胎盘种植部位中间型滋养细胞疾病的临床与病理分析

A analysis of placental plant site intermediate trophoblast disease and tumor in clinical and pathological characteristics

目的:研究胎盘种植部位中间型滋养细胞病变的发病机理和病理组织学特征,探讨有效的治疗方法。方法:对5例子宫切除标本、6例刮宫(宫腔钳取)标本进行临床资料分析、病理检查、免疫组化HPL、CK、PLAP、HCG、p53、Ki-67标记。结果:10例胎盘部位超常反应(EPS)中既往有人流史占70%(7/10),她们中胎盘粘连发生率为71%(5/7),前置胎盘28%(1/7),4例因大出血切除子宫。1例胎盘部位滋养细胞肿瘤(PSTT)近期有水泡状胎块病史。种植部位中间型滋养细胞(IT)在EPS中无明显异型,但侵蚀子宫肌层、血管,可造成组织变性和纤维素样坏死;在PSTT中有异型性,组织出血、坏死较严重。IT对CK、HPL呈100%阳性表达、HCG<50%阳性、3例EPS Ki-67阴性、1例PSTT Ki-67弱阳性表达。结论:EPS是种植部位(IT)良性过度增殖结果,可能与先期子宫内膜损伤有关;子宫平滑肌、血管变性,影响收缩功能或同时引发了凝血机制障碍是分娩大出血原因,及时去除病灶是治疗的关键。PSTT为肿瘤性病变,与EPS及其他滋养细胞疾病鉴别时需结合影像学检查、免疫组化及电镜等,手术切除才能最终诊断与治疗。

Objective：To study the pathogenesis, pathological features of placental site intermediate trophoblast disease and to discuss the method of efficient treatment. Methods： The clinical characteristics and the pathological features were analysed in 11 patients including 5 cases of uterectomy and 6 cases of uterine curettement. All of the cases were marked HPL,CK,PLAP,HCG,p53 ,Ki- 67 by immunohistochemical staining. Results：There are seven of ten cases of exaggerated placental site （EPS） which had induced abortion story. Five cases had placental conglutination and placental previa was observed in one case, 4 cases had to have uterectomy for the hemorrhea in these seven cases. A case of placental site trophplastic tumor（PSTT） had a hydatidiform mole course recently. Placental site intermediate trophoblast（IT） was non-atypia in EPS, but they corroded the smooth muscles and the blood vessel of uterus and caused the tissues degeneration and fibrinoid necrosis. There were atypical IT and serious haemorrhage and necrosis in PSTT. Immunohistochemical stainingas for CK and HPL were positive in 11 cases （the positive rate is 100% ）, HCG was low （the positive rate is below 50% ）. Ki-67 were negative in 3 cases of EPS and was low positive in 1 case of PsTr. Conclusion：EPS were benign exaggerated placental implantation ＂site trophoblast and might be correlated with endometrial injury history. The degeneration of the smooth muscles and the blood vessel of uterus, restrain its contract function and/or caused the drawback of blood coagulation mechanism may be the reasons of massive haemorrhage in childbearing course. Removing the focus in time is the key to treatment. PSTT were genuine trophoblastic neoplasms. Distinction of PSTT from EPS and other trophoblast tumors must combine the photography, immunohistochemistry and electron microscopy with clinic feature and can be diagnosed by surgical removal at last. The surgical is the right therapy.