超常胎盘部位的病理形态与免疫组化研究

Pathological and immunohistochemical study of exaggerated placental site

目的：探讨超常胎盘部位（ＥＰＳ） 的病理形态与免疫组化特征，提出鉴别诊断要点。方法：对１７ 例经病理检查诊断为ＥＰＳ的病例进行病理学形态观察，采用免疫组化方法标记滋养细胞ＨＣＧ、ＨＰＬ、ＥＭＡ、ＰＲＬ、ＰＬＡＰ、Ｖｉｍ 、ａｃｔｉｎ、ｃｅｒｂＢ２ 和ｃｍｙｃ。结果：ＥＰＳ组织学特征为以中间型为主的滋养细胞向蜕膜及平滑肌浸润，不破坏原有组织结构，并保留部分胎盘床特点。免疫组化标记ＨＰＬ、ＥＭＡ呈阳性或强阳性，ＨＣＧ多为弱阳性，其他多为阴性。结论：ＥＰＳ属于中间型滋养细胞为主的妊娠滋养细胞疾病。鉴别诊断应结合组织学、免疫组化及临床表现综合判断。

Purpose To study the pathological features and immunohistochemical expressions of exaggerated placental site (EPS) and to propose its differential diagnosis. Methods The pathological features of EPS were observed in 17 cases, and the expressions of HCG, HPL, EMA, PRL, PLAP, Vim, actin, c erbB 2 and c myc were analyzed immunohistochemically. Results The histological features of EPS were that trophoblasts, mainly intermediate trophoblast (IT), infiltrated into decidua and myometrium layers, while original histological features were not destroyed, and placental site features were remained partially. The expressions of HPL and EMA were positive or strongly positive in all cases, HCG weakly positive in the most cases. Conclusion EPS is a lesion of gestational trophoblastic disease primarily involving IT. Its differential diagnosis depends on combining histological characteristics, immunohistochemical findings and clinical features.