胎盘部位滋养细胞肿瘤临床病理观察  

Clinical pathologic observation of placental site trophoblastic tumor

作　　者：张江宇[1] 李荔[1] 陈文静[1] 李嘉蔚[1] 杜维[2] 冯晓冬 郜红艺[1] 

机构地区：[1]广东省妇幼保健院,广州510010 [2]湖南省常德市第一人民医院,415003 [3]广州金域检验中心,广州510280

出　　处：《临床与实验病理学杂志》2014年第7期725-727,731,共4页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的 探讨胎盘部位滋养细胞肿瘤（placental site trophoblastic tumor,PSTT）的临床病理特征与鉴别诊断。方法 对9例PSTT的临床、超声、组织学形态和免疫表型进行分析,并结合随访资料复习相关文献。结果 9例PSTT患者均为女性,年龄22～38岁。临床均表现为妊娠2～6个月阴道不规则流血,尿妊娠试验阳性,8例子宫增大;7例行子宫全切,2例仅行肿瘤消融术＋化疗。光镜下瘤细胞主要为中间型滋养细胞,可见单核和多核两种形态。两种细胞分布无规律,有明显嗜血管倾向,但血管结构仍存在。肿瘤浸润平滑肌生长,间质中有广泛的纤维蛋白样物质沉积。广谱CK和hPL弥漫性阳性（9/9）,β-hCG散在阳性（9/9）,inhibin-α（4/9）、PLAP（2/9）部分阳性,vimentin、p63均呈阴性,Ki-67增殖指数10%～40%。随访3个月～10年,3例失访,6例未发现复发及死亡。结论 PSTT是一种极少见的滋养细胞肿瘤,综合临床检查、形态学特征并结合免疫表型,有助于PSTT的诊断及与其它滋养细胞疾病的鉴别,对临床治疗有指导意义。Purpose To explore the clinical pathologic features of placental site trophoblastic tumor （PSTT） and differential diagnosis. Methods 9 cases of PSTT were analyzed with clinical, ultrasound, histological morphology, immunophenotype and follow-up materials, revelant literatures were reviewed. Results All patients were women with the age from 22 to 38 year-old. All patients presented with irregular vaginal bleeding. Blood 13-hCG was increased, with 8 cases of enlarged uterus. 7 cases were hysterectomy and 2 cases were chemotherapy radio-frequency ablation. Microscope showed tumor cells were mainly composed of intermediate trophoblast, a few mononucleated or muhinucleated cells. They distributed haphazardly, with marked angiotropic, but vascular architecture still existed. Tumor infiltrated smooth muscle with extensive intervening fibrous protein deposited. Immunophenotype showed tumor cells were positive for CK （9/9） and hPL （9/9）, sporadically positive （ 9/9 ） for 13-hCG, partly positive for inhibin-tx （4/9） and PLAP （ 2/9 ）, negative for vimentin and p63. Ki-67 index was from 10% to 40%. Follow-up time was from 3 months to 10 years, 3 cases missed, 6 cases were not found recurrence and death. Conclusion PSTT is rare trophoblastic tumor. The integration of the clinical examination, histological morphology and immunophenotype can helpful the diagnosis of PSTT and the distinguishing from other trophoblastic tumor and the treatment.

关 键 词：胎盘部位滋养细胞肿瘤 绒癌 临床病理 鉴别诊断 治疗 

分 类 号：R737.33[医药卫生—肿瘤]