妊娠合并系统性红斑狼疮的胎盘病理研究

对３４例妊娠合并系统性红斑狼疮患者的胎盘作病理研究，并与２３例正常妊娠妇女进行对照。结果发现：ＳＬＥ组胎盘重量明显低于对照组（Ｐ＜０．０５），胎盘数两组丙差异无显著性。对ＳＬＥ组中１８例作组织计量分析得出：ＳＬＥ组胎盘绒毛面积比小于对照组（Ｐ＜０．０１）。扫描电镜观察所见：绒毛外观纤细、分枝较少，末梢绒毛呈豆芽状，绒毛表面有多个针尖样小孔，还可见到崩裂团块。免疫组化研究提示：绒毛血管壁上可见到Ｉｇ     

青心酮对妊高征患者胎盘血管壁一氧化氮合成酶和血浆内皮素的影响

目的：观察青心酮（３，４二羟基苯乙酮，ＤＨＡＰ）对妊高征（ＰＩＨ）患者胎盘血管内皮细胞（ＶＥＣ）和平滑肌细胞（ＶＳＭＣ）内一氧化氮合成酶（ＮＯＳ）活性和血浆内皮素（ＥＴ）水平的影响。方法：将２２例ＰＩＨ患者随机分为妊高征组和ＤＨＡＰ治疗组（ＤＨＡＰ每天１６０～２４０ｍｇ），同时取１０例非妊娠妇女（对照组）及１０例正常妊娠妇女（正常妊娠组）作对照。于给药前或（和）剖宫产前采外周静脉血，分离血浆，采用放射免疫法测定ＥＴ；取新鲜胎盘行组织化学分析。结果：正常妊娠组胎盘ＶＥＣ和ＶＳＭＣ内ＮＯＳ活性较高，而妊高征组相应细胞内ＮＯＳ活性明显减弱，并伴有组织和细胞的形态学损伤；ＤＨＡＰ治疗组ＮＯＳ活性较治疗前或未经ＤＨＡＰ治疗的ＰＩＨ患者明显增加，其组织和细胞损伤也减轻；正常妊娠组血浆ＥＴ水平高于对照组而妊高征组血浆ＥＴ水平又高于正常妊娠组，ＤＨＡＰ治疗组血浆ＥＴ水平明显低于妊高征组。结论：ＤＨＡＰ可纠正病理性一氧化氮／内皮素失衡，对改善孕妇及胎儿血液循环有重要作用。     

正常妊娠妇女内源性类洋地黄物质来源的研究

目的研究正常妊娠妇女外周血中增高的内源性类洋地黄物质（ＥＤＬＳ）的来源。方法采用放射免疫分析法测定早孕绒毛,晚孕胎儿附属物组织,正常非孕妇女,早、中、晚孕期,产后２４～４８小时,产时孕妇外周血及脐血中ＥＤＬＳ含量。结果早孕绒毛、胎盘、胎膜及脐带胶质中ＥＤＬＳ含量分别为孕妇外周血的３７、３３、２９和２４倍;胎儿附属物组织间ＥＤＬＳ含量呈显著正相关。早、中孕期血浆ＥＤＬＳ含量与正常非孕妇女比较无明显差异,孕晚期则明显升高,产后２４～４８小时明显下降。孕晚期外周血ＥＤＬＳ含量与平均动脉压（ＭＡＰ）和孕周呈正相关。脐静脉和脐动脉血ＥＤＬＳ含量为外周血的３．１和２．９倍,且脐血和外周血ＥＤＬＳ与胎盘和胎儿的重量之和呈正相关。结论胎儿－胎盘单位是正常妊娠妇女外周血中增高的ＥＤＬＳ的来源     

高频电波刀用于子宫颈病变诊断与治疗的临床观察

目的 总结应用高频电波刀的电圈切除术（ＬＥＥＰ）对宫颈病变诊治的指征、病灶切除范围和病理特点。方法 将细胞学和阴道镜检查异常［宫颈上皮内瘤样变（ＣＩＮ）、不典型鳞状细胞（ＡＳＣＵＳ）］的１７６例患者,分成两部分。对≥ＣＩＮ２行锥切除术,采用ＬＥＥＰ３３例、传统电刀３０例;对ＣＩＮ１和ＡＳＣＵＳ行活检术,采用ＬＥＥＰ６０例、宫颈活检钳５３例。ＬＥＥＰ锥切宫颈管组织深１５ｍｍ,宫颈组织深７ｍｍ;活检术     

卵巢癌DNA水平、S期比例、雌孕激素受体与临床病理组织学的关系

测定了２４例卵巢癌标本的ＤＮＡ水平、Ｓ期比例（ＳＰＦ）及雌、孕激素受体（ＥＲ、ＰＲ），分析了它们之间以及与临床病理组织学之间的关系。结果表明，卵巢癌ＤＮＡ水平、ＳＰＦ与有无腹水及病理分级有明显的关系；二倍体组的ＰＲ阳性率明显高于异倍体组；二倍体组的ＳＰＦ明显低于异倍体组；ＥＲ（－）ＰＲ（－）组的ＳＰＦ明显高于ＥＲ（＋）ＰＲ（＋）组。提示卵巢癌ＤＮＡ水平和ＳＰＦ可作为一个相对独立的反映卵巢癌生物学行为的客观指标，对估计卵巢癌的预后和选择治疗方案有较大的价值。     

胎盘表皮生长因子受体的表达改变与胎儿宫内生长迟缓 …

目的 研究胎儿宫内生长迟缓（ＩＵＧＲ）患者胎盘表皮生长因子受体（ＥＧＦＲ）的表达与正常妊娠及巨大儿胎盘之间是否有差异,并分析其变化与胎盘绒毛发育是否有关。方法 取足月分娩胎盘组织标本６３例,于分娩后立即置于４％中性甲醛缓冲液固定。用免疫组织化学ＳＰ法进行胎盘ＥＧＦＲ检测。同时对肖绒毛血管大小、面积及绒毛面密度等进行分析测量。结果 ＩＵＧＲ组胎盘ＥＧＦＲ的表达较正常对照组和巨大儿组明显增加,ＩＵＧＲ     

一氧化氮合酶与妊高征发病及与雌三醇相关性的研究

目的　探索一氧化氮合酶（ＮＯＳ） 在妊娠高血压综合征（Ｐｒｅｇｎａｎｃｙｉｎｄｕｃｅｄ ｂｙ ｈｙｐｅｒｔｅｎｔｉｏｎ，ＰＩＨ） 发病中的作用及其与雌三醇的关系。　方法　选取妊娠晚期重度妊高征孕妇３２ 例为研究对象，正常足月妊娠孕妇３０ 例为对照组，以分光光度法测定胎盘组织ＮＯＳ活性，放射免疫法测定母亲静脉血游离雌三醇（ＦＥ３） 水平。　结果　ＰＩＨ 组胎盘组织ＮＯＳ活性及母亲静脉血ＦＥ３ 水平明显低于正常对照组（ Ｐ＜ ０ ．０１），经相关关系测定，两者之间具正相关关系（ｒ＝ ０．５１ ，Ｐ＜ ０．０１）。胎盘组织ＮＯＳ活性与新生儿出生体重之间具正相关关系（ｒ ＝ ０．５２，Ｐ＜ ０ ．０１） 。　结论　ＮＯＳ 合成障碍在ＰＩＨ 发病中起一定的作用；雌三醇与ＮＯＳ活性有一定的相关性，提示雌三醇可能是ＮＯＳ产生的刺激剂；ＮＯＳ活性与新生儿出生体重具正相关关系，为ＰＩＨ的防治提供了理论依据     

妊娠肝内胆汁淤积症胎儿宫内缺氧机理的初步探讨

目的探讨妊娠肝内胆汁淤积症（ＩＣＰ）胎儿宫内缺氧的原因及机理。方法分别测定择期行剖宫产术的正常对照组胎儿４６例及ＩＣＰ组胎儿３７例脐静脉血促红细胞生成素（ＥＰＯ）水平;并利用人离体胎盘小叶双面灌流模型,比较正常胎盘膜及ＩＣＰ胎盘膜对氧的扩散功能。结果ＩＣＰ胎盘小叶对氧的转运速度在各时间点与正常胎盘小叶相似,ＩＣＰ胎儿脐血ＥＰＯ水平（１３．５８±８．８８ＩＵ／Ｌ）明显低于正常对照组胎儿（２０．４３±１４．１５ＩＵ／Ｌ,Ｐ＜０．０５）。结论ＩＣＰ胎盘膜对氧的扩散功能正常;ＩＣＰ胎儿ＥＰＯ水平低下,可能是其缺氧最重要原因之一。     

妊娠肝内胆汁淤积症患者脂质过氧化物及雌激素水平变化

妊娠肝内胆汁淤积症 (ＩＣＰ)多发生在妊娠中、晚期 ,可增加早产、产时胎儿窘迫及胎儿死亡发生率[1] 。本研究测定ＩＣＰ产妇血清丙二醛 (ＭＤＡ)、超氧化物歧化酶 (ＳＯＤ)、雌三醇(Ｅ3 )及 β人绒毛膜促性腺激素 (β ｈＣＧ)水平 ,并用免疫组织化学 (免疫组化 )方法测定产后胎盘组织中雌激素受体 (ＥＲ)和人绒毛膜促性腺激素 (ｈＣＧ)的表达强度 ,旨在探讨ＩＣＰ患者体内脂质过氧化物和雌激素水平的变化及胎盘雌激素受体的表达强度与ＩＣＰ发生、发展的关系。一、资料与方法1.研究对象 :(1)ＩＣＰ组 :为 1999年 1月至 12月在我院住院 ,于…     

环形电刀切除术治疗宫颈病变的初步观察

目的 评价一次ＬＥＥＰ同时达到治疗和诊断宫颈病变的临床价值。方法 对经妇科、阴道镜及活检初步诊断为各处宫颈病变收住院的３０例患者，采用ＬＥＥＰ治疗，切除全部宫颈移行区。切除组织全部送病理。观察手术时间，出血量病人反应及术后修复情况。结果 ＬＥＥＰ治疗成功率为９９．３％，平均手术时间为５．２分钟出血量９．８ｍｌ，无继发性出因和感染发生。结论 ＬＥＥＰ治疗宫颈病变操作简单、安全、成功率高，尤其适用于Ｃ     

Pathology of gestational trophoblastic diseases

Gestational trophoblastic disease (GTD) is a heterogeneous group of diseases. This used to include partial and complete hydatidiform moles, invasive mole, choriocarcinoma and placental site trophoblastic tumour. In recent years, new entities, including epithelioid trophoblastic tumour, have been added to this family. Non-neoplastic and neoplastic lesions derived from implantation site and chorion intermediate trophoblast have been gaining attention in the literature. New markers for trophoblasts have been identified facilitating histological diagnosis in cases with unusual clinical or pathological features. It is worth noting that histological distinction between hydropic abortion and partial mole and between complete and partial moles, especially at early gestational age, may be difficult. It may not be possible to predict progress of the heterogeneous group of GTD from histopathological features, except probably in placental site trophoblastic tumour. Alternative biological markers may be explored for better patient management.     

Exaggerated placental site erroneously diagnosed as non-metastatic trophoblastic disease. A case report.

BACKGROUND: Exaggerated placental site (EPS) is classified as a non-neoplastic trophoblastic lesion, and histologically it consists of endometrial and myometrial invasion of intermediate trophoblasts and syncytiotrophoblasts and it differs morphologically from placental site trophoblastic tumors and placental nodules. The purpose of this report is to increase physicians' awareness of this lesion. CASE: A 48-year-old woman with post-molar rising betahCG titers and a clinical diagnosis of non-metastatic trophoblastic disease underwent hysterectomy. Final histopathology showed exaggerated placental site--a lesion often unfamiliar to clinicians. CONCLUSION: It is suggested that operative hysteroscopy may be useful in the diagnosis and management of EPS.     

Immunohistochemical expression analysis of inhibin-alpha and -beta subunits in partial and complete moles, trophoblastic tumors, and endometrial decidua.

The expression of inhibin-alpha subunit has been described in normal placentas, hydatidiform moles, and trophoblastic tumors. We performed a double immunohistochemical expression analysis of inhibin-alpha and inhibin-beta subunits in a cytogenetically well characterized series of 21 complete and 22 partial hydatidiform moles, 2 placental site trophoblastic tumors, and one choriocarcinoma. Syncytiotrophoblastic cells were consistently inhibin-alpha and inhibin-beta positive in all hydatidiform moles and in the one choriocarcinoma. Cytotrophoblast was negative for both subunits in all trophoblastic lesions studied. While villous intermediate trophoblastic cells were consistently inhibin-alpha negative in all hydatidiform moles, focal inhibin-beta immunoreactivity was detected in villous intermediate trophoblast in approximately one third of complete and partial hydatidiform moles. Decidual stromal cells in 40 hydatidiform moles were inhibin-alpha and inhibin-beta positive in approximately one third of cases. Both placental site trophoblastic tumors were inhibin-alpha positive but inhibin-beta negative. Our findings indicate that inhibin-alpha and -beta subunits are consistently coexpressed in syncytiotrophoblast in complete and partial moles. Immunohistochemical detection of inhibin subunits may be useful in the differential diagnosis of trophoblastic lesions.     

Immunohistochemical localization of inhibin-alpha in the placenta and gestational trophoblastic lesions.

The immunohistochemical distribution of inhibin-alpha in formalin-fixed, paraffin-embedded tissues was evaluated in placentas (2 to 40 weeks of gestation), implantation sites, and a variety of trophoblastic lesions. In the first trimester placenta, inhibin-alpha was strongly and diffusely expressed in syncytiotrophoblast. Implantation site intermediate trophoblast in normal and exaggerated placental sites was either negative or only weakly and focally positive for inhibin-alpha. With increasing gestational age, the staining intensity and distribution of inhibin-alpha decreased in syncytiotrophoblast but increased in the implantation site intermediate trophoblast. Chorionic-type intermediate trophoblast, present in the chorion laeve of the term placenta, was weakly but diffusely positive for inhibin-alpha. Cytotrophoblast remained negative for inhibin-alpha throughout gestation. In trophoblastic lesions, inhibin-alpha immunoreactivity was detected in all 17 hydatidiform moles (7 complete and 10 partial), 32 placental site nodules, 23 placental site trophoblastic tumors, 15 epithelioid trophoblastic tumors, and 16 choriocarcinomas. Inhibin-alpha immunoreactivity was confined to the syncytiotrophoblast in hydatidiform moles and choriocarcinoma. As with the normal placenta, inhibin-alpha was not detected in cytotrophoblast. To evaluate the utility of inhibin-alpha in the differential diagnosis of gestational trophoblastic lesions, we tested 32 squamous cell carcinoma of the cervix, 11 low-grade endometrial stromal sarcomas, 12 endometrial (7 well differentiated and 5 moderately differentiated) carcinomas, 7 epithelioid leiomyomas, and 10 leiomyosarcomas for the expression of inhibin-alpha. None of these lesions was positive. These data indicate that inhibin-alpha is expressed by all populations of trophoblast except cytotrophoblast and in all gestational trophoblastic lesions. Accordingly, immunohistochemical detection of inhibin-alpha is useful in the differential diagnosis of gestational trophoblastic lesions.     

The pathology of intermediate trophoblastic tumors and tumor-like lesions.

An intermediate trophoblast is a distinctive trophoblastic cell population from which four trophoblastic lesions are thought to arise: exaggerated placental site (EPS), placental site nodule (PSN), placental site trophoblastic tumor (PSTT), and epithelioid trophoblastic tumor (ETT). EPSs and PSTTs are related to the differentiation of the intermediate trophoblast in the implantation site (implantation site intermediate trophoblast), whereas PSNs and ETTs are related to the intermediate trophoblast of the chorion laeve (chorionic-type intermediate trophoblast). EPSs and PSNs are nonneoplastic lesions, whereas PSTTs and ETTs are neoplasms with a potential for local invasion and metastasis. Microscopically, intermediate trophoblastic lesions can be confused with a variety of trophoblastic and nontrophoblastic tumors, but an appreciation of the morphologic features and immunophenotype allows their diagnosis to be relatively straightforward in most instances. Correct diagnosis is important because each of these lesions may require different therapeutic approaches.     

Classification and Morphology of Gestational Trophoblastic Disease

Gestational trophoblastic disease (GTD) is a clinically and morphologically very heterogeneous group of interrelated lesions, characterised by abnormal growth of the different types of trophoblastic cells, sometimes associated with villous dysmaturity. The management and follow up of the patients and risk calculation for persistent GTD is mainly based on histopathologic diagnosis. The morphologic and differential diagnostic criteria of the villous forms of GTD (complete, partial and invasive hydatidiform moles) are summarised in the paper as well as ancillary techniques for correct diagnoses. Exaggerated placental sites (EPS) and placental site nodules (PSN) represent benign lesions, derived from the intermediate trophoblast and their characteristics are given. The concept of atypical PSN as a recently defined lesion is discussed. Gestational choriocarcinoma (CC), placental site trophoblastic tumor (PSTT) and the epitheloid trophoblastic tumor (ETT) represent tumorous forms of GTD, also termed as gestational trophoblastic tumors (GTT). Their morphologic criteria and clues for differential diagnosis are given, including the discussion about the transition from one lesion into another.     

Clinical and pathologic characteristics and prognosis of placental site trophoblastic tumor

OBJECTIVE: To analyze the clinical and pathologic characteristics of placental site trophoblastic tumor (PSTT) cases and to discuss the diagnosis, treatment and prognosis of PSTT. STUDY DESIGN: The clinical and pathologic data on 11 patients with PSTT at Peking Union Medical College Hospital (PUMCH) from 2000 to 2005 were analyzed retrospectively using SPSS 11.0 software (Chicago, Illinois). RESULTS: Between 2000 and 2005, 635 patients with gestational trophoblastic neoplasms were treated at PUMCH, 11 with PSTT (1.73%). The mean age was 36 years. The antecedent pregnancy was molar in 5 cases (45.5%), full-term delivery in 4 cases (36.4%) and missed abortion in 2 cases (18.2%). The mean interval from the antecedent pregnancy to diagnosis was 16 months. The most common presentations were vaginal bleeding (72.7%) and amenorrhea (63.6%). All patients were pathologically diagnosed, in most cases with human placental lactogen immunohistochemical stain. Chemotherapy and hysterectomy were performed on all patients. Nine complete remissions and 1 partial remission were attained after therapy. CONCLUSION: Pathologic diagnosis of PSTT was the gold standard. Multidrug chemotherapy combined with hysterectomy was effective in metastasis cases. (J Re-     

Immunocytochemical localization of placental lactogen and chorionic gonadotropin in the normal placenta and trophoblastic tumors, with emphasis on intermediate trophoblast and the placental site trophoblastic tumor

This report presents preliminary observations on the immunocytochemical localization of human chorionic gonadotropin (hCG) and human placental lactogen (hPL) in placental site trophoblastic tumors, hydatidiform moles, and choriocarcinomas and compares the findings with those of a similar immunocytochemical analysis of the placenta at various stages of development. In addition to cytotrophoblast (CT) and syncytiotrophoblast (ST), a third form of trophoblast designated "intermediate trophoblast" (IT) is present during normal pregnancy and in trophoblastic disease. Intermediate trophoblastic cells are mononucleate, larger than CT, and contain more abundant eosinophilic cytoplasm, resulting in a partial resemblance to ST. Intermediate trophoblast has distinctive immunocytochemical features that distinguish it from CT and ST. The localization of hPL and hCG in both IT and ST varies with the age of the placenta, with the type of trophoblastic neoplasm, and from one specimen to another within each category of tumor. Syncytiotrophoblast may contain both hormones in large amounts, whereas IT contains hPL predominantly and hCG focally. Cytotrophoblast is devoid of hCG and hPL except in choriocarcinoma, which may show focal weak staining for hCG. Immunocytochemical identification of hCG and hPL has proved helpful in clarifying the histogenesis of trophoblastic neoplasms and may also be of value in establishing their diagnosis and in determining their prognosis.     

Diagnóstico atípico de un tumor trofoblástico del lecho placentario: presentación de un caso y revisión de la literatura

Placental site trophoblastic tumour is a rare form of gestational trophoblastic disease. The most common clinical manifestation is abnormal vaginal bleeding. Due to its rarity there is no optimal standardised treatment. A case is presented of placental site trophoblastic tumour after an atypical diagnosis associated with a postpartum haemorrhage that required an emergency peri-partum hysterectomy.     

妊娠滋养细胞疾病的组织病理学和分子病理学研究现状

妊娠滋养细胞疾病包括非肿瘤性的水泡状胎块和肿瘤性的绒癌、胎盘部位滋养细胞肿瘤和上皮样滋养细胞肿瘤。通过对发病机制的深入研究,陆续发现了一些新的疾病亚型,如家族性复发性水泡状胎块、双胎一胎为完全性水泡状胎块等;同时拓展了与临床诊治密切相关的分子诊断方法,如p57免疫组化染色和微卫星位点（short tandom repeat,STR）分子分型等,使病理诊断较既往的形态学诊断更为精确,并更能反映肿瘤发生的深层机制。文章结合最新的文献和世界卫生组织（WHO）女性生殖道肿瘤分类对该类疾病的病理特征和分子检测进行综述。