Reda Hemida

Morphological Features and Immunohistochemical Expression of p57Kip2 in Early Molar Pregnancies and Their Relations to the Progression to Persistent Trophoblastic Disease

Background Although the morphological features characteristic of products of conception specimens including molar pregnancies are well described, substantial histopathological similarities are observed between the different entities, especially in cases of early pregnancies. Furthermore, there are no current solid criteria that could predict cases with progression to persistent gestational trophoblastic disease. In this study, we aimed to determine the most specific histopathological and immunohistochemical features required for accurate diagnosis that can reliably predict the clinical behavior. Methods Sixty-five cases of products of conception were reviewed clinically and pathologically, and any progression to persistent gestational trophoblastic disease (GTD), if present, was noted. Pathological assessment of the archival material included re-cut sections of 5 μm in thickness, routine staining with hematoxylin and eosin and immunohistochemical staining of p57Kip2. Results Certain histopathological criteria were found to be significant in differentiation between complete hydatidiform mole (CHM) and partial hydatidiform mole including villous shape and outline, villous trophoblast hyperplasia, and atypia in extravillous trophoblasts. There were no significant differences in any morphological or immunohistochemical features between cases with or without subsequent development of GTD. Conclusions Histopathological diagnosis of molar pregnancy remains problematic especially in early gestation. Their diagnosis should be stated after a constellation of specific histopathological criteria in order not to miss CHM. p57Kip2 immunohistochemistry is of great value in diagnosis of cases that had equivocal morphology by histopathological examination. However, there were no significant features to predict cases that subsequently developed persistent GTD.

Can Revised Visual Inspection with Acetic Acid (VIA) Test Improve the Performance of Crude VIA Test of in Low-Resource-Setting Countries?

PurposeTo compare the performance of our suggested “revised VIA” test to the traditional crude VIA test.MethodsA cross-sectional study was conducted in the early cancer detection unit. During the period from June 2014 to January 2016, 500 patients were included in our study. After clinical assessment, VIA test was performed followed by applying the five criteria of the revised test at the same time. All cases were referred to colposcopy for confirmation. Cervical punch biopsy was performed for cases with positive colposcopic findings.ResultsThe prevalence of CIN in this study was 11/500 (2.2%). The positive cases with crude VIA test were 236 of 500 screened women (47%). Its sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy (100, 53.98, 4.66, 100, and 55%, respectively). When we applied the five criteria of our suggested “revised VIA” test, only 175 cases (35%) were positive. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy became 100, 66.46, 6.28, 100, and 67%, respectively.ConclusionThe suggested “revised VIA” test improved the performance of the crude VIA test by improving its specificity. We recommend further studies to evaluate its performance.