IMP3 Expression In The Hydatidiform Mole And Invasive Mole Patients Over 40 Years Old

Objective: Gestational Trophoblastic Disease is a set of derived from placental Trophoblastic Disease, including Mole, invasive Mole, chorio-Carcinoma (called choriocarcinoma) and placental site Trophoblastic tumor. Pregnancy placental villous trophoblast cell hyperplasia and interstitial edema form hydatidiform mole.But invasive mole belonging to Trophoblastic tumor, with malignant behavior, after secondary to Mole, are common diseases in women of reproductive age. Human chorionic gonadotropin hCG is secreted by Trophoblastic tumor specificity and sensitivity of tumor markers, diagnosis and treatment monitoring Trophoblastic tumor is the main reference index. Trophoblastic tumors to chemotherapy, supplemented by other therapies such as surgery and radiotherapy means。Women over 40, due to physiological and functional characteristics, hydatidiform mole and malignant transformation occurs after pregnancy rate significant increase in younger women.Women in this age the diseases great harm to life and physical and mental health of women, could easily lead to misdiagnosis, so that patients do not receive timely and effective treatment, and its prognosis. IMP3 is a member of insulin-like growth factorⅡmRNA binding protein family ,The members of the family in the early embryo formation of RNA transport, stability, plays an important role in cell growth and migration. IMP3 in tumor formation in embryonic development and stimulate role of cell adhesion, migration and invasion. Immunohistochemical SP method for the detection of this research through IMP3 expression in the hydatidiform mole and invasive mole patients over 40 years, to explore its role in hydatidiform mole deterioration progress and invasive mole's condition to determine the treatment effect evaluation and prognosis estimation and other aspects in the clinical significance. Materials and Mothods:Specimens from The Second Hospital of Hebei Medical University and Capital Medical University of September 1990- September 2010 of pathology archive of over 40 years of hydatidiform mole after curettage in paraffin-embedded tissue specimens a total of 103 cases, and all cases before the operation is not any therapy. Age 40-56, 67 cases of serumβ-hCG>2X10~5mIU/ml, average age of 47.06±0.61, development for invasive mole 24 cases ,36 cases of serumβ-hCG<2X10~5mIU/ml with an average age of 46.78±0.41, development for invasive mole 10 cases. Over 40 years of aggressive chemotherapy and chemotherapy in patients with hydatidiform undergoing hysterectomy paraffin-embedded tissue specimens a total of 88 cases, Specimens are taken from the uterus of the original lesion. Age 40-57, are in phase I, double gun chemotherapy before operation, the average course of 3.55±1.83 course. 52 cases ofβ-hCG>2X10~5mIU/ml (prognostic score≥7) with an average age of 46.89±0.50, 36 cases of beta-HCG<2X10~5mIU/ml (prognostic score≤6) average age of 46.72±0.54. Between the groups above age no differences. All cases for clinical diagnosis, final pathology confirmed. Specimens are continuous slices, thick 5μm, take the 3 slices, 1 of which HE dyed, remaining for immunohistochemical SP method to detect expression of IMP3. IMP3 gene in placenta tissue as a positive control, resistance replaced by PBS as a negative control. IMP3 positive signal positioning in the tumor within the cytoplasm of cells, with 10% tumors appear yellow or brown particles in the plasma is positive, and dye intensity into negative, weak positive, positive and strong positive, Immunohistochemical results using SPSS 16 statistical software for data processing. P <0.05 for statistical significance.Results:1 IMP3 gene expression in hydatidiform mole:Immunohistochemical staining results: IMP3 expression of protein in the cytoplasm in gestational Trophoblastic, in both the serumβ-hCG>2X10~5mIU/ml group andβ-hCG<2X10~5mIU/ml group expression, positive expression rate of IMP3 asβ-hCG>2X10~5mIU/ml Group (35.82%), in which strong positive expression in 7 cases, positive expression of 11 cases, weak positive 6,βIMP3 positive expression of these 24 cases, evil becomes aggressive 16 cases of hydatidiform mole, canceration rate of 66.67% (16/24), negative expression of IMP3 43 cases, evil becomes aggressive Mole 8 cases, canceration rate (18.6%). Comparison of canceration rate has significant differences between the two groups (x 2 =15.477 P=0.000<0.05); positive expression rate of IMP3 asβ-hCG<2X10~5mIU/ml Group (8.33%) which strongly positive expression 0, positive expression 1, weak positive expression of 2 cases,βIMP3 positive expression of these 3 cases, evil becomes aggressive Mole 3, canceration rate of 100% (3/3), IMP3 negative expression in 33 cases, evil becomes aggressive 7 cases of hydatidiform mole, canceration rate (21.21%). Canceration rate more statistically significant differences between the two groups (P=0.017<0.05).βIMP3 positive expression rate comparison between the two groups have significant difference (x 2 =9.148 P=0.002<0.05)2 IMP3 gene expression in invasive mole:2.1 Immunohistochemical staining results:IMP3 in invasive mole expression in the cytoplasm,in bothβ-hCG>2X10~5mIU/ml group andβ-hCG<2X10~5mIU/ml group expression,β-hCG>2X10~5mIU/ml group in serum before chemotherapy positive expression rate of IMP3 as (94.23%) which strongly positive expression in 32 cases, positive expression of 8 cases, the weak positive expression of 9 cases, After several courses of chemotherapy IMP3 positive expression rate of undergoing surgery (82.69%), in which the strong positive expression in 18 cases, positive expression in 16 cases, weak positive expression of 9 cases. Chemotherapy before and after chemotherapy by comparison, statistically significant differences between the two groups ( P =0.049<0.05).2.2 Serumβ-hCG<2X10~5mIU/ml group positive expression rate of preoperative IMP3 (77.78%) which strongly positive expression in 7 cases, positive expression in 14 cases, weak positive expression in 7 cases, Surgery through several courses of chemotherapy positive expression rate of IMP3 as (58.33%) strongly positive expression of which 4 cases, positive expression of 8 cases, the weak positive expression of 9 cases. Chemotherapy before and after chemotherapy by comparison, statistically significant differences between the two groups (P =0.048<0.05).2.3 Similar with Mole, in invasive mole preoperative serumβ-hCG>2X10~5mIU/ml in a total of 52 cases, strong positive expression of these 32 cases, positive expression of 8 cases, weak positive expression of 9 cases of positive expression rate (94.23%), serumβ-hCG<2X10~5mIU/ml group before chemotherapy a total of 36 cases, strong positive expression of which 7 cases, positive expression in 14 cases, weak positive expression in 7 cases, positive expression rate (77.78%). Statistically significant differences for comparing two groups (X2 =3.868 P =0.049<0.05). After chemotherapy, serumβ-hCG>2X10~5mIU/ml group andβ-hCG<2X10~5mIU/ml group, statistically significant differences between the two groups (X2 =6.364 P =0.012<0.05).Conclusion:1 Serumβ-hCG>1X10~5mIU/ml considered partial hydatidiform transfers and or distant metastasis-related risk factors, High rates of positive bloodβ-hCG>2X10~5mIU/ml IMP3, and IMP3-positive development for the high rate of erosion of mole, you can detect IMP3 judging by the expression in hydatidiform mole deterioration progress ,So you can detect IMP3 judging by the expression in hydatidiform mole is there risk transfer, partial transfer and detection of IMP3 as mole or distant metastasis of new molecular markers.2 In the erosion of hydatidiform mole, after chemotherapy IMP3 positive rate had dropped before chemotherapy,which described that chemotherapy drugs to inhibit tumor cell activity and further proliferation, IMP3 function is the promotion of cell proliferation, differentiation and metastasis, results that are consistent with this theory.3 After several courses of chemotherapy andβserumβ-hCG declining or negative conversion parallel operation, IMP3 positive rate after surgery although chemotherapy has declined before, butβ-hCG>2X10~5mIU/ml group- not obvious decline than hCG<2X10~5mIU/ml group. Chemotherapy does not completely kill all nourish cells and tumor cellstill have proliferation ,andβ-hCG>2X10~5mIU/ml groups have more cells of the active presence of relevant, should continue to provide the appropriate treatment and follow-up.