子宫上皮样滋养细胞肿瘤

Epithelioid trophoblastic tumor of the uterus: a report of three cases and review of the literature

目的:探讨子宫上皮样滋养细胞肿瘤的临床病理学特征。方法:复习3例子宫上皮样滋养细胞肿瘤的临床资料,并进行组织病理学和免疫组织化学方法观察。结果:3例子宫上皮样滋养细胞肿瘤患者的年龄分别36、46和48岁。临床上主要表现为不规则的阴道流血和盆腔包块。组织学检查显示肿瘤主要由相对单一的单个核滋养细胞组成,排列成片状和条索状的紧密细胞巢,常见广泛坏死区周围绕以存活的瘤细胞岛,形成“地图样外观”。免疫组化标记检查显示瘤细胞表达人体胎盘催乳素(hPL)、β-人绒毛膜促性腺激素(β-hCG)、胎盘碱性磷酸酶(PLAP)、细胞角蛋白(CKpan)、CK18、上皮膜抗原(EMA)、表皮因子生长受体(EGFR)、上皮钙黏素、黑色素瘤细胞黏附分子(Mel-CAM)和抑制素-α。结论:子宫上皮样滋养细胞肿瘤是罕见的、起源于中间滋养细胞的肿瘤。确诊依赖于组织病理学观察和免疫组织化学标记。

Objective To investigate the clinical, pathological and immunohistochemical features of a rare epithelioid trophoblastic tumor （ETT） in uterine. Methods HE and immunochemical staining were used to study the morphological and immunohistochemical characteristics in 3 cases of uterine ETF. The antibodies for immunostaining included Beta-human chorionic gonadotropin （β-hCG）, human placental lactogen （hPL）, placental-like alkaline phosphatase （PLAP）, cytokeratin （CKpan）, CK 18, inhibin-α, E-cadherin. epidermal growth factor receptor （EGFR）, epidermal membrane antigen （EMA）, and melanoma cell adhesion molecule （Mel-CAM）. Results The age of the 3 patients were 36, 46 and 48 years respectively with the main clinical manifestations of vaginal spotting and pelvic mass. Histopathologically, ETT were composed of a relatively uniform population of the mononucleate trophoblastic cells in the forms of nests and cords which were merged into large sheets and masses associated with “geographic” pattern necrosis. Immunohistochemically, hPL, β- hCG, PLAP, CK, CK18, EMA, EGFR, and E-cadherin were positive expressed in ETF cells, and a few of other tumor markers which were usually associated with intermediate trophoblastic lesions, such as Mel-CAM and inhibin-α, were also expressed. Conclusions ETr is a kind of rare tumor arising from trophoblastic cell. Based on the morphologic and immunohistochemical features, it appears reasonable to assume that ETF is a tumor of chorionic-type intermediate trophoblast.