IHC for partial moles vs. hydropic abortions

[ygdrasil]

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We get a few POCs per week, and of those a small percentage have morphologic changes that put them in the "cannot rule out a partial mole" category. These get sent out for molecular testing, which takes a long time to result. The May issue of AJCP had an interesting article "Diagnostic utility of Twist1, Ki-67, and E-cadherin in diagnosing molar gestations and hydropic abortions." by Rabab A. Moussa et al.

In it, the authors purported across the board 100% sensitivity, specificity, PPV and NPV using Twist1 IHC. Which is great, but adding Twist1 to our IHC menu to solve this problem may not be efficient.

We already have Ki-67 and e-cadherin in use, however, and the study reports that those do a good job in partial moles vs. hydropic abortions. The application is a bit fiddly, however, as you have to semi-quantitatively assess the percentage and strength of expression of the two stains, respectively. I.e. High Ki-67 % and low e-cadherin: partial mole, low Ki-67 and high e-cadherin: hydropic abortion.

Is anyone out there using this approach?

 

[bauber]

I would just use high Ki-67 to support partial mole morphology. If it comes back low then maybe do e-cadherin. The pictures they used for high vs low e-cad in the article aren't very convincing.

 

[LADoc00]

We get a few POCs per week, and of those a small percentage have morphologic changes that put them in the "cannot rule out a partial mole" category. These get sent out for molecular testing, which takes a long time to result. The May issue of AJCP had an interesting article "Diagnostic utility of Twist1, Ki-67, and E-cadherin in diagnosing molar gestations and hydropic abortions." by Rabab A. Moussa et al.

In it, the authors purported across the board 100% sensitivity, specificity, PPV and NPV using Twist1 IHC. Which is great, but adding Twist1 to our IHC menu to solve this problem may not be efficient.

We already have Ki-67 and e-cadherin in use, however, and the study reports that those do a good job in partial moles vs. hydropic abortions. The application is a bit fiddly, however, as you have to semi-quantitatively assess the percentage and strength of expression of the two stains, respectively. I.e. High Ki-67 % and low e-cadherin: partial mole, low Ki-67 and high e-cadherin: hydropic abortion.

Is anyone out there using this approach?

Oh wow, I think I literally just learned something USEFUL about Pathology I might actually incorporate in my practice..after only what? 14+ years of trolling SDN...Ygdrasil you get a big cookie. Find me at the next CAP if I ever decide to go again, its in Chicago or something this year?

 

[Slab]

We get a few POCs per week, and of those a small percentage have morphologic changes that put them in the "cannot rule out a partial mole" category. These get sent out for molecular testing, which takes a long time to result. The May issue of AJCP had an interesting article "Diagnostic utility of Twist1, Ki-67, and E-cadherin in diagnosing molar gestations and hydropic abortions." by Rabab A. Moussa et al.

In it, the authors purported across the board 100% sensitivity, specificity, PPV and NPV using Twist1 IHC. Which is great, but adding Twist1 to our IHC menu to solve this problem may not be efficient.

We already have Ki-67 and e-cadherin in use, however, and the study reports that those do a good job in partial moles vs. hydropic abortions. The application is a bit fiddly, however, as you have to semi-quantitatively assess the percentage and strength of expression of the two stains, respectively. I.e. High Ki-67 % and low e-cadherin: partial mole, low Ki-67 and high e-cadherin: hydropic abortion.

Is anyone out there using this approach?

Ploidy analysis has worked fine for me and it's quick- nearly all partial moles are triploid. I've never looked into using IHC.

 

[ygdrasil]

Thanks for your reply, bauber. I agree, the e-cadherin images were harder to interpret. I can see using Ki-67 as a "nudge" stain, i.e. "I really doubt this is a mole, my colleague that I showed the case to is more on the fence, I'll get the stain and that'll nudge me one way or the other."

LADoc- Thanks for the cookie! I agree that, while this site is very useful for a lot of different aspects of the job, I get the most out of discussions of practices and new developments.