人胎盘泌乳素标记中间滋养细胞的诊断价值

Diagnostic value of HPL-expressed intermediate trophoblasts

目的探讨人胎盘泌乳素(HPL)标记中间滋养细胞的诊断价值,藉以协助诊断宫内、外孕及进一步确定超常胎盘部位病变(EPS)、胎盘部位结节(PSN)、胎盘部位滋养细胞肿瘤(PSTT)和上皮样滋养细胞肿瘤(ETT)。方法Ⅰ组:选择蜕膜中疑似中间滋养细胞植入标本15例;Ⅱ组:宫内膜间质细胞肥硕呈蜕膜样变和/或宫内膜腺上皮呈A-S现象标本10例;Ⅲ组:妊娠滋养细胞疾病EPS 2例、PSN 1例、PSTT 4例、ETT 1例,共8例;对照组:宫内孕标本15例;对观察的3组测定免疫组化HPL(SP法)。结果对照组15例宫内孕具备蜕膜及绒毛,11例HPL(+),4例(-)。Ⅰ组15例蜕膜组织疑似中间滋养细胞(IT)植入,12例HPL(+),证实为宫内孕;3例(-),其中1例为宫内孕,2例为宫外孕。Ⅱ组10例蜕膜样组织伴/不伴A-S现象,其中5例HPL(+)均为宫内孕;5例(-),其中4例为宫外孕,1例为宫内孕。Ⅲ组EPS 2例、PSN 1例、PSTT 4例及ETT 1例,其中间滋养细胞肿瘤HPL均呈(+)。结论Ⅰ组和Ⅱ组HPL(+)测定种植型中间滋养细胞对诊断宫内孕发生率高达76%,宫外孕24%。Ⅰ组和Ⅱ组HPL阳性100%为宫内孕,HPL阴性75%为宫外孕,25%为宫内孕。妊娠滋养疾病共8例,HPL阳性表达率达100%,故均具有诊断价值。

Objective To explore the value of the HPL-expressed intermediate trophoblast cells in the diagnosis of intrauterine or ectopie pregnancy in order to further identify the exaggerated placental site （EPS）, placental site nodule （PSN）, placental site trophoblast tumor （PSTF） and epithelioid trophoblast tumor （ETT）. Methods The specimens included： 15 cases of suspected intermediated trophoblast （IT） implantation part of intrauterine decidua （ group Ⅰ）, 10 cases of decidua-like, plump endometrial stromal cells and/or endometrial glandular epithelia showing A-S phenomenon （group Ⅱ ）, 2 cases of EPS, 1 ease of PSN, 4 cases of PSTF, and 1 ease of ETF （group Ⅲ）. 15 eases of intrauterine pregnancy specimen with deeiduas and villi were chosen in control group. HPL was detected in all specimens mentioned above with S-P method of In control group, 1 1 cases were positive for HPL and 4 cases were negative. In group Ⅱ , 12 cases were positive for HPL, which was confirmed as intrauterine pregnancy, and 3 cases were negative, in which 1 case confmned as intrauterine pregnancy, and the other 2 cases were ectopic pregnancy. In group Ⅱ, 5 cases were HPL （ ＋ ）, which was confirmed as intrauterine pregnancy, and 4 in 5 HPL- negative cases were confn-med as ectopic pregnancy and 1 case was intrauterine pregnancy. In group Ⅲ HPL were positively expressed in the intermediate trophoblastic tumor cells in 2 cases of EPS, 1 case of PSN, 4 cases of PSTT and 1 cases of ETY. Conclusions By detection of HPL expression in the implantal IT, the positive rate for diagnosis of intrauterine pregnancy is 76% （ 19/25 cases）, and 6/25 cases are positive for ectopic pregnancy in groups Ⅰ and Ⅱ . For cases with HPL （ ＋ ）, 17/17 cases are intrauterine pregnancy; however, for HPL （ - ） patients, 6/8 cases （75%） are ectopic pregnancy and 25% of intrauterine pregnancy. All the cases of gestational trophoblastic diseases （including EPS, PSN, PSIT and ETY） are HPL （ ＋ ） in group Ⅲ . Therefore, HPL expression has certainly diagnostic value in these diseases.