ABSTRACT
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
Subject(s)
Humans , Female , Adult , Hydatidiform Mole, Invasive/complications , Pre-Eclampsia/complications , Dilatation and Curettage/methods , Hydatidiform Mole, Invasive/diagnosis , Hydatidiform Mole, Invasive/physiopathology , Hydatidiform Mole, Invasive/surgery , Hysterectomy , Pre-Eclampsia/diagnosis , Pre-Eclampsia/physiopathologyABSTRACT
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.