Background: Mainly for economic reasons, histopathologic analysis is not a systematic practice in medical structures in Senegal, and the utility of this exam is being questioned by many authors. The purpose of this paper is to report the results of this exam, in our medical practice and try to determine if this exam should be systematic of kept only for individualized cases. Material and Methods: It was a retrospective study from January 2010 to December 2018, carried out in the Laboratory of Pathology of the Teaching Hospital of Grand Yoff in Dakar. The data were collected from the register of pathologic examinations of the laboratory. Results: We registered 543 results of histopathologic examination of products of conception from the first trimester abortion. The women mean age was 22.4 years ± 6.2 with extremes of 17 and 46 years. The routine histopathologic assessment of products of first- trimester miscarriages highlighted in our study three pathologies: hydatidiform mole (24.7%), infection (4.6%) and ectopic pregnancy (0.09%). Only 11.7% of cases of Hydatidiform mole (HM) were suspected before the histopathologic assessment. In our sample, molar pregnancy seems to be higher in anembryonic conception with a prevalence of 45%. The prevalence of Complete Hydatidiform Mole (CHM) was higher than the one of Partial Hydatidiform Mole (PHM) (14.8% vs. 9.9% of miscarriages). Indeed, both require follow up to prevent or manage at time the occurrence of choriocarcinoma. Conclusion: The results of the histologic analysis after abortion in the first trimester of pregnancy show that this exam should be practiced systematically in routine in our context because of high prevalence of hydatidiform mole.
References
[1]
Heath, V., Chadwick, V., Cooke, I., Manek, S. and MacKenzie, I.Z. (2000) Should Tissue from Pregnancy Termination and Uterine Evacuation Routinely Be Examined Histologically? British Journal of Obstetrics and Gynaecology, 107, 727-730.
https://doi.org/10.1111/j.1471-0528.2000.tb13332.x
[2]
Grimes, D.A. (1984) Epidemiology of Gestational Trophoblastic Disease. American Journal of Obstetrics & Gynecology, 150, 309-318.
https://doi.org/10.1016/S0002-9378(84)90370-3
[3]
Slim, R., Coullin, P., Diatta, A.L., Chebaro, W., Courtin, D., Abdelhak, S. and Garcia, A. (2012) NLRP7 and the Genetics of Post-Molar Choriocarcinomas in Senegal. Molecular Human Reproduction, 18, 52-56.
https://doi.org/10.1093/molehr/gar060
[4]
Afoutou, J.M., Moreau, J.C., Couillin, Ph. and Correa, P. (1991) Physiopathologie des trophoblastomes benins. Bulletin de la Société médicale d'Afrique noire de langue française, 30, 165-174.
[5]
Couillin, P., Afoutou, J.M., Faye, O., Ravisé, N., Correa, P. and Boué, A. (1985) Androgenetic Origin of African Complete Hydatidiform Moles Demonstrated by HLA Markers. Human Genetics, 71, 113-116.
[6]
Sebire, N.J., Rees, H., Paradinas, F., Seckl, M. and Newlands, E. (2001) The Diagnostic Implications of Routine Ultrasound Examination in Histologically Confirmed Early Molar Pregnancies. Ultrasound in Obstetrics & Gynecology, 18, 662-665.
[7]
Savage, P.M., Sita-Lumsden, A., Dickson, S., Iyer, R., Everard, J., Coleman, R., Fisher, R.A., Short, D., Casalboni, S., Catalano, K., et al. (2013) The Relationship of Maternal Age to Molar Pregnancy Incidence, Risks for Chemotherapy and Subsequent Pregnancy Outcome. Journal of Obstetrics and Gynaecology, 33, 406-411.
https://doi.org/10.1046/j.0960-7692.2001.00589.x
[8]
Lazrak, I., Ihssane, H., Babahabib, M.A., Kouach, J., El Ochi, M.R., Moulay, Moussaoui, D. and Dehayni, M. (2014) Partial Invasive and Metastatic Hydatidiform Mole: Report of a Case. Pan African Medical Journal, 19, 175.
https://doi.org/10.3109/01443615.2013.771159
[9]
Seckl, M.J., Fisher, R.A., Salerno, G., Rees, H., Paradinas, F.J., Foskett, M. and Newlands, E.S. (2000) Choriocarcinoma and Partial Hydatidiform Moles. The Lancet, 356, 36-39. https://doi.org/10.11604/pamj.2014.19.175.5487
[10]
Cisse, C.T., Lo, N., Moreau, J.C., Fall-Gaye, C., Mendez, V. and Diadhiou, F. (2002) Choriocarcinoma in Senegal: Epidemiology, Prognosis and Prevention. Gynécologie Obstétrique & Fertilité, 30, 862-869. https://doi.org/10.1016/S0140-6736(00)02432-6
[11]
Sebire, N.J. and Seckl, M.J. (2008) Gestational Trophoblastic Disease: Current Management of Hydatidiform Mole. British Medical Journal, 337, 453-458.
https://doi.org/10.1016/S1297-9589(02)00456-3
[12]
Pal, A.K., Ambulkar, P.S., Waghmare, J.E., Wankhede, V., Shende, M.R. and Tarnekar, A.M. (2018) Chromosomal Aberrations in Couples with Pregnancy Loss: A Retrospective Study. Reproductive Sciences, 11, 247-253.
https://doi.org/10.1136/bmj.a1193
[13]
Mulisya, O., Roberts, D.J., Sengupta, E.S, Agaba, E., Laffita, D., Tobias, T., Mpiima, D.P., Henry, L., Augustine, S., Abraham, M., Hillary, T. and Mugisha, J. (2018) Prevalence and Factors Associated with Hydatidiform Mole among Patients Undergoing Uterine Evacuation at Mbarara Regional Referral Hospital. Obstetrics and Gynecology International, 2018, Article ID: 9561413.
https://doi.org/10.4103/jhrs.JHRS_124_17
[14]
Ravindra, S., Prasad, S. and Suguna, B.V. (2016) Histomorphology of Fallopian Tubes in Ectopic Pregnancy. Archives of Medicine and Health Sciences, 4, 201-204.
https://doi.org/10.1155/2018/9561413
[15]
Skibsted, L., Sperling, L., Hansen, U. and Hertz, J. (1991) Salpingitis Isthmica Nodosa in Female Infertility and Tubal Diseases. Human Reproduction, 6, 828-831.
https://doi.org/10.1093/oxfordjournals.humrep.a137436
[16]
Altieri, A., Franceschi, S., Ferlay, J., Smith, J. and La Vecchia, C. (2003) Epidemiology and Etiology of Gestational Trophoblastic Diseases. The Lancet Oncology, 4, 670-678. https://doi.org/10.1016/S1470-2045(03)01245-2
[17]
Faye, O., Moreau, J.C., Thiaw, O.T., Mattei, X. and Moreau, J.C. (1999) Etude ultrastructurale de la móle hydatiforme au Sénégal: Données préliminaires. Revue Française de Gynécologie et d’Obstétrique, 95, 409-413.
[18]
Jeffers, M.D., O’Dwyer, P., Curran, B., Leader, M. and Gillan, J.E. (1993) Partial Hydatidiform Mole: A Common but Underdiagnosed Condition. A 3-Year Retrospective Clinicopathological and DNA Flow Cytometric Analysis. International Journal of Gynecological Pathology, 12, 315-323.
[19]
Genest, D.R. (2001) Partial Hydatidiform Mole: Clinicopathological Features, Differential Diagnosis, Ploidy and Molecular Studies, and Gold Standards for Diagnosis. International Journal of Gynecological Pathology, 20, 315-322.
https://doi.org/10.1097/00004347-200110000-00001
[20]
Moodley, M., Tunkyi, K. and Moodley, J. (2003) Gestational Trophoblastic Syndrome: An Audit of 112 Patients. A South African Experience. International Journal of Gynecologic Cancer, 13, 234-239.
https://doi.org/10.1136/ijgc-00009577-200303000-00023
[21]
Xue, W.C., Chan, K.Y., Feng, H.C., Chiu, P.M., Ngan, H.Y., Tsao, S.W. and Cheung, A.N. (2004) Promoter Hypermethylation of Multiple Genes in Hydatidiform Mole and Choriocarcinoma. The Journal of Molecular Diagnostics, 6, 326-334.
https://doi.org/10.1016/S1525-1578(10)60528-4
[22]
Gueye, M., Ndiaye-Gueye, M.D., Gueye, S.M.K. and Moreau, J.C. (2016) Fatal Cases of Gestational Trophoblastic Neoplasia in a National Trophoblastic Disease Reference Center in Dakar Senegal. International Journal of MCH and AIDS, 5, 32-38.
https://doi.org/10.21106/ijma.90
[23]
Poaty, H., Coullin, P., Leguern, E., Dessen, P., Valent, A., Afoutou, J.M., Peko, J.F., Candelier, J.J., Gombé-Mbalawa, C., Picard, J.Y. and Bernheim, A. (2012) Cytogenomic Studies of Hydatiform Moles and Gestational Choriocarcinoma. Bulletin du Cancer, 99, 827-843. https://doi.org/10.1684/bdc.2012.1621
[24]
Poaty, H., Coullin, P., Peko, J.F., Dessen, P., Diatta, A.L., Valent, A., Leguern, E., Prévot, S., Gombé-Mbalawa, C., Candelier, J.J., Picard, J.Y. and Bernheim, A. (2012) Genome-Wide High-Resolution aCGH Analysis of Gestational Choriocarcinomas. PLoS ONE, 7, e29426. https://doi.org/10.1371/journal.pone.0029426
[25]
May, J. and Stark, Z. (2015) Thomas Partial Hydatidiform Mole Following Intracytoplasmic Sperm Injection and the Transfer of a Cryopreserved-Thawed Blastocyst. Journal of Obstetrics and Gynaecology, 35, 320-321.
https://doi.org/10.3109/01443615.2014.948397
[26]
Paradinas, F.J. (1998) The Diagnosis and Prognosis of Molar Pregnancy: The Experience of the National Referral Centre in London. International Journal of Gynecology & Obstetrics, 60, S57-S64. https://doi.org/10.1016/S0020-7292(98)80006-4
[27]
Kim, K.R., Park, B.H., Hong, Y.O., Kwon, H.C. and Robboy, S.J. (2009) The Villous Stromal Constituents of Complete Hydatidiform Mole Differ Histologically in Very Early Pregnancy from the Normally Developing Placenta. The American Journal of Surgical Pathology, 33, 176-185. https://doi.org/10.1097/PAS.0b013e31817fada1
[28]
Madi, J.M., Braga, A.R, Paganella, M.P., Litvin, I.E. and Da Ros Wendland, E.M. (2016) Accuracy of p57KIP2 Compared with Genotyping for the Diagnosis of Complete Hydatidiform Mole: Protocol for a Systematic Review and Meta-Analysis. Systematic Reviews, 5, 169. https://doi.org/10.1186/s13643-016-0349-7
[29]
Lewis, G.H., De Scipio, C. and Murphy, K.M. (2013) Characterization of Androgenetic/Biparental Mosaic/Chimeric Conceptions, Including Those with a Molar Component: Morphology, p57 Immunohistochemistry, Molecular Genotyping, and Risk of Persistent Gestational Trophoblastic Disease. International Journal of Gynecological Pathology, 32, 199-214. https://doi.org/10.1097/PGP.0b013e3182630d8c