%0 Journal Article
%T Trophoblastic Infiltration in Tubal Pregnancy Evaluated by Immunohistochemistry and Correlation with Variation of Beta-Human Chorionic Gonadotropin
%A Danyelle Farias Ferreira
%A Julio Elito J¨²nior
%A Edward Araujo J¨²nior
%A Jo£¿o Norberto Stavale
%A Luiz Camano
%A Antonio Fernandes Moron
%J Pathology Research International
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/302634
%X Objective. To evaluate trophoblastic cell proliferation and angiogenesis in tubal pregnancy assessed by immunohistochemical study and their correlation with an average variation of ¦Â-hCG in an interval of 48 hours before surgery. Methods. A prospective study was conducted on 18 patients with a diagnosis of tubal pregnancy. The patients were divided into two groups of ectopic pregnancy of which 11 showed rise of ¦Â-hCG levels and 7 patients showed declining ¦Â-hCG levels in an interval of 48 hours prior to surgery. Trophoblastic cell proliferation and angiogenesis were assessed by Ki-67 and VEGF, respectively. Trophoblastic cell proliferation was assessed by Ki-67 and was classified into three groups (grade I: less than 1/3 of stained nuclei, grade II: 1/3 to 2/3 of the stained nuclei, and grade III: more than 2/3 of the nuclei stained). The cases analyzed for VEGF were divided into three groups (grade I: less than 1/3 of the stained cytoplasm; grade II: 1/3 to 2/3 of the stained cytoplasm; grade III: more than 2/3 of the stained cytoplasm). Statistical analysis was performed using the chi-square, ANOVA, and Kruskal-Wallis tests. Results. The mean variation in the serum ¦Â-hCG levels in 48 hours in tubal pregnancy patients correlated with trophoblastic cell proliferation assessed by Ki-67 and showed a decline of 13.46% in grade I, a rise of 45.99% in grade II, and ascension of 36.68% in grade III ( ). The average variation in the serum ¦Â-hCG in 48 hours, where angiogenesis was evaluated by VEGF, showed a decline of 18.35% in grade I, a rise of 32.95% in grade II, and ascension of 37.55% in grade III ( ). Conclusions. Our observations showed a direct correlation of increased levels of serum ¦Â-hCG in 48h period prior to surgery with higher trophoblastic cell proliferation assessed by Ki-67 and angiogenesis assessed by VEGF in tubal pregnancy. 1. Introduction An ectopic pregnancy is any pregnancy where the embryo is implanted outside the uterus cavity and tubal pregnancy is when the embryo is implanted in a fallopian tube. Hence, tubal pregnancy is one type of ectopic pregnancy. Ectopic pregnancy (EP) is the leading cause of maternal mortality in the first trimester of pregnancy resulting from acute abdominal bleeding [1, 2]. It is important to find mechanisms that are able to predict indirectly the risk of tubal rupture. EP presents a broad clinical spectrum; some cases progress to healing spontaneously, while other cases result in tubal rupture. Treatment can be surgical (radical or conservative), clinical with methotrexate (MTX), or expectant management. In
%U http://www.hindawi.com/journals/pri/2014/302634/