胎盘部位滋养细胞肿瘤九例临床病理报告  

Clinicopathologic report of nine placental site trophoblastic tumors

作　　者：刘佳 李丽[2] LIU Jia;LI Li(Department of Pathology,Hospital Affiliated to Xuzhou Medical University,Xuzhou 221006,P.R.China;Department of Pathology,Qilu Hospital Affiliated to Shandong University,Jinan 250012,P.R.China)

机构地区：[1]徐州医科大学附属医院病理科,江苏徐州221006 [2]山东大学齐鲁医院病理科,山东济南250012

出　　处：《中华肿瘤防治杂志》2019年第23期1805-1809,共5页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的胎盘部位滋养细胞肿瘤(placental site trophoblastic tumor,PSTT)是一种罕见的妊娠滋养细胞疾病,因临床及病理医生诊断经验不足易误诊,因此本研究分析PSTT的临床病理特征,探讨其病理诊断与鉴别诊断,提高诊断准确性,为该肿瘤的深入研究提供支持。方法收集2008-01-01-2018-06-30山东大学齐鲁医院病理科(8例)和徐州医科大学附属医院病理科(1例)诊断的9例PSTT患者资料,免疫组织化学法检测9例肿瘤免疫表型,收集随访资料,表述其临床与病理学特征,并复习相关文献。结果9例PSTT患者主要临床症状为阴道不规则流血(4例)、闭经(2例)以及葡萄胎治疗后血清人绒毛膜促性腺激素(human chorionic gonadotrophin,HCG)持续升高(2例),1例患者无明显临床症状。全部肿瘤均继发于正常妊娠、葡萄胎或流产后,距上次妊娠平均间隔时间为16.1个月。免疫组化结果显示,所有病例CK18、CD146、人绒毛膜促性腺激素(human chorionic gonadotrophin,HCG)、人胎盘催乳素(human placental lactogen,HPL)呈阳性表达,p63均为阴性,α-inhibin在7例肿瘤中呈不同程度阳性表达,Ki-67指数为5%~20%。随访2~45个月,除2例失访外,7例患者均未发现复发或转移。结论PSTT临床表现复杂,且对化疗药物不敏感,手术是主要的治疗方法,总体预后较好,临床和病理医生对于已绝经老年女性以及既往有葡萄胎病史的患者,需提高PSTT的诊断意识。OBJECTIVE Placental site trophoblastic tumor(PSTT)is a rare gestational trophoblastic disease that is easily misdiagnosed due to lack of diagnostic experience by clinicians and pathologist.Therefore,this study analyzed the clinicopathological characteristics of PSTT,discusses its pathological diagnosis and differential diagnosis,improves the accuracy of diagnosis,and provides support for the further study of PSTT.METHODS Nine cases of PSTT who were pathologically confirmed by Qilu Hospital Affiliated to Shandong University(8 cases)and Hospital Affiliated to Xuzhou Medical University(1 case)form January 1,2008 to June 30,2018 were retrospectively analyzed.The immunophenotype of 9 tumors was detected by immunohistochemistry and follow-up data were collected and related literatures were reviewed.RESULTS The main clinical symptoms of 9 PSTT patients were irregular vaginal bleeding(4 cases),amenorrhea(2 cases)and the continuous increase of serum human chorionic gonadotropin(HCG)after the treatment of hydatidiform mole(2 cases).One patient had no obvious clinical symptoms.All the tumors were secondary to normal pregnancy,hydatidiform mole or abortion,with an average interval of 16.1 months from the last pregnancy.The results of immunohistochemistry showed that CK18,CD146,HCG,human placental lactogen(HPL)were positive in all cases,p63 was negative,α-inhibin was positive in 7 cases,Ki-67 index was 5%-20%.During the follow-up period from 2 months to 45 months,no recurrence and metastasis were found in 7 patients whose following-up data were available.CONCLUSIONS PSTT is a rare trophoblastic tumor with complex clinical manifestations and is not sensitive to chemotherapy drugs.Surgical resection is the main treatment and its overall prognosis is good.Clinicians and pathologists need to improve the diagnostic awareness of PSTT in postmenopausal women and patients with previous history of hydatidiform mole.

关 键 词：胎盘部位滋养细胞肿瘤 免疫表型 鉴别诊断 预后 

分 类 号：R737.3[医药卫生—肿瘤]