ABSTRACT
Identifying patients with increased risk for developing persistent trophoblastic disease [PTD] following evacuation of hydatiform mole, whether partial or complete, is essential to prevent unnecessary prophylactic chemotherapy. It is challenging to find an adequate diagnostic modality that identifies patients at increased risk for developing PTD. This study was investigating villous angiogenesis by identification of CD34 antigen, trophopastic epidermal growth factor receptor [EGFr] as well as trophoblastic cell proliferation to predict the risky patients with molar pregnancy. Thirty aborted patients were conducted for clinical examination, ultrasonography, and estimation of serum human chorionic gonadotropin [HCG] before abortion and frequent measurement after evacuation for six months. Contents of evacuation were fixed in buffered formalin [10%], processed, paraffin embedded and 4 sets of sections were subjected for hematoxylin and eosin stain, immunohistochemistry using monoclonal CD34 and EGFr antibodies and silver stain to asses proliferative potentiality by counting the Argerophilic nucleolar organizer regions [AgNor]. Clinical, ultrasonographic examination revealed molar pregnancy in 25 cases. Histopathologic examination of post evacuation tissue revealed normal pattern of chorionic villi in 5 cases and they were considered as control. Patterns consistent with partial vesicular mole [PVM] were detected in 12 case and features of complete vesicular mole [CVM] were seen in 13 cases. Persistent elevation of HCG-alpha titer after evacuation was detected in 4 molar cases [16%] [one out of 12 partial mole cases [8.33%] and 3 of the 13 complete partial moles [23.08%]. Immunohistochemistry study comprised frequent expression of CD34 with increased microvessel density per villous [MVD/villous] in control cases [mean 7.5 +/- 0.56]. The microvessels located at the periphery beneath vasculosyncytial membrane to perform margination. However, the mean MVD/Villous was significantly reduced in PVM and CVM [3 +/- 0.75 and 1.75 +/- 0.68 respectively]. In 5 out of 12 PVM [41.7%] the micro vessels were located centrally while rest cases perform margination. Contrary, in all CVM specimens the micro vessels if present were located centrally. In control group, EGFr The trophoblasts were negative for EGFr expression, while in PVM group, trophoblasts displayed mild to moderate expression in 5/12 [41.67%] with a mean of 1.8 +/- 0.58. Contrary, all CVM showed moderate to strong expression of EGFr [mean=2.56 +/- 0.75]. High expression of EGFr was in parallel with decreased MVD/villous. There was increased EGFr expression in 3 cases that were associated with persistent elevation of serum HCG following evacuation [1/12 [8.3%] was PVM and 2/13 [15.4%] were CVM]. Proliferative potential was noticed to be increased with increased AgNor count in the trophblasts of CVM versus PVM and control groups [4.29 +/- 1.25, 1.98 +/- 0.32 and 1.1 +/- 0.07 respectively]. Significant reduction of MVD/Villous and increased expression of EGFr confirm diagnosis h of CVM. In addition, absence of CD34 positive micro vessels and high expression of EGFr could be used as markers to predict the possibility for persistent trophoblastic disease, providing better chance for early medical intervention