超常胎盘部位反应的临床与病理学研究

目的:探讨超常胎盘部位反应(EPS)的病理与临床特点,提高对EPS病变的认识及诊断率。方法:对2003-2005年17例EPS病例资料进行临床特点及病理学分析,并与20例产后非肿瘤性(非EPS)病变作病理组织学对照分析。结果:EPS发生在与妊娠有关疾病的生育期妇女,临床主要表现为产后出血。病理组织学特点为多量中间型为主的滋养细胞向子宫壁的浅肌层及血管壁浸润,但原有的组织结构不被破坏;而非EPS病变则以少量合体型为主的细胞向子宫壁浅肌层及血管壁浸润。结论:EPS是来自于中间型滋养细胞为主的妊娠滋养细胞疾病,属于正常胎盘反应的过度发展,是由生理反应到病理反应过程的一种少见的非肿瘤性良性病变。正确的诊断依赖于病理组织学检查。EPS预后良好,一般局部病变清除后无需特殊治疗。

Clinical and pathological characteristics of exaggerated placental site

Objective:To evaluate the pathological and clinical features of exaggerated placental site(EPS)and to improve its understanding and diagnosis.Methods:The data of 17 cases with EPS during 2003～2005 were studied and analyzed on its clinical and pathological characteristics.Their pathology were compared between the 17 cases with EPS and 20 cases with non-tumour disease(non-EPS).Results:EPS came on bearing period women of gestational concerned.The primary clinical presentation of EPS was postpartum hemorrhage.The pathological histological feature of EPS was that the more trophoblasts which were mainly intermediate trophoblasts(IT)infiltrated into shallow level myometrium layers and blood vessel wall of uterus.The histological structure was not destroyed while non-EPS was that a few trophoblasts which were mainly syncytiotrophoblast(ST)infiltrated.Conclusion:The EPS is a kind of gestational trophoblastic disease mainly.It is excess of normal placental site reaction.It is a benign non-tumour pathological change from a physiological reaction to pathological reaction.The final correct diagnosis depends on pathological histological test.The prognosis of EPS is good.It needs not particular cure after local pathological changes eliminated.