子宫上皮样滋养细胞肿瘤的临床病理特征

目的探讨子宫上皮样滋养细胞肿瘤(ETT)的临床病理特征。方法分析1例合并局灶绒毛膜细胞癌的临床和病理资料，结合文献进行讨论。观察病变的大体及镜下特点，采用HE染色及免疫组化S-P法测定cK(AEl／AE3)、HPL、HCG、α-inhibin。结果肿瘤由绒毛膜型中间滋养细胞组成，瘤细胞巢呈地图样分布，瘤巢间充满嗜酸性透明变性物质。肿瘤的免疫表型：CK(AE1／AE3)、HPL、PLAP和α-inhibin均呈阳性表达。结论ETT为滋养细胞肿瘤的新类型，系由绒毛膜型中间滋养细胞组成，属于低度恶性肿瘤。ETT应与胎盘部位滋养细胞肿瘤、胎盘部位结节、绒毛膜细胞癌和宫颈鳞癌鉴别。     

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…     

子宫上皮样滋养细胞肿瘤临床病理分析

目的 探讨子宫上皮样滋养细胞肿瘤(ETT)的临床病理特征及鉴别诊断,及其与预后相关因素.方法 回顾浙江大学附属妇产科医院2000-2007年间共5例ETT病例,分析其临床病理及CK18、p63、α-抑制素、人绒毛膜促性腺激素(HCG)、人胎盘泌乳素(HPL)、胎盘碱性磷酸酶(PLAP)、Ki-67等免疫表型特征.对所有病例随访11～50个月,并简要分析预后相关因素.结果 5例ETT病例均为生育年龄妇女,平均年龄33岁,发生率占同期妊娠滋养细胞疾病0.48%(5/1037).镜下见肿瘤由相对一致的单核滋养细胞排列成结节状浸润生长,肿瘤细胞巢中可见玻璃样物质.肿瘤坏死较常见,典型者可呈地图状坏死.肿瘤细胞CKl8、p63弥漫阳性,HCG、HPL、PLAP灶性阳性或阴性.α-抑制素表现为阳性或阴性.随访期间,死亡2例:1例核分裂象达15/10 HPF,发病1年后死亡,另1例发生肺转移,2年后死亡.结论 ETT是一种罕见的滋养细胞疾病,具有独特的组织形态和免疫表型特征,核分裂象高与发生肺转移的病例预后可能较差.     

子宫上皮样滋养细胞肿瘤临床病理分析

Objective To study the clinicopathologic features,immunophenotype,differential diagnosis and prognosis of uterine epithelioid trophoblastic tumor(ETT).Methods From 2000 to 2007,5 ETTs cases were diagnosed in the affiliated Women's Hospital,School of Medicine,Zhejiang University.The pathologic characteristics and immunophenotype of the tumors were analyzed by histological examination and immunohistochemistry of CK18,p63,inhibin-α,HCG,HPL,PLAP and Ki-67.The clinical prognostic factors were evaluated based on a following-up data with a period of 11-SO months.Results The overall prevalence of ETT was 0.48% among all the gestational trophoblastic diseases patients received in the same period.Five ETT patients were in the reproductive ages with a median of 33 years.Histologically,the tumor showed an invasive,nodular growth consisting of uniform mononuclear trophoblastic cells.There were zones of hyaline material in the tumour nests.Necrosis was commonly seen with a characteristic geographic pattern.Immunohistochemically,all cases displayed a diffuse CK18 and p63 positivity,to be either positive focally or negative for HCG,HPL and PLAP staining.Inhibin-a staining was positive or negative either in the 5 cases.Two patients died of the tumour relapse:one died after 1 year with the tumor having a high mitotic activity(averagely 15 mitotic figures per 10 high-power fields),and the other died of lung metastasis 2 years after the diagnosis.Conclusions ETT is a rare trophoblastic disease with distinct clinicopathological features and immunostaining patterns.A high mitotic index and lung metastasis are indicators for an unfavorable prognosis.     

子宫外上皮样滋养细胞肿瘤

患者女，28岁。1998年行产钳分娩一男婴，同年早孕人流一次。2001年12月4日，因停经48天，阴道流血10d，近4天出现下腹隐痛伴肛门附胀及里急后重来院就诊，拟诊“宫外孕”收治入院。     

上皮样滋养细胞肿瘤肺转移1例

<正>患者女性,51岁,主因"阴道不规则流血2个月,咳痰、咯血并胸痛2个月"于2017年2月入院。无腹痛、腹胀,二便正常。既往身体一般,初潮14岁,绝经47岁,孕3产2,23年前2次生产之间有葡萄胎清宫术1次(未行病理检查)。患者曾因"阴道不规则流血1个月,咳嗽、咯血伴胸痛1个月"于2016年8月在当地医院就诊。CT示:右肺中叶软组织肿块影,大小5. 7 cm×4. 2 cm,密度欠均匀,边界欠佳,提     

子宫血管周上皮样细胞肿瘤临床病理观察

目的研究子宫血管周上皮样细胞肿瘤的病理学特征、诊断、鉴别诊断和生物学行为。方法对5例子宫血管周上皮样细胞肿瘤进行常规组织学和免疫组织化学（SP法）染色和观察,对患者进行随访,并复习相关文献。结果光镜下5例肿瘤均由透明或嗜酸细胞巢或宽窄不等的细胞索组成,间质有丰富的小血管和程度不等的透明变。免疫组织化学染色示5例瘤细胞均黑色素细胞标记阳性和程度不等的结蛋白和平滑肌肌动蛋白（SMA）阳性,CK和CD10阴性。5例患者现均存活。结论子宫血管周上皮样细胞肿瘤具有较特征性的组织病理及免疫组织化学特点,HMB45阳性对诊断有重要作用。该肿瘤分良性、恶性潜能不能确定和恶性三类,应与透明细胞癌和上皮样平滑肌肿瘤区别。     

子宫阔韧带上皮样滋养细胞肿瘤1例并文献复习

目的探讨上皮样滋养细胞肿瘤(epithelioid tropho-blastic tumor,ETT)临床病理学特点、诊断、鉴别诊断及预后。方法对1例子宫阔韧带ETT临床特征、组织学及免疫表型进行观察,并复习相关文献。结果患者因月经紊乱半年入院,B超提示盆腔包块,手术标本见肿块位于子宫左侧阔韧带。组织学表现为典型的上皮样瘤细胞巢、地图样坏死、血管瘤细胞套样结构及膨胀性生长方式。免疫组化标记瘤细胞CK、CK18、p63、CD10呈弥漫强阳性表达,EMA、HCG、PLAP、PR、E-cad呈局灶阳性,α-inhibin、HPL、ER、desmin、SMA呈阴性,Ki-67增殖指数约20%。患者术后随访1年未见复发或转移。结论 ETT是一种罕见的具有恶性潜能的中间滋养细胞肿瘤,可发生于子宫阔韧带,具有独特的生长方式及组织学、免疫学表现,尚需与绒毛膜癌、上皮样平滑肌肉瘤、角化型鳞状细胞癌等相鉴别。     

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.     

上皮样滋养叶细胞肿瘤误诊为子宫内膜鳞癌1例

患者女性,36岁,17年前产子后至今未孕.因月经过多就诊于当地门诊.子宫颈活检示慢性子宫颈炎,有糜烂.B超显示子宫体下段有一稍强回声的境界清楚的团块.临床考虑为黏膜下平滑肌瘤,药物治疗后未见缓解.子宫腔镜下行肿块摘除术,术中见一肿块位于子宫腔与子宫颈管之间.     

Trophoblastic gestational disease: a placental site trophoblastic tumor and an epithelioid trophoblastic tumor

Placental site trophoblastic tumor and epithelioid trophoblastic tumor are rare gestational trophoblastic tumors. They both appear in the same context and follow the same course. We report two cases in patients aged 44 and 20 years. These lesions usually affect young women with a history of multiple gestations. Clinical manifestations include vaginal bleeding, uterine mass, and moderate elevation of serum beta human chorionic gonadotrophin levels. These morphologically distinct trophoblastic proliferations usually have a favorable course if complete excision is performed.     

上皮样血管平滑肌脂肪瘤的临床病理特征

目的:探讨上皮样血管平滑肌脂肪瘤(epithelioid angiomyolipoma,EAML)的临床病理学特征.方法:回顾性分析17例病理诊断为EAML的组织学形态、免疫组织化学特点、临床及随访资料.结果:男5例,女12例,年龄21~62(平均31.2)岁,其中14例发生于肾脏(3例伴有子宫平滑肌瘤,2例伴有宫内孕);2例发生于肝脏,1例发生于腹腔;肿瘤最大径3~15 cm,镜下瘤细胞呈上皮样巢、片状分布,可见围绕血管呈放射状排列的结构;细胞体积大,卵圆形、梭形,胞质丰富,异型明显,核分裂少见,其中2例伴有出血、坏死.免疫组织化学HMB-45,Melan-A,SMA阳性,vimentin,ER和PR表达率分别为41%(7/17),23%(4/17)以及35%(6/17).17例EAML均行肿瘤根治或肿瘤切除术,术后随访5~52个月,1例2年后肝肺转移死亡,其余16例均健在,无复发及转移.结论:EAML多发生于女性,可能与激素水平有关;肾脏最常见,其次为肝、腹腔;病理形态多样,免疫组织化学对其诊断有重要价值,手术效果好,有转移可能.     

子宫血管周上皮样细胞肿瘤

例1女,33岁。2002年2月开始感觉腰酸、腹胀、经量增多来我院就诊。妇科检查示子宫前位,增大如孕2个月左右。B超检查子宫前壁峡部一7·7cm×6·5cm×5·5cm大小低回声团块,向浆膜面突出,内部光点分布不均匀,以后每年定期2次子宫附件B超检查,均示子宫峡部肿块逐渐增大,考虑子宫平滑肌瘤。2004年9月B超检查示子宫前壁峡部一8·5cm×4·3cm×6·4cm低回声团块,周边见血流信号,其内见2·0cm×1·9cm不规则液性暗区,子宫内膜及两侧附件无特殊。诊断为子宫肌瘤部分液化行子宫全切术。CA199、CA125、癌胚抗原(CEA)等各项实验室检查均无异常。术…     

Coexisting epithelioid trophoblastic tumor and choriocarcinoma of the uterus following a chemoresistant hydatidiform mole

The epithelioid trophoblastic tumor is an unusual type of trophoblastic tumor. Herein, we describe a patient with coexisting epithelioid trophoblastic tumor and choriocarcinoma in the uterus. The patient had a history of hydatidiform mole with recurrent elevation of human chorionic gonadotrophin level that is resistant to chemotherapy. Histopathologic and immunohistochemical examination showed distinctive differences between the 2 trophoblastic tumors. The development of epithelioid trophoblastic tumor may be related to the persistence of locally invasive disease, which was unresponsive to chemotherapy. The patient responded well to surgery. The presence of an epithelioid trophoblastic tumor should be considered in chemoresistant gestational trophoblast tumor.     

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.     

Molecular genetic analysis of placental site trophoblastic tumors and epithelioid trophoblastic tumors confirms their trophoblastic origin

Trophoblastic tumors represent a unique group of human neoplasms because they are derived from fetal tissue. Except for choriocarcinoma, the neoplasms that develop from human trophoblast are poorly characterized. Placental site trophoblastic tumors and epithelioid trophoblastic tumors are thought to arise from intermediate (extravillous) trophoblasts based on histopathological studies, but direct molecular evidence of a trophoblastic origin has not been established. In this study, we performed molecular analysis in an attempt to confirm their presumable trophoblastic origin. We demonstrated that such tumors contain a Y-chromosomal locus and/or new (paternal) alleles not present in adjacent normal uterine tissue in all 31 informative cases. Loss of heterozygosity was found in 60% of tumors and all 42 tumors assessed contained wild-type K-ras. All of the trophoblastic tumors were heterozygous in at least 1 of 10 single-nucleotide polymorphism markers studied in contrast to homozygosity in all 10 single-nucleotide polymorphism markers in most complete hydatidiform moles indicating that these tumors are not related to complete hydatidiform moles. This study provides the first molecular evidence that placental site trophoblastic tumors and epithelioid trophoblastic tumors are of fetal (trophoblastic) origin.     

原发于宫颈的胎盘部位滋养细胞肿瘤一例

患者女,28岁,G3P1+2.13个月前曾行人工流产术.因"停经40 d后阴道不规则流血20余日"于外院行宫颈活检,病理诊断为"宫颈鳞状细胞癌".后于2008年9月来我院会诊,病理诊断为"宫颈胎盘部位滋养细胞肿瘤".我院门诊B超示"子宫下段见7.2 cm×5.5 cm×6.8 cm实性不均匀回声团块".血清人绒毛膜促性腺激素(HCG)值1946.8IU/L.胸片及腹部彩超均未见异常.给予5-氟尿嘧啶(5-FU)化疗5 d后行子宫切除术.