Prognostic significance of soluble fas and soluble fas ligand in serum of patients with complete hydatidiform moles.

PROBLEM: Despite of advances in diagnosis and staging, the prognosis of hydatidiform mole (HM) remains intricate. HM possesses the substantial risk of developing persistent trophoblastic disease (PTD), which is considerably high for complete hydatidiform moles (CHMs). Significance of serum soluble Fas (sFas) and soluble FasL (sFasL) has been observed in various malignancies; however, there is no report till date on HM. METHOD OF STUDY: The serum levels of sFas and sFasL were measured using enzyme-linked immunosorbent assay in 62 patients with CHMs and 64 healthy controls. The protein concentrations were also correlated with clinicopathological parameters, ß-hCG level, and clinical outcome. RESULTS: The serum sFas and sFasL levels in patients with CHM were significantly higher than those in control group (mean±SD: 703.497±491.759 versus 348.141±175.24; P<0.004 and 31.17±18.758 versus 18.802± 6.775; P<0.0001, respectively). Patients who progressed to PTD demonstrated higher sFas and sFasL concentrations than those who regressed spontaneously (794.211±415.892 versus 446.69±161.382; P<0.046 and 37.55±20.337 versus 22.763±6.52; P<0.011, respectively). Furthermore, significant associations were observed among sFas, sFasL, and ß-hCG levels (P<0.0001 for all associations). CONCLUSION: Production of sFas and sFasL may play a crucial role in progression of CHM and may serve both as prognostic tool and therapeutic target in improving the clinical outcome.

High origin of an ulnar artery--development and surgical significance.

Variations in the main arteries of the upper limb are common and these anomalies can be of substantial interest to orthopedic surgeons, plastic surgeons, radiologists and anatomists. We present here a case of a high origin of the ulnar artery from the brachial artery found during anatomical dissection of a right upper limb of a 50-year-old man. This superficial ulnar artery, after running over the bicipital aponeurosis in the cubital fossa superficial to the flexor muscles in the forearm terminated as the superficial palmar arch in the hand. The embryological and clinical importance of the anomalous ulnar artery is discussed.

Fas-FasL system in molar pregnancy.

PROBLEM: Hydatidiform mole (molar pregnancy) is the commonest form of Gestational Trophoblastic Disease, with the risk of undergoing malignant transformation. The molecular pathway leading to pathogenesis and progression of molar pregnancy is barely understood. The study focuses on Fas/FasL system which represents one of the main apoptotic pathways controlling placental morphogenesis. METHOD OF STUDY: Placental tissues from 52 patients with complete hydatidiform moles (CHMs) and 55 age-matched controls were examined for Fas and FasL expression using immunohistochemistry, immunofluorescence and Western blotting. The protein expression was also correlated with trophoblast apoptosis (assessed by M30 Cyto DEATH), clinico-pathological parameters and disease progression. RESULTS: Immunohistochemistry and immunofluorescence revealed both cytoplasmic and membranous expression of Fas in villous syncytiotrophoblast as well as cytotrophoblast but FasL was confined merely to the cytoplasm of syncytiotrophoblast. Both Fas (cytoplasm and membrane) and FasL were significantly upregulated in syncytiotrophoblast of CHMs (P = 0.004, P < 0.0001 and P < 0.0002 respectively) and showed a positive association between them (P = 0.019). However, none of the proteins reveal any correlation with M30 index. The results were revalidated using Western blotting. CONCLUSION: This study demonstrated differential expression of Fas and FasL in CHMs and its implications in the pathogenesis of molar pregnancy has been discussed.

Anomalous pectoral musculature.

Anomalous disposition of pectoral muscles was encountered in an adult female cadaver on the left side. A prominent cleft separating the sternocostal and clavicular portions of the pectoralis major was noticed. The fibers of pectoralis major were partially fused with the deltoid, resulting in obliteration of the deltopectoral groove. Interestingly, cephalic vein was seen traversing superficial to the clavicular portion of the pectoralis major and pierced it to drain into the axillary vein. The pectoralis minor was inserted mainly on the coracoid process and few fibers were found blending with the coracobrachialis and short head of biceps brachii. Further, pectoralis minimus, a rare anatomic variant, was also observed lying superior to pectoralis minor. It was innervated by a twig from the lateral pectoral nerve at its superficial surface. Awareness of possibility of such anomalous muscles is important for surgeons operating on the chest wall.