胎盘部位中间型滋养细胞良性病变及其临床病理分析  

Clinicopathologic features of benign condition of placental site intermediate trophoblasts

作　　者：柴大敏[1,2] 周蕾[1,2] 谢群[1,2] 冯振中[1,2] 龚晓萌[1,2] 姚楠[1,2] 陶仪声[1,2] 

机构地区：[1]蚌埠医学院第一附属医院病理科 [2]蚌埠医学院病理学教研室,安徽233030

出　　处：《中国组织化学与细胞化学杂志》2012年第4期372-376,共5页Chinese Journal of Histochemistry and Cytochemistry

基　　金：安徽省高校优秀青年人才基金项目(2009SQRZ130);安徽省教育厅自然科学研究重点项目(KJ2011A203);蚌埠医学院基金(BY0801)

摘　　要：目的探讨胎盘部位结节(PSN)和胎盘部位过度反应(EPS)的临床病理特征。方法结合临床表现、形态学特征、发病机制和免疫表型,对3例PSN及4例EPS病例进行分析,并对鉴别诊断、治疗和预后的情况进行分析。结果 PSN和EPS临床表现为末次妊娠后阴道不规则流血、产后大出血或妊娠合并子宫不全破裂等。镜下见PSN由圆形到卵圆形的中间型滋养细胞结节组成,并伴致密玻璃样变间质。EPS绒毛附着的蜕膜区及其下浅肌层中见单核的多边形或梭形中间型滋养细胞浸润细胞呈片块状或条索状穿插于子宫肌层平滑肌束间。免疫表型PSN和EPS示广谱CK(AE1/AE3)均强阳性,但PSN中PLAP、P63、a-inhibin也呈强阳性,而EPS中hPL强阳性;两者hCG、CEA均局灶阳性或阴性,SMA、vimentin阴性,Ki-67指数均小于5%。治疗手段以刮宫及全子宫切除术,预后较好。结论 PSN和EPS是罕见的中间型滋养细胞(IT)良性病变,二者具有不同的形态学特征和免疫表型,但临床表现及治疗方式比较相似,且预后较好。Objective To investigate the clinicopathological features of placental site nodules （PSN） and exaggerated placental site （EPS）. Methods 4 cases of EPS and 3 cases of PSN were studied using usual histopathologic （HE staining）, and immunohistochemical （Elivision method） techniques, and clinicopathological characteristics were de- scribed. ResultsMajor clinical findings of PSN and EPS included irregular vaginal bleeding, amenorrhea, hernorrhoea after childbirth , and pregnancy combined incomplete uterine rupture. PSN consisted of intermediate trophoblasts （IT） which were round or ovoid, accompanied by pyknotic hyaline degeneration. EPS consisted of one implantation- site IT cell and permeated decidua region and superficial myometrial of fiber secidua region, either individually or con- nected in cords. Immunohistochemically, the cases were strong positive for cytokeratin （CK, AE1/AE3）. However, PSN were strong positive for PLAP, P63 and a-inhibin, while EPS were strong positive for hPL. All the cases were negative or only little positive for hCG, CEA, SMA and vimentin, and the index number of Ki-67 was less than 5%. Main treatments included dilation and curettage of uterus and hysterectomy, and prognosis of most patients was good. ConclusionPSN and EPS are rare benign diseases of intermediate trophoblasts of placental site. They are different in pathologic features and immunophenotype, but the clinical behavior of PSN is similar to that of EPS.

关 键 词：中间型滋养细胞 胎盘部位结节 胎盘部位过度反应 免组疫化染色 

分 类 号：R321.4[医药卫生—人体解剖和组织胚胎学]