早期完全性水泡状胎块临床病理分析

Clinicopathological Analysis of Early Complete Hydatidiform Moles

目的探讨早期完全性水泡状胎块的临床病理及免疫组化特征、鉴别诊断及治疗与预后。方法回顾性分析43例早期完全性水泡状胎块的临床资料、病理学及免疫组化特征以及预后随访。结果 28例早期完全性水泡状胎块以阴道出血为首发症状,21例患者既往有流产史,26例肉眼可见散在大小不一的小水泡。镜下观察部分绒毛增大水肿伴中央水池形成,多量的球茎状的终末绒毛伴周围滋养细胞不规则出芽性增生;绒毛间隙和胎盘种植部位滋养细胞非典型性增生;富于细胞的嗜碱性粘液样绒毛间质内可见迷路状的血管网形成及多量核碎片。免疫组化显示p57在绒毛间质及细胞滋养细胞表达阴性。40例患者随访均未出现继发性滋养细胞疾病。结论早期完全性水泡状胎块有相对独特的临床及组织病理学及免疫组化特征,预后良好。

Objective To investigate the clinicopathological and immunohistochemical features,differential diagnosis and prognosis of early complete moles（ECM）.Methods A retrospective analysis was conducted on the clinical data,histopathological and immunohistochemical features and follow-up of the 43 cases of ECM.Results 28 of 43 patients had vaginal bleeding as the first symptom,21 of 43 patients had miscarriage history.Grossly,enlarged villi forming variant transparent vesicles were showed in 26 cases.Histologically,most villi showed striking edema and some contained center cisterns,so did redundant bulbous budding of terminal villi with circumferential trophoblastic sprouts-like proliferation.Besides hyperplasia and cytologic atypia of the intervillous trophoblast and implantation-site trophoblast,there were hypercellular villous stroma with labyrinthine vascular networks associated with myxoid background and karyorrhexis debris.Immunohistochemically,p57 was negative in villous stromal cells and cytotrophoblasts.No gestational trophoblastic diseases occurred during the follow-up on 40 patients.Conclusion ECM has unique clinicopathological and immunohistochemical features and good prognosis.