bromochloroacetic-acid and Pregnancy--Ectopic

The receptor for urokinase plasminogen activator (uPAR) is a key molecule in cell surface-directed plasminogen activation. uPAR binds urokinase plasminogen activator (uPA) and thereby focuses plasminogen activation on the cell surface. Plasmin dissolves fibrin deposits and facilitates cell migration during tissue repair processes by degrading the extracellular matrix. During human implantation and placental development, plasmin is considered important for both trophoblast migration/invasion and for fibrin surveillance. This study examined the expression of uPAR in normal and ectopic human placentae by immunohistochemistry. In first and third trimester normal placentae as well as in tubal ectopic placental tissues, a high uPAR expression was seen in the trophoblast associated with deposits of fibrin-type fibrinoid. Extravillous trophoblast of the basal plate, of the cell islands, and of the cell columns was also positive for uPAR in the first trimester whereas at term the expression of the protein was decreased. Moreover, uPAR immunostaining was observed in decidual cells throughout normal gestation and in endometrial tissues of patients with ectopic pregnancies. These findings suggest that uPAR participates in placental development and in trophoblast invasion particularly in the first trimester of pregnancy and that uPAR is involved in repair mechanisms of the trophoblast and fibrin surveillance.

Topics: Adult; Chorion; Endometrium; Fallopian Tubes; Female; Fibrin; Humans; Immunoenzyme Techniques; Immunoglobulin G; Keratins; Placenta; Plasminogen Activators; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Third; Pregnancy, Ectopic; Receptors, Cell Surface; Receptors, Urokinase Plasminogen Activator

Five patients had retained trophoblastic tissue within the Fallopian tubes, which suggested remote ectopic pregnancies. Four remote ectopic pregnancies were identified in patients after delivery. One patient underwent salpingo-oophorectomy after the identification of a small ovarian mass and 1.0 cm "necrotic area" in the fallopian tube at cesarean section. The other three patients underwent tubal ligation, and one was noted to have a 1.0 cm "calcified" nodule in the distal fallopian tube. The fifth patient underwent laparotomy and was found to have an acute ectopic pregnancy in one fallopian tube and a clinically unsuspected 3.0 cm mass in the other, which proved to be an ectopic pregnancy with ghost outlines of chorionic villi and trophoblast. Histopathologically, all five patients showed foci of viable-appearing intermediate trophoblast and surrounding abundant eosinophilic hyalinized material in the fallopian tubes; four patients also had hyalinized ghost outlines of chorionic villi. None of the mothers had a history of previous ectopic pregnancy. The natural history of clinically unsuspected ectopic tubal pregnancies is not well understood, but these cases illustrate that trophoblast may persist in fallopian tubes and potentially result in clinical confusion as well as tubal pathology.

Topics: Adult; Alkaline Phosphatase; Chorionic Gonadotropin; Fallopian Tubes; Female; Humans; Hyalin; Keratins; Placental Lactogen; Pregnancy; Pregnancy, Ectopic; Trophoblasts

With spontaneous abortion the conceptus is often expelled and lost right at the beginning, and uterine curettings then contain only endometrial fragments and clotted blood. Even complete embedding of all available material for histologic examination will not reveal any chorionic villi, and ectopic pregnancy can thus not be excluded. In such cases, the intermediate trophoblast can sometimes still be demonstrated within the endometrial tissue. This highly invasive trophoblast is difficult to identify using conventional staining, but cytokeratin antibodies are reliable markers of this cell type. Using immunohistochemistry, these fetal components could be demonstrated in 27 of 95 specimens (28.5%), proving the intrauterine nature of the aborted pregnancy. In some cases the fetal derivation of intermediate trophoblast was demonstrated by using in situ hybridisation to mark repetitive sequences on the Y-chromosome in the interphase nucleus.

Topics: Abortion, Spontaneous; Adult; Chromosomes, Human, Pair 17; Diagnosis, Differential; Dilatation and Curettage; Endometrium; Female; Humans; Immunoenzyme Techniques; In Situ Hybridization; Keratins; Pregnancy; Pregnancy, Ectopic; Trophoblasts; Y Chromosome

Fetal trophoblast populations in ectopic fallopian tube pregnancy have been characterised using immunohistochemical techniques. The distribution of trophoblast membrane antigens, low molecular weight epithelial cytokeratins, epithelial membrane antigen, human chorionic gonadotrophin, human placental lactogen, and pregnancy-specific beta 1-glycoprotein in ectopic tubal pregnancy appears similar to that reported in normal early intrauterine pregnancy. These findings emphasise the potential importance of ectopic pregnancy in the study of human gestation.

Topics: Antigens, Surface; Chorionic Gonadotropin; Female; Histocytochemistry; Humans; Immunoenzyme Techniques; Keratins; Placental Lactogen; Pregnancy; Pregnancy-Specific beta 1-Glycoproteins; Pregnancy, Ectopic; Trophoblasts