胎盘部位滋养叶细胞肿瘤的临床病理分析

目的探索胎盘部位滋养叶细胞肿瘤（placental site trophoblastic,PSTT）的临床病理特征及免疫表型表达特点、诊断及预后.方法收集我院1982年～2006年住院治疗的5例PSTT,对其临床特征、病理诊断要点及免疫组织化学（Envision两步法）结果进行分析,抗体包括CK8、胎盘催乳素（hPL）、人绒毛膜促性腺激素（hCG）、Mel-CAM（CD146）及胎盘碱性磷酸酶（PLAP）.对照组为20例附有底蜕膜的早期绒毛及20例葡萄胎.结果平均年龄28.4岁;症状主要为阴道不规则出血和闭经;术前检查hCG呈正常-轻度-中度增高趋势,1例血睾酮明显增高.5例术前行刮宫及宫腔镜切取标本之确诊率为60%.镜下瘤细胞呈单个、条索状或片状浸润于肌纤维间,将单个或一束肌纤维分离.治疗手段以子宫切除术后辅以化疗为主.随访时间3～14a,均无复发.结论PSTT发生于着床部位的中间型滋养细胞（IT）,免疫组织化学特征性表达可辅助诊断和鉴别诊断;术前诊断性刮宫病理诊断具有重要临床意义.

The Clinicopathologic Analysis of Placental Site Trophoblastic Tumor

Objective trophoblastic tumor （PSTT）. TO study Methods the clinicopathologic features and immunophenotype of placental site During the period from 1982 to 2006, 5 case of PSTT were diagnosed in Yanan hospital. Immunohistochemical study for cytokeratin 18, human chorionic gonadotropin （hCG） , human placental lactogen （hPL） , Mel-CAM （CD146） , placental-like alkaline phosphatase （PLAP） , epithelial membrane antigen （EMA） , inhibin-alpha and proliferative cell nuclear antigen （PCNA） were performed. The morphologic features and immunohistochemical findings were compared with those of the control group which consisted of 20 cases of early gestational villi with deciduas basalis and 20 case of hydatidiform moles with implantation site. Results The mean age of patients with PSTT was 32.4, Major clinical findings included irregular vaginal bleeding and amenorrhea. Preoperative serum hCG level varied from normal to moderately elevated. Serum testosterone level was raised in 1 case. Uterine curettage could achieve an accurate pathologic diagnosis in 60% of cases. PSTT cells permeated between the myometrial fibers and vessels either individually or connecting in cords or sheets in a manner reminiscent of the implantation site reaction, immunohistochemical study for Hpl, Hcg, Mel-CAM （CD146） and PLAP was most helpful for the differential diagnosis. The duration of followup varied from 3 to 14 years. The remaining patients survived without tumor recurrence. Conclusions PSTT is a tumor of implantation siteintermediate trophoblasts. The different pathologic features
and immunophenotype observed are closely related with the difference in tumor cell differentiation. An accurate pathologic diagnosis of the uterine curettage material is important for the clinical management according to the limited follow-up date available.