Sabato 27 ottobre 2012 - Pacini Editore

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5 Ko ML, Jeng CJ, Huang SH, et al. Primary peritoneal carcinosarcoma
GEnITALE MASCHILE E FEMMInILE
Comparative clinical and immunophenotypic
study of placental alkaline phosphatase
and human chorionic gonadotropin,
in different stages of placental development,
in normal and pathological conditions
A. Nocita, A. Tommasini, F. Vitale, S. Mazza, F. Vittimberga,
F. Tallarigo
U.O.C. Anatomia Patologica e Citodiagnostica, P.O. San Giovanni di Dio,
ASP Crotone
Introduction. The placenta undergoes a continuous process
from conception to birth. During its development, the placenta
performs numerous functions, and produces various biologically
active compounds, which are for most proteins. A large
number of these proteins, has been identified and named according
to their biological activity. Examples are specific placental
hormones hCG (human Chorionic Gonadotropin) and hPL (human
placental lactogen) and enzymes specific placental PLAP
(Placental Alkaline Phosphatase), DAO (diamine oxidase) and
CAP (Cystine Aminopeptidase Ossitocinasi. These proteins have
special functions related to pregnancy. Are synthesized by the
trophoblast and decidua, and then secreted in large amounts in the
maternal circulation. The experimental study has been performed,
is divided into two parts: the first were compared with serology
immunohistochemical hCG, this double-chain glycoprotein hormone,
normally present in blood and urine during pregnancy, is
secreted by placental tissue almost immediately after implantation,
and serves primarily to support the corpus luteum during
the first weeks of pregnancy. In the second part of this work were
evaluated the distribution of hCG and PLAP in the placentas
of normal fetuses in all ages of gestation, and in pathological
placentas (partial mole idatiformi in the first two quarters and
gestosis in the third quarter). PLAP, tested in the second part
of the study, a sialoprotein is localized to the apical membrane
of syncytiotrophoblast cells, released into the maternal circulation,
and increases gradually with the progress of concentration
of the pregnancy. The qualitative and quantitative expression of
the antibody in question, is estimated in terms of immunohistochemistry
in placental trophoblastic compartments; noting that
the assessment of positive immunohistochemical reaction to these
antigens (hCG and PLAP) may find application in the differential
diagnosis of placental pathology.
Material and methods. The immunohistochemical investigations
were conducted on 116 histological samples of placentas,
30 spontaneous abortions in the first quarter, 28 of the second
trimester of pregnancy, and 31 samples from placentas during
the third quarter of spontaneous delivery. As for the pathological
cases, were examined 15 cases of mole idatiformi type partial and
12 placentas from women with gestosis. The gestational age of
the grinding wheels idatiformi is between the 9th and 20th week,
while that of placentas gestosis, is between 24° and 37° week.
The survey performed immunohistochemistry, had as main objec-
CONGRESSO aNNualE di aNatOmia patOlOGiCa SiapEC – iap • fiRENzE, 25-27 OttOBRE 2012
Venerdì, 26 ottobre 2012
Sala Giotto – ore 17,00-18,30
(malignant mixed müllerian tumor): Report of a case with five year
disease free survival after surgery and chemoradiation and a review
of literature. Acta Oncol 2005;44:756-60.
tive to analyze the antibody distribuizione hCG and PLAP in the
placentas of normal fetuses at different gestational ages, assessing
their quantitative expression in different placental cell compartments,
highlighting also, as the reactivity of these antigens could
be used, with the support of serological data, in the differential
diagnosis of these diseases.
Results. The pattern of antibody positivity is citoplasm polyclonal
hCG. His expression immunohistochemical, observed in
the different gestational ages, increases exponentially from the
5 the week of gestation, reaching a peak at 9 weeks, this would
probably be determined by the maximum development of both
trophoblastic layers: syncytium and cytotrophoblast. Soon after,
the expression begins to decrease gradually until 28 weeks, then
decline sharply until the end of pregnancy. The profile of immunophenotypic
‘antibody in question is perfectly comparable
with the trend serological, in fact, the serum concentration of
hCG, increases exponentially, doubling every 2 days, for the first
5-6 weeks.
The peak of approximately 100,000 U / L, is reached between
the 7 th and 10 th week of pregnancy. Subsequently, its concentration
decreases by 10 times, before reaching a plateau at
around 16 weeks and remained constant for the remainder of the
pregnancy, then decreases sharply after delivery. As regards the
profile of immunophenotypic PLAP, this has a trend inversely
proportional to hCG, as the positivity of PLAP, begins to be detectable
by 9 weeks gestation, increases steadily up to 25 weeks
and then grows logarithmically throughout the third quarter.
Comparing the two immunophenotypic profiles, shows that
PLAP has a trend inversely proportional to hCG. In placentes
pathological conditions, particularly in the grinding wheel partial
mole has PLAP antibody has a pattern of positivity differently
than normal placentas of fetuses. Indeed, as early as the 9 th
week, we begin to observe the increase of PLAP, with increased
cytoplasmic positivity, while maintaining its typical logarithmic
trend but with higher values in all gestational ages studied (up to
20 weeks). While for the ‘hCG, the immunohistochemical score
slightly higher than the physiological condition. The two trends
are similar in the first and second trimester placentas examined.
These results are also confirmed by the serum concentrations of
hCG glycoprotein, which comparing them with those measured
in physiological conditions, shows a high elevations, which are
considered useful from a laboratory point of view in the differential
diagnosis with immunophenotypic profile. Interesting data
were observed in the placentas gestosis, (24°-37° weeks), which
showed a profile immunophenotypic, similar and comparable to
that of the first trimester placentas physiological (5°-16° week),
with a sharp increase in values. From the data obtained, the hypothesis
emerges that the overproduction of secreted glycoprotein
for the entire first quarter (as known from the literature) and
physiologically degraded, is considered one of the most potent
stimulators for the release of relaxin, increasing its concentration
and contributing to the onset of gestosis. The second part of the
study focused on the description and microscopic examination of
tissues of the trophoblast: syncytiotrophoblast and cytotrophoblast,
in the various placental sites after immunohistochemical
investigation. The immunohistochemical criteria of hCG and