglucemia materna. Un total de 20 placentas fueron seleccionadas para un estudio en un centro médico de atención terciaria en la ciudad de La Meca, Arabia Saudita. De 20 placentas, 10 de estas fueron de pacientes diagnosticadas con diabetes mellitus gestacional (DMG) según los criterios de IADSPG, y 10 placentas fueron de pacientes con embarazos normales sin DMG. Las mediciones morfométricas fueron registradas. El peso medio de las placentas GDM fue mayor que la placenta normal. Tras la histopatología, se observaron cambios significativos tales como nudos sincitiales, proliferación celular citotrofoblástica, necrosis fibrinoide, fibrosis estromal y vellosidades hialinizadas en placenta con DMG. La DMG produce alteraciones morfológicas significativas en las placentas, que pueden afectar al desarrollo del feto.

Enfermedad trofoblástica gestacional / Gestational trophoblastic disease

El término enfermedad trofoblástica gestacional agrupa a un conjunto de trastornos caracterizados por una proliferación anormal de las vellosidades coriales placentarias. Las variedades más conocidas son la mola hidatiforme (completa y parcial), la mola invasora y el coriocarcinoma. Se presentan datos epidemiológicos, incluidos los factores de riesgo, una revisión sumaria de los rasgos clínicos y se enfatizan los cambios anatomopatológicos. A continuación se tratan aspectos diversos de entidades más raras como el tumor trofoblástico del sitio de implantación placentaria, y el tumor trofoblástico epiteliode. Para la estadificación se recurre a los estadios propuestos por la FIGO, aunque el uso de la tomografía con emisión de positrones, la biopsia de ganglio centinela y la quimioterapia neoadyuvante no están previstas en el esquema de la FIGO. El artículo está ilustrado con figuras a color y la bibliografía ha sido seleccionada y actualizada AU)

Caso Clínico: Mola Hidatiforme Parcial. Resolución Obstétrica / Case Report: Partial Hydatiform Mole Obstetric Resolution

INTRODUCCIÓN: La mola hidatiforme parcial es una enfermedad del tejido trofoblástico que se caracteriza por presentar sobrecrecimiento del mismo, con feto presente, sus manifestaciones tanto clínicas como de laboratorio indican que puede transformarse en tumor de características malignas. CASO CLÍNICO: Paciente de 28 años de edad de 17.1 Semanas de Gestación (SG) por fecha de última menstruación (FUM), con presencia de sangrado rojo rutilante hace 9 horas, vómitos postprandiales durante todo embarazo, niveles de hormona gonadotropina coriónica fracción B (BHCG) 90000 mUI/ml, ecografía que reporta placenta multiquística en patrón de racimo de uvas con presencia de feto vivo. EVOLUCIÓN: Paciente es sometida a un aborto terapéutico modo parto y legrado, presenta un valor de BHCG 25000 mUI/ml, se realiza evaluación periódica de BHCG, a los 15 días después del procedimiento presenta un nivel de BHCG de 470 mUI/ml, al mes presenta un valor de BHCG de 183 mUI/ml. Se optó por administrar manejo anticonceptivo mediante Drospirenona + Etinilestradiol mínimo por 6 meses, al segundo mes de BHCG disminuye a 86 mUI/ml, ecografía de control con reporte normal, a los 4 meses el valor de BHCG reportado es < 1 mUI/ml por lo cual oncología decide el alta médica definitiva. CONCLUSIONES: Según datos bibliográficos la presentación de la enfermedad es muy similar a la del caso expuesto, siendo una rara afección del tejido trofoblástico, que mediante un pronto diagnóstico y manejo, tuvo un desenlace y evolución favorable, llegando a una resolución completa de la enfermedad. (au)

BACKGROUND: The partial hydatidmole is a disease oftrophoblastic tissue characterized by trophoblastic overgrowth with a fetus present, both clinical and laboratory manifestations that indicate being able to transforminto a tumor ofmalignant characteristics. CASE REPORT A 28-year-old patient 17.1 gestation weeks, with red bleeding 9 hours ago, postprandial vomiting throughout pregnancy, BHCG 90000mUI/ml levels, ultrasound thatreports amulticystic placenta in the formof a honeycomb of bees with presence of vivid fetus. EVOLUTION: Patientis submitted to therapeutic abortion in themode of delivery and curettage presents a BHCG value of 25000 mUI/ml, a periodic evaluation of BHCG is performed, 15 days after the procedure has aBHCGlevel of 470mUI/ml, amonthlyBHCGvalue of 183 , it was decided to administer contraceptive management by means of Drospirenona + Etinilestradiol minimum for 6 months, the second month of BHCG decreases to 86 mUI/ml, control ultrasound with normal report, at 4 months the value of BHCG reported is < 1mUI/ml for which oncology decides high definitivemedical. CONCLUSIONS: According to bibliographical data the presentation of the disease is very similar to that of the exposed case, being a rare affection of the trophoblastic tissue, which through a prompt diagnosis and management had a favorable outcome and evolution, reaching a complete resolution ofthe disease.(au)

Utility of p57KIP2 and Her-2 fluorescence in situ hybridization in differentiating partial from complete hydatidiform mole

INTRODUCTION: Hydatidiform mole (HM) is an abnormal gestation characterized by significant hydropic enlargement, trophoblastic proliferation and atypia involving part or all of the chorionic villi. The diagnosis and classification of hydatidiform moles is subject to great inter-observer variability due to significant morphologic overlaps. This study aims to evaluate the utility of p57KIP2 immunohistochemistry and ploidy by Her-2 FISH in refining the diagnosis of molar tissues. METHOD: 113 and 78 molar cases were retrieved from the archives of the Histopathology Section of the Philippine General Hospital and Pathology Department of Seoul National University Hospital, respectively. TMA sections were submitted for immunohistochemical analysis for p57KIP2. Ploidy was determined by fluorescence in situ hybridization using Her-2 probe. An interrater reliability analysis was done using the Kappa statistics with 95% confidence interval. RESULTS: All 68 (100%) cases diagnosed as CH were negative for p57KIP2 staining and are diploid. Among the 54 cases of PH, only 1 (2%) is positive for p57KIP2 and is diploid. The interrater reliability between p57KIP2 and Her-2 FISH ploidy results is 0.66 (p CONCLUSION: Morphologic assessment alone may not be sufficient in problematic cases. p57KIP2 in conjunction with by Her-2 FISH are good adjuncts in the diagnosis and classification of hydatidiform mole.

Detection of chromosome aneuploidies in spontaneous abortion villus samples by quantitative fluorescence PCR / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To assess the value of quantitative fluorescence polymerase chain reaction (QF-PCR) for the detection of chromosomal aneuploidies in chorionic villus samples from early abortion.</p><p><b>METHODS</b>One hundred seventy seven specimens were collected. Genomic DNA was extracted, and aneuploidies of 8 chromosomes (13, 15, 16, 18, 21, 22, X and Y) were detected by QF-PCR analysis.</p><p><b>RESULTS</b>The QF-PCR was successful in 176 (99.4%) of the cases. All detection was completed in 48 hours. Sixty three(35.8%) cases have shown abnormal signals, which included 3 cases of trisomy 13, 3 cases of trisomy 15, 14 cases of trisomy 16, 2 cases of trisomy 18, 7 cases of trisomy 22, 3 cases of trisomy 21, 13 cases of 45,X, 1 case of 47,XXX, 2 cases of 47,XXY, 2 cases of haploidy, 11 cases of triploidy, 1 case of trisomy 16 and trisomy 22, 1 case of trisomy 21 and trisomy 22. Trisomy 16 was the most common chromosome aneuploidy (22.22%), which was followed by 45,X (20.63%), triploidy (17.46%) and trisomy 22 (11.11%).</p><p><b>CONCLUSION</b>QF-PCR is a quick and easy method for detecting chromosomal aneuploidies in chorionic villi tissue. The results can provide important information for genetic counseling for spontaneous abortions.</p>

Quantitative fluorescent polymerase chain reaction for rapid prenatal diagnosis of fetal aneuploidies in chorionic villus sampling in a single institution

OBJECTIVE: To validate quantitative fluorescent polymerase chain reaction (QF-PCR) via chorionic villus sampling (CVS) for the diagnosis of fetal aneuploidies. METHODS: We retrospectively reviewed the medical records of consecutive pregnant women who had undergone CVS at Cheil General Hospital between December 2009 and June 2014. Only cases with reported QF-PCR before long-term culture (LTC) for conventional cytogenetic analysis were included, and the results of these two methods were compared. RESULTS: A total of 383 pregnant women underwent QF-PCR and LTC via CVS during the study period and 403 CVS specimens were collected. The indications of CVS were as follows: abnormal first-trimester ultrasonographic findings, including increased fetal nuchal translucency (85.1%), advanced maternal age (6.8%), previous history of fetal anomalies (4.2%), and positive dual test results for trisomy 21 (3.9%). The results of QF-PCR via CVS were as follows: 76 (18.9%) cases were identified as trisomy 21 (36 cases), 18 (33 cases), or 13 (seven cases), and 4 (1.0%) cases were suspected to be mosaicism. All results of common autosomal trisomies by QF-PCR were consistent with those of LTC and there were no false-positive findings. Four cases suspected as mosaicism in QF-PCR were confirmed as non-mosaic trisomies of trisomy 21 (one case) or trisomy 18 (three cases) in LTC. CONCLUSION: QF-PCR via CVS has the advantage of rapid prenatal screening at an earlier stage of pregnancy for common chromosomal trisomies and thus can reduce the anxiety of parents. In particular, it can be helpful for pregnant women with increased fetal nuchal translucency or abnormal first-trimester ultrasonographic findings.

High-intensity focused ultrasound combined with hysteroscopic resection to treat retained placenta accreta

We present a case of retained placenta accreta treated by high-intensity focused ultrasound (HIFU) ablation followed by hysteroscopic resection. The patient was diagnosed as submucosal myoma based on ultrasonography in local clinic. Pathologic examination of several pieces of tumor mass from the hysteroscopic procedure revealed necrotic chorionic villi with calcification. HIFU was performed using an ultrasound-guided HIFU tumor therapeutic system. The ultrasound machine had been used for real-time monitoring of the HIFU procedure. After HIFU treatment, no additional vaginal bleeding or complications were observed. A hysteroscopic resection was performed to remove ablated placental tissue 7 days later. No abnormal vaginal bleeding or discharge was seen after the procedure. The patient was stable postoperatively. We proposed HIFU and applied additional hysteroscopic resection for a safe and effective method for treating retained placenta accreta to prevent complications from the remaining placental tissue and to improve fertility options.

High-intensity focused ultrasound combined with hysteroscopic resection to treat retained placenta accreta

We present a case of retained placenta accreta treated by high-intensity focused ultrasound (HIFU) ablation followed by hysteroscopic resection. The patient was diagnosed as submucosal myoma based on ultrasonography in local clinic. Pathologic examination of several pieces of tumor mass from the hysteroscopic procedure revealed necrotic chorionic villi with calcification. HIFU was performed using an ultrasound-guided HIFU tumor therapeutic system. The ultrasound machine had been used for real-time monitoring of the HIFU procedure. After HIFU treatment, no additional vaginal bleeding or complications were observed. A hysteroscopic resection was performed to remove ablated placental tissue 7 days later. No abnormal vaginal bleeding or discharge was seen after the procedure. The patient was stable postoperatively. We proposed HIFU and applied additional hysteroscopic resection for a safe and effective method for treating retained placenta accreta to prevent complications from the remaining placental tissue and to improve fertility options.

Pulmonary Placental Transmogrification Presenting as a Small Lung Nodule / 대한내과학회지

Pulmonary placental transmogrification (PT) is a rare lung disease that takes on the histologic appearance of placental chorionic villi. We herein report a case of PT in a 66-year-old woman who presented with a single nodule on chest radiography performed during a routine health examination. She had no complaints of any symptoms. Chest radiography showed a focal ill-defined nodular opacity in the right lower lobe; chest computed tomography revealed a 17-mm lobulated, focal irregular mass with fissural retraction in the right lower lobe, suggestive of lung cancer. Pathology of a percutaneous needle aspiration biopsy revealed papillary structures resembling placental villi. These were lined by cytotrophoblast-like cells and syncytiotrophoblasts. This characteristic pathologic finding led to a diagnosis of PT. PT of the lung is found mainly in bullous or cystic lesions. However, this patient presented with a single nodule on chest radiography.

Caracterização das proteínas caveolinas -1 e -2 na placenta de conceptos bovinos clonados transgênicos / Caracterization of caveolin -1 and -2 proteins in cloned and transgenic placenta of cattle

A utilização da transgenia com a proteína fluorescente verde (GFP) como marcador de células de origem fetal nas placentas de clones bovinos servirá de modelo inédito para estudo morfofisiológico e imunológico da interação materno-fetal, visto que possibilitará o seu mapeamento, diferenciando as células fetais das maternas. Tal modelo terá aplicação direta, principalmente porque estes são animais que apresentam problemas em relação ao seu desenvolvimento. Com o auxílio deste modelo, pretende-se verificar o transporte de substâncias entre a mãe e o feto via endocitose, pela imunolocalização das proteínas chamadas de caveolinas. Para tanto foram utilizados 06 bovinos clonados e 30 bovinos de inseminação artificial (IA) com idade até 90 dias de gestação, os quais tiveram seu desenvolvimento interrompido mediante abate humanitário das receptoras e ovariosalpingohisterectomia, com posterior recuperação do útero gestante. Foram coletados os placentônios e o cório. Uma parte das amostras foi recortada e fixada, por imersão, em solução de parafolmaldeído a 4% ou formoldeído a 10% em tampão fosfato de sódio (PBS) a 0,1M pH 7.4, solução de Zamboni (4% de paraformoldeído, 15% de ácido pícrico, em tampão fosfato de sódio a 0,1M pH 7.4), metacarn (60% de metanol, 30% de clorofórmio, e 10% de ácido acético glacial), para verificação da morfologia e realização de imuno-histoquímica para as proteínas caveolinas -1 e -2 (CAV -1 e CAV-2)...

The transgenic application of green fluorescent protein (GFP) as fetal cell marker on cattle cloned placenta could provide an exclusive model for studying the morphologic and immunologic maternal-fetal interactions, providing information about its mapping, distinguishing the fetal from maternal cells. This model will have direct application, mainly because these animals present problems during its development. With this model's support, we intend to verify the substances transport between mother and fetus during endocytosis, through the immunolocalization of protein named caveolae. For these, we used 06 cloned bovine and 30 cattle samples of artificial insemination (AI) with 90 days of pregnancy, which had been their development interrupted by humanitarian slaughter of the recipient and recovery of the pregnant uterus. We collected the placentome and the chorion. A part of the samples was cut and fixed, by immersion, on a solution containing 4% of parafomaldehyde or 10% of formaldehyde on a sodium phosphate buffer (PBS), at 0,1M pH 7.4, Zamboni solution (4% of paraformaldehyde, 15% of picric acid, on sodium phosphate buffer 0,1M pH 7.4), metacarn (60% of metanol, 30% of chloroform, and 10% glacial acetic acid), for morphologic and immunohistochemistry verification for caveolinas proteins -1 and -2 (CAV -1 and CAV- 2). The caveolins -1 were found in fetal and maternal villi, but its strongest staining was observed in the endometrial stroma. The caveolins -2 had positive staining in trophoblast and chorioallantoic membrane, and specifically in giant trophoblastic binucleated cell. Therefore the results were compared between cloned cattle and from AI or natural mating, for assisting on detection of the reason of many placental alterations, embryonic losses, spontaneous abortion, post-natal mortality and large offspring syndrome on laboratory-manipulated animals. The result suggests that the proteins caveolins -1 and -2 (CAV-1 and CAV-2)...

Adherent placenta Previa; outcome of abnormally

Abnormally adherent placenta is a condition in which all of part of the placenta is adherent to the uterine wall because of myometrial invasion by chorionic villi. In majority of cases chorionic villi are in contact with the myometrium i.e. placenta accretes. To detect the prevalence of morbidity adherent placenta and its outcome in terms of maternal morbidity and mortality. Over one year from October 2006 to October 2007. Gynaecology Unit-ll, Nishtar Hospital, Multan. All women who had pregnancy complicated by morbidity adherent placenta were identified and their case notes retrieved. Information was collected on a prescribed Performa designed for this purpose. There was 2114 deliveries during the study period in labour ward of Nishtar Hospital, Multan. Eight women fulfilled the study criteria. The prevalence was found to be 0.4%. Complications were PPH, acute renal failure, depression, cellulities of wound site and UTI. Due to rising rate of LSCS in present era, the prevalence adherent is also on raise

SNP microarray analysis of retention abortion chorionic villus / 中华医学遗传学杂志

<p><b>OBJECTIVE</b>To compare villus cell culture and karyotype analysis with single nucleotide polymorphism (SNP) microarray technology for the detection of chorionic villus chromosome in patients with retention of abortion.</p><p><b>METHODS</b>Forty cases were analyzed with the two methods.</p><p><b>RESULTS</b>Chorionic villus culturing was successful in 29 cases, among which 10 were found to have an abnormal karyotypes. For the SNP microarray analysis, all 40 cases were successful, among which 16 were shown to have an abnormal molecular karyotype.</p><p><b>CONCLUSION</b>SNP microarray technology is highly accurate and specific, which is particularly suitable for the detection of chromosomal deletions or duplications, uniparental disomy, low-percentage mosaicism and other chromosomal abnormalities. It has provided an effective supplement to the conventional chorionic villus culture and karyotype analysis.</p>