子宫上皮样滋养细胞肿瘤临床病理观察

Epithelioid trophoblastic tumor of uterus:a clinicopathologic observation

目的 探讨子宫上皮样滋养细胞肿瘤（ETT）的临床病理特征、生物学行为及预后。方法 分析1例子宫ETT的临床和病理资料，并复习相关文献。结果 患者女性，48岁。经期延长、不规则阴道出血2年。大体见子宫峡部有一病灶呈溃疡状，直径3cm伴出血、坏死，肿瘤浸润肌层距浆膜〈0．1cm。镜下见ETT呈膨胀性生长，推进式浸润子宫肌层；肿瘤由绒毛膜型中间滋养细胞组成，瘤细胞排列成巢状、片状、团块状，位于玻璃样或嗜伊红色肿瘤坏死碎屑组织中，形成“地图样外观”；上皮样分化瘤细胞中～大，胞质透亮或嗜伊红色，细胞境界清楚，核不规则、核仁明显；细胞巢中央可见小血管。肿瘤细胞AE1／AK3、CK18、inhibin、HCG、PLAP、p63和Ki-67均（＋）。结论 ETT是一种罕见的滋养细胞肿瘤，具有恶性的生物学行为，但恶性程度较低。ETT应与宫颈鳞状细胞癌及其他滋养细胞肿瘤等鉴别。

Objective To investigate the clinicopathological features of epithelioid trophoblastic tumor （ETT） of the uterus and its behaviour and prognosis. Methods The clinicopathological data of 1 case of ETT was analysed and the literature was reviewed. Results A 48-year-old woman presented with delayed menstruation and abnormal vaginal bleeding for 2 years. Gross examination of the hysterectomy specimen revealed an ulcerated mass involving uterine isthmus. The ttunor was 3 cm in size and was necrotic with areas of hemorrhage, grossly infiltrating myometrium and less than 0.1 cm from the serosal surface. Microscopically, the ttunor grew in an expansile fashion that invaded the myometrium with a pushing border. The tumor was composed of chorionic type intermediate trophoblast cells arranged in nests, sheets and cords, which distributed in a geographical parttem with hyalinization or eosinophilic debris of tumor cell necrosis, the epithelial-differentiated tumor cell contained abundant eusinophilic or clear cytoplasm and medium to large, distinct cell borders, irregular nuclei with distinct nucleoli. In the center of tumor nests, there was blood vessels. Immununhistechemical staining revealed reactivity to AE1/AK3, CK18, HCG, inhibin, PLAP, P63 and Ki-67 in tumor cells. Conclusion E1T is a rare gestational trophoblastic tumor that has malignant biological behaviour of lower grade. ETT should be differentiated from cervical squamous cell carcinoma, and other trophoblastic tumors.