Expression And Significance Of Ezrin In Hydatidiform Mole And Its Malignant Transformation

Objective:By detecting the expression of Ezrin in normal early pregnancy villi,non-malignant hydatidiform mole tissues and malignant hydatidiform mole tissues after uterine curettage to explore the role of Ezrin in malignant transformation of hydatidiform mole and the relationship between Ezrin and high risk factors of malignant transformation of hydatidiform mole,and to provide a new idea for the pathophysiological mechanism of malignant transformation of hydatidiform mole and a new reference index for early prediction of malignant transformation of hydatidiform mole.Methods:A total of 210 patients with hydatidiform mole were collected from January 2009 to December 2018 in the Department of Obstetrics and Gynecology,Affiliated Hospital of Yan'an University,who received uterine curettage and were followed up for 1 year.Among them,31 cases developed into invasive hydatidiform mole,1 case developed into choriocarcinoma.A total of 32 patients were assigned as malignant change group.35 cases of non-malignant hydatidiform mole were selected as non-malignant group by pure random number method.32 specimens of normal early pregnancy chorionic tissue in the same period were collected as the control group.The complete clinical data,tissue wax after the first uterine curettage or surgery,and normal villus tissue wax in early pregnancy of all patients were collected.Immunohistochemical SP method was used to detect the expression of Ezrin in 32 cases of normal chorionic tissue(control group),35 cases of non-malignant hydatidiform mole(non-malignant group)and 32 cases of malignant hydatidiform mole and choriocarcinoma(malignant group),and to explore the relationship between Ezrin and the high risk factors of malignant transformation of hydatidiform mole was discussed.Data were analyzed by SPSS 22.0 statistical software.Results:(1)The positive expression of Ezrin was localized in the cell membrane and(or)cytoplasm of cytotrophoblasts and syncytiotrophoblasts,showing light yellow,brown yellow or yellowish brown.(2)The positive expression rates of Ezrin in malignant,non-malignant and control groups were 68.75%(22/32)?88.57%(31/35)and 93.75%(30/32),respectively.The difference was statistically significant(?~2=8.275,P=0.016).Moreover,there were also statistically significant differences in Ezrin expression intensity among the three groups(H=14.873,P=0.001).There were significant differences in Ezrin expression intensity between the control group and malignant transformation group,non-malignant transformation group and malignant transformation group(P=0.000<0.017,P=0.003<0.017),while there was no significant difference in the expression intensity of Ezrin between the control group and the non-malignant transformation group(P=0.429>0.017).In conclusion,Ezrin expression in malignant transformation group was lower than that in non-malignant group and control group.(3)The staining intensity of Ezrin in control group and non-malignant group was moderately positive,while that in malignant group was weakly positive.(4)The positive rates of Ezrin in all hydatidiform mole patients with age>40 years old and age?40 years old were 59.09%and 84.44%,respectively.The difference was statistically significant(P=0.022);The positive rates of Ezrin in all hydatidiform mole patients with hCG>10~5U/L and hCG?10~5U/L were 62.50%and 88.57%,respectively.The difference was statistically significant(P=0.012);The positive rates of Ezrin were 63.64%and 88.24%in all hydatidiform mole patients with uterine volume>corresponding gestational week and uterine volume?corresponding gestational week,respectively,and the difference between them was statistically significant(P=0.018).The positive rates of Ezrin in hydatidiform mole patients with ovarian luteinized cyst diameter>6cm and ovarian luteinizing cyst diameter?6cm were 45.45%and 82.14%,respectively.The difference was statistically significant(P=0.009).The positive rates of Ezrin in all hydatidiform moles with and without repetitive hydatidiform mole history were 50.00%and 76.92%,respectively.There was no significant difference between the two groups(P=0.423>0.05).Conclusion:(1)The positive expression of Ezrin was localized in the cell membrane and(or)cytoplasm of cytotrophoblasts and syncytiotrophoblasts,showing light yellow,brown yellow or yellowish brown.(2)The expression of Ezrin in malignant transformation hydatidiform mole tissue was lower than that in non-malignant hydatidiform mole tissue.(3)The expression of Ezrin was weakened in hydatidiform mole patients with high risk factors such as age>40 years old,hCG>10~5U/L,uterine volume>corresponding gestational week and ovarian luteinized cyst diameter>6cm.(4)The decreased expression of Ezrin may increase the invasiveness of trophoblast,participate in the malignant change of hydatidiform mole and may combine with the high risk factors of malignant change of hydatidiform mole as a potential index to predict the prognosis of hydatidiform mole.