富于核分裂象的胎盘血管源性肿瘤3例临床病理分析

Placental vascular tumors with high mitosis figures: a clinicopathological study of 3 cases

目的 探讨富于核分裂象的胎盘血管源性肿瘤的临床病理特点及核分裂计数的诊断意义。方法 采用光镜结合免疫组化标记对 3例富于核分裂象的胎盘血管源性肿瘤进行研究并随访。结果 3例孕妇 2 3～ 2 8岁 ,妊娠 36～ 38周 ,初产。胎盘表面浅层或实质内有 2.5～ 4 .5cm大小实性结节。切面暗红色 ,质韧如橡皮。镜下肿瘤呈小叶状结构 ,小叶间为不成熟的疏松间叶组织 ,主要为梭形细胞 ,核长圆或不规则形 ,核仁不明显 ,有大量核分裂象 ,平均 8～ 12个至 15～ 2 0个 10HPF ,无病理性核分裂。部分肿瘤细胞形成血管腔 ,肿瘤细胞CD34(+) ,VEGF( )。分别随访 1.5、5、18年 ,母亲及小孩均健在。结论 胎盘血管源性肿瘤中的核分裂计数不具备恶性肿瘤的鉴别诊断意义。

Objective To investigate the clinicopathological features and diagnostic values of mitotic activity in the placental vascular tumors with numerous mitotic figures. Methods Three cases of the placental vascular tumors with numerous mitotic figures were studied by light microscopy and followed up. Results The ages of the pregnant women with gestation in 36～38 weeks and for the first parturition ranged from 23 to 28. There were flat-round masses being 2.4cm～4.5cm inthe placentas and gloomy reddish solid nodules tough just like rubber on cutting surface. Histologically, spindle cells with long-round nuclei formed capillary-vascular channels. The mitotic figures numbered up to 6 in one high power field (median 8～12 per 10 high power fields in two cases and 15～20 per 10 high power fields in another case) with no atypical mitotic figures identified, but the nucleoli of tumor cells were not obvious. The lobular pattern was arranged with immature loose stroma between the lobuli. Immunohistochemical staining of the tumor cells was positive for CD34 and VEGF. After following-up for 1.5, 5 and 18 years respectively, all the mothers and children were alive healthily. Conclusions High rate of mitotic figures is not malignant characteristic in placental vascular tumors. Diagnosis of placental chorioangioma is supported by the differentiation of tumor cells into blood vessels with a lobular pattern.