The Expression And Significance Of E-cadherin,Inhibin-?,ki-67,p57 And P63 In Gestational Trophoblastic Disease

Background and Objective Gestational trophoblastic disease(GTD)is a group of diseases derived from placental trophoblast cells.According to histology,it is divided into partial hydatidiform mole(PHM),complete hydatidiform mo le(CHM),invasive mole,choriocarcinoma,epithelioid trophoblastic tumor(ET T),and placental site trophoblastic tumor(PSTT).Hydrophytic abortion(HA)i s the degeneration of villi,due to fetal death,villi within blood vessels to sto p development,then disappear,chorionic epithelium from maternal blood absor ption of moisture which can not be transported to the fetus by the internal va scular transport of the villi,and it can be retained in the villi,resulting in the swelling of the villi and the formation of the bubbles.Complete hydatidiform mole(13.9%-17.8%)was more likely than partial hydatidiform mole(1.1%-3.5%)to develop invasive mole and Choriocarcinoma.Compared with PHM and HA,CHM requires appropriate chemotherapy in addition to follow-up,so it is very important for the accurate classification of the mole.At present,the diagnosis of CHM,PHM and HA mainly depends on pathological morphological o bservation and detection of p57 and ki-67 immunohistochemistry.Most cases c an be accurately diagnosed,but early PHM that lacks typical pathological feat ures is misdiagnosed as CHM or HA.Cytogenetic studies have found that DNA ploidy analysis is important to distinguish PHM from CHM,but it is restric ted in many clinical pathology departments due to economic and technical reas ons.So a rapid,simple and low-cost detection method is needed to differentiat e the early gestational trophoblast disease.In this study,the expression of the normal villi,HA,PHM and CHM of E-cadherin,inhibin-?,ki-67,p57 and p63 was tested by the joint test.Evaluation of the differential diagnosis of the E-cadherin,inhibin-?,ki-67,p57,p63 in gestational trophoblastic disease.Material and Methods Hydatidiform mole and HA specimens were collected in company of Kunming KingMed Diagnostics between 2015 and 2016,inclu ding 20 cases of CHM,22 cases of PHM and 19 cases of HA.10 cases of n ormal placent were chosen for normal control.Two highly qualified pathologist confirmed the assigned specimens.The age of the 71 patients ranged from 17 to 51(median,27)years.The median age of patients with HA,PHM,and CHM were 20,28,and 26 years respectively.Routine HE staining was perfor med on 71 cases,simultaneously immunohistochemistry was used to detect the expression of E-cadherin,inhibin-?,ki-67,p57,and p63 in the 71 cases of pa-raffin tissue samples,and all data analyzed by statistic software SPSS 17.Nu-merical comparison among the four groups were performed using the KruskalWallis test,and pairwise comparisons were conducted using the Mann-whitney U-test with Bonferroni correction.The specificity and sensitivity of each index were evaluated by ROC curve.Results1.The normal villi,HA,PHM,and CHM of histopathological features: Normal villi without edema and trophoblast hyperplasia.Through microscope,HA wer e seen villous stromal edema.In PHM,two types of villi,large hydropic villi with scalloped outlines and small fibrotic villi,trophoblast inclusion bodies and nucleated RBC may be present.CHM under microscope,all villi abnormal,m arked hydropic swelling,circumferential trophoblastic proliferation.2.The expression of E-cadherin in normal villi,HA,PHM,and CHM: E-cadhe rin in protein expressed in all the four groups.E-cadherin proteins expression localizalied cell membrane of cytotrophoblast.The expression of E-cadherin in CHM was higher than that in HA,and the difference was statistically significa nt(P<0.017).3.The expression of inhibin-? in normal villi,HA,PHM,and CHM: Inhibin-?expressed in the cytoplasm of syncytiotrophoblast.CHM was higher than PHM in the percentage of positive cells,and the difference was statistically significa nt(P<0.017).Inhibin-? expressed in HA is lower than the expression of CHM,the difference was statistically significant(P < 0.017).4.The expression of ki-67 in normal villi,HA,PHM,and CHM: ki-67 mainly expressed in the cytotrophoblast cells.The expression of ki-67 in CHM higher than in PHM(P<0.001).The expression of ki-67 in HA lower than in PHM(P<0.001).5.The expression of p57 in normal villi,HA,PHM,and CHM: In normal villi,HA,PHM,and CHM groups,p57 was expressed mainly in cytotrophoblast a nd mesenchymal cells.The positive rate of p57 in normal villi,HA,PHM wa s 100%(10/10),100%(19/19),100%(22/22).respectively,with no stastistical difference.The number of negative cases in p57 immunohistochemistry were 20.The positive rate is 0%(0/20).The difference between CHM and PHM was statistically significant(P<0.001).6.The expression of p63 in normal villi,HA,PHM,and CHM: p63 expressed in the nucleus of cytotrophoblast.The nucleus is brown.P63 expression was higher than PHM in CHM,and the difference was statistically significant(P<0.017).There was no statistically significant difference between p63 expression positive percentages in PHM and HA(P>0.017),and the difference in color in tensity was statistically significant(P<0.017).Conclusions1.This study found that E-cadherin was down-regulated in HA,PHM and CH M,suggesting that E-cadherin expression was down-regulated to promote troph oblast proliferation.The expression of E-cadherin in CHM was significantly lo wer than that in HA,suggesting that E-cadherin may be related to the adhesio n and differentiation of trophoblasts.2.P63 was significantly increased in HA,PHM and CHM,and the difference between CHM and PHM was statistically significant.It is suggested that p63 expression may be related to the growth of trophoblast,and the detection of it s expression may help to identify CHM and PHM.3.P57 expression deletion is a key indicator of CHM and other diseases.4.The combined detection of E-cadherin,inhibin-?,ki-67,p63 and p57 can b e used to assist in the identification of HA,PHM and CHM.