胎盘部位滋养细胞肿瘤和胎盘部位过度反应临床病理分析

目的 探讨胎盘部位滋养细胞肿瘤(placental site trophoblastic tumor,PSTT)和胎盘部位过度反应(exaggerated placental site,EPS)的临床病理学特征、诊断及鉴别诊断.方法 回顾性分析4例PSTT和12例EPS的临床病理学及免疫表型特征,并复习相关文献.结果 ...     

子宫胎盘部位滋养细胞肿瘤1例

患者,女,35岁,因停经5个月、腹腔出血3h入院.术中见腹腔大量积血4500ml左右,子宫破裂,胎儿、胎盘破入腹腔。[第一段]     

绝经后子宫胎盘部位滋养叶细胞肿瘤一例

患者女 ,6 3岁 ,因腹部不适、腹胀 2个多月 ,腹痛 5天于1 998年 1 0月 1 9日入院。绝经 1 3年。妇科检查 :发现子宫增大约 1 6ｃｍ× 1 5ｃｍ× 1 0ｃｍ ,不规则 ,质硬 ,活动。Ｘ线胸片示 :心肺正常 ,血放射免疫分析 β ｈＣＧ(ＲＩＡ β ｈＣＧ)值 :8.3ｎｇ/Ｌ(正常值 :<3.1ｎｇ/Ｌ)。术中见子宫增大如儿头 ,腹腔见陈旧性积血约 1 0 0 0ｍｌ,肝表面结节约 0 .8ｃｍ× 0 .3ｃｍ ,腹腔其他器官未见异常。临床诊断为子宫恶性肿瘤 ,行子宫及双附件以及肝表面结节切除术。病理检查 :送检子宫体均匀增大 1 7 0ｃｍ× 1 6 0ｃｍ× 8 0ｃｍ ,…     

胎盘部位滋养细胞肿瘤免疫组织化学分析

目的 :探讨免疫组织化学在胎盘部位滋养细胞肿瘤 (PSTT)病理诊断中的意义。方法 :应用免疫组织化学检测 8例PSTT中HPL、HCG及PCNA表达 ,并与胎盘部位过度反应及绒毛膜癌比较。结果 :HPL染色 8例PSTT均为阳性 ,阳性细胞指数为 6 2 2 5 %± 10 95 % ,高于绒毛膜癌的 11 13%± 9 2 6 %和EPS的 40 30 %± 2 3 90 % (P <0 0 1,P <0 0 5 ) ;6例PSTT细胞HCG染色阳性 (75 % ) ,阳性细胞指数为 10 87%± 8 31% ,EPS为 2 5 0 %± 4 40 % ,绒毛膜癌为 5 3 0 0 %± 2 2 10 % ;PSTT增殖细胞指数为 31 2 5 %± 8 86 % ,EPS为 10 37%± 5 2 8% ,绒毛膜癌为 71 10 %± 5 12 %。PSTT的HCG和增殖细胞指数与EPS和绒毛膜癌相比差异均有显著性 (P <0 0 1)。结论 :免疫组织化学检测HPL、HCG及PCNA对PSTT的诊断和鉴别诊断具有重要意义 ,但需结合临床与常规病理形态     

中间型滋养细胞肿瘤的临床病理特征

目的 探讨上皮样滋养细胞肿瘤(ETT)和胎盘部位滋养叶细胞肿瘤(PSTY)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4例PSTT及1例ETT病例进行分析,并对鉴别诊断、治疗和预后进行分析.结果 PSTT和ETT临床表现为阴道不规则流血,伴HCG轻一中度升高.PSTT瘤细胞呈片块状或条索状穿插于子宫肌层平滑肌束间,常浸润血管壁;ETT瘤细胞排列成巢团状,位于玻璃样物或肿瘤坏死物中,呈地图样外观.免疫表型表达上皮性、滋养细胞性标志物,但对HPL、Mel-CAM、PLAP及p63的表达有差异.治疗手段以全子宫切除术和术后化疗为主,预后较好.结论 PSTT与ETT是罕见的中间型滋养细胞肿瘤(ITT),二者具有不同的形态学特征和免疫表型,但临床表现及惰性生物学行为相似.     

10例胎盘部位滋养层细胞肿瘤临床,病理免疫组化及超微结构研究

报告10例胎盘部位滋养层细胞肿瘤,平均年龄28.8岁,都有生育史。临床表现为阴道不规则流血或闭经。病理组织学特征为多边形或梭形胞浆丰富的瘤细胞弥漫或片状、索条状浸润于子宫肌纤维间。电镜下瘤细胞表面有少量微绒毛,瘤细胞间可见桥粒。免疫组化染色显示良性病例HPI强阳性,恶性病例HCG明显阳性。病人血HCG值明显升高,瘤细胞核分裂增多,HCG染色阳性增强似可作为提示生物学行为的参考。     

中间滋养细胞肿瘤及瘤样病变

在人胎盘中与绒毛相关的滋养细胞称为绒毛滋养细胞，而在其他部位的滋养细胞称为绒毛外滋养细胞。绒毛滋养细胞主要由细胞滋养细胞和合体滋养细胞组成，并有少量中间滋养细胞(IT)。而绒毛外的滋养细胞几乎全部由IT组成，它浸润在蜕膜，子宫肌壁间和胎盘部位的螺旋动脉。根据IT所在部位的不同又将其分为绒毛IT、种植部位细胞以     

继发性不孕患者胎盘部位结节25例临床病理分析

目的 探讨胎盘部位结节(placental site nodules or plaque,PSNP)的临床表现、组织学特征及其临床意义.方法 回顾性分析2019年6月～2020年9月山东大学附属生殖医院诊治的25例PSNP患者,分析其临床表现、超声检查及组织学形态,应用免疫组化SP两步法检测HCG、hPL、CK(AE1...     

上皮样滋养细胞肿瘤二例

例 1女 ,36岁。因体检发现子宫肌瘤于 1998年 5月 2 6日入院。体检 :子宫增大如孕 5 0ｄ ,浆膜下见肌瘤 2个。患者称近年无妊娠史。行手术治疗。病理检察 :全切子宫标本大小 7.0ｃｍ× 4 .5ｃｍ× 5 .0ｃｍ ,切面见宫腔内膜面有一大小 2ｃｍ× 4ｃｍ的菜花状肿块 ,色淡黄白 ,质硬。子宫肌层厚 1ｃｍ ,浆膜下有 2个直径 1ｃｍ的肌瘤。镜下观察 :内膜面肿瘤的瘤组织中有多灶性凝固性坏死 ,似地图状 (图 1) ,瘤细胞中等大小 ,多边形或卵圆形 ,胞界清楚 ,核卵圆或圆形 ,染色较深 ,有的可见小而清楚的核仁 ,核分裂象易见 ,多数瘤细胞胞质透明 ,少…     

Diagnosis and treatment of placental site trophoblastic tumor

Here we report a case of a placental site trophoblastic tumor in a 36 year old Chinese woman, 31 months following a prior normal pregnancy. Her clinical presentation and ultrasound findings were uncharacteristic; and the final definitive diagnosis was established based on histological examination in conjunction with immunohistochemistry studies and a normal beta human chorionic gonadotropin level. The tumor exhibited high grade histological features with tumor necrosis, nuclear atypia and high mitosis. The patient was successfully treated with hysterectomy with pre- and post-operative chemotherapy.     

Placental site trophoblastic tumor of the mediastinum

Choriocarcinoma has been described as the most frequent subtype of mediastinal germ cell tumors showing trophoblastic differentiation. We report a unique case of a placental site trophoblastic tumor, which developed in the mediastinum of a 14-year-old boy 2 years after the resection of a mature teratoma. The recurrent tumor was composed of a grossly hemorrhagic and necrotic mass. Histologically, diffusely infiltrating large polygonal cells with focal nodular growth and a teratomatous part containing mature intestinal, respiratory, and squamous epithelium with adjacent cutaneous adnexal structures were found. The typical morphologic features included vessel wall infiltration by the neoplastic cells with fibrinoid deposits and geographic necroses within the tumor masses. Characteristic diffuse positivity for melanoma cell adhesion molecule and human leucocyte antigen G was found on immunohistochemical investigation, confirming the diagnosis of placental site trophoblastic tumor. The patient died 1 year later after polychemotherapy. The outcome of this rare tumor is similar to the reported poor clinical outcome in patients with mediastinal choriocarcinomas.     

Coexisting epithelioid trophoblastic tumor and placental site trophoblastic tumor of the uterus following a term pregnancy: report of a case and review of literature

Gestational trophoblastic neoplasms are a group of fetal trophoblastic tumors including choriocarcinomas, epithelioid trophoblastic tumors (ETTs), and placental site trophoblastic tumors (PSTTs). Mixed gestational trophoblastic neoplasms are extremely rare. The existence of mixed gestational trophoblastic neoplasms that were composed of choriocarcinoma and/or PSTT and/or ETT was also reported. Herein, we present a case of uterine mixed gestational trophoblastic neoplasm which is ETT admixed with PSTT, and reviewed 9 cases of mixed gestational trophoblastic neoplasms reported in English literature available. The most common combination was a choriocarcinoma admixed with an ETT and/or PSTT. Mixed gestational trophoblastic neoplasms present in women of reproductive age and rare in postmenopausal, Abnormal vaginal bleeding is the most common presenting symptom, serum β-HCG levels are elevated, mostly below 2500 mIU/ml, the tumor was limited to uterus in 7 cases, the rest of 3 with pulmonary metastases at the time of diagnosis. Mixed gestational trophoblastic neoplasms have more similar clinical features with intermediate trophoblastic tumors (ITTs). Total hysterectomy with lymph node dissection is recommended treatment for mixed gestational trophoblastic neoplasms, and chemotherapy should be used in patients with metastatic disease and with nonmetastatic disease who have adverse prognostic factors.     

Placental site trophoblastic tumor

Placental site trophoblastic tumor is very rare. It is a gestational trophoblastic neoplasm which follows normal or molar pregnancy. It is usually confined to uterus & 15-20% behave in a malignant fashion. Clinically patients present with abnormal excessive bleeding or amenorrhoea. Though several trophoblastic lesions & tumors enter in the differential diagnosis, microscopically the diagnosis is usually straightforward in hysterectomy specimens. Hysterectomy is the treatment with or without chemotherapy. Progress after surgery should be monitored by placental lactogenic hormone.     

Placental site trophoblastic tumour (trophoblastic pseudotumour): a study of four cases requiring hysterectomy including one fatal case

The clinico-pathological features of four patients with placental-site trophoblastic tumour (trophoblastic pseudotumour) are presented. One patient had the nephrotic syndrome associated with evidence of disseminated intravascular coagulation, with complete resolution after hysterectomy. In two patients the tumour extended beyond the uterus, and one of them died with many metastases in spite of intensive post-operative chemotherapy and 'second look' laparotomy. In three patients the tumour behaved as an actively infiltrative neoplasm resistant to chemotherapeutic regimes usually effective for choriocarcinoma. Serum HCG levels were relatively low compared with those of choriocarcinoma. Histologically the tumours were predominantly composed of mononuclear cells supported by a variable amount of vascular stroma and lacked the bilaminar structure characteristic of choriocarcinoma. Scattered cells stained positively with anti-beta HCG and anti-alpha HCG antisera. Prior curettage was diagnostic in two of three cases. We did not find a clear correlation between mitotic activity and subsequent behaviour. Inflammatory cell infiltration and evidence of organisation around the tumour may be favourable prognostic indicators. We agree with a recent publication stressing the variable behaviour of this tumour, and emphasize the importance of serum HCG monitoring. Total surgical excision is usually feasible and in aggressive cases offers the best chance of eradication. We support the recent suggestion that 'trophoblastic pseudotumour' is an unsuitable name for a potentially lethal disease.     

Epithelioid trophoblastic tumor after induced abortion with previous broad choriocarcinoma: a case report and review of literature

Epithelioid trophoblastic tumor (ETT) is a rare trophoblastic tumor originating from chorionic-type intermediate trophoblasts (ITs). It is usually associated with a prior gestational event. We present a 44-year-old woman who had unusual pregnancy related history. The patient received her second spontaneous abortion at the age of 25 years and had suffered from choriocarcinoma in left board ligament at the age of 29 years. She admitted no more treatment after 3 courses of multiagent chemotherapy when serum β-hCG returned to normal. Then she had Full-term delivery, induced abortion at the ages of 32, 33 years. The patient had high serum levels of beta-human chorionic gonadotropin (6587 IU/L). Microscopically, the tumor was composed of mainly mononuclear tumor cells, grew in cords, nests, and sheets within which were aggregates of hyaline material. Most were with distinct cell borders, eosinophilic cytoplasm. Immunohistochemical staining revealed strong diffuse reactivity for cytokeratins (AE1/AE3, CK18), P63, focal reactivity for beta-human chorionic gonadotropin, human placental lactogen, and inhibin-alpha. The Ki-67 index was 77%. The histological and immunohistochemical features were characteristic of epithelioid trophoblastic tumor. This is the first reported case of these two gestational trophoblastic tumor happened on one person with the intervening normal pregnancy.     

胎盘部位滋养细胞肿瘤的临床病理特点及鉴别诊断

目的了解胎盘部位滋养细胞肿瘤（ＰＳＴＴ）的临床病理特点及其鉴别诊断要点。方法对５例ＰＳＴＴ进行临床,光镜,电镜及免疫组化研究,并同时对比观察１０例绒癌及２例过度的胎盘部位反应（ＥＰＳ）。结果ＰＳＴＴ见于育龄妇女,前次妊娠多为足月产,常见症状为闭经及／或阴道出血。血清绒毛膜促性腺激素（ｈＣＧ）可有轻～中度升高。光镜下瘤细胞组成单一,仅见中间型滋养细胞,成片状,条索状穿插浸润于子宫平滑肌束间。血管浸润明显,却少有出血或坏死。分裂相少见。电镜下瘤细胞核周有丰富的中间丝。免疫组化表现为胎盘催乳素（ｈＰＬ）阳性而ｈＣＧ多为阴性。结论ＰＳＴＴ为一少见的滋养细胞肿瘤,具有独特的光镜,电镜及免疫组化特点,这些特点可与其它滋养细胞疾病鉴别     

Placental site trophoblastic tumour--a case report

Placental site trophoblastic tumour is a rare form of gestational trophoblastic disease, which seldom metastasizes. It is chemoresistant though has an excellent prognosis after complete resection of the tumour. Its characterization is thus important for treatment and further management. We present an unusual case who presented with ascites of non-neoplastic origin and was found to have metastases to the lymph node.