10例胎盘部位结节或斑块的临床病理分析

Clinicopathological analysis on 10 cases with placental site nodules and plaques

目的探讨胎盘部位结节或斑块(PSN/P)的临床表现、病理学特征,并研究其诊断和鉴别诊断要点及临床意义。方法收集北京市垂杨柳医院病理科2005-2016年间诊断的10例PSN/P病例进行回顾性研究,分析其临床资料特点、随访结果,镜下病理组织学观察,并进行免疫组织化学(组化)染色。结果患者年龄22~48岁,平均(32.90±8.52)岁;患者妊娠史1~2次,所有患者距上次妊娠间隔3~130个月,平均(43.90±44.64)个月,8例患者因阴道不规则出血就诊,其中1例患者伴有水泡状胎块病史,1例患者因宫颈低级别鳞状病变(LSIL)就诊,1例为剖宫产术中发现,随访6例患者均未再出现异常阴道出血情况。镜下特征:增殖期子宫内膜6例,子宫内膜增殖症1例,子宫内膜不规则增殖2例,蜕膜组织及浅层平滑肌组织1例;在内膜组织内可见到单发或多发的玻璃样变性的结节,境界清楚,结节内可见多少不等的绒毛膜中间型滋养细胞(IT);免疫组化染色结果较一致,10例PSN/P患者均CK8、P63、Inhibin-α(+),PLAP、hPL、CK5、CD146、HCG(-),Ki67增殖指数0%~3%。结论 PSN/P是一种来源于绒毛膜IT的良性非肿瘤性病变。

Objective To explore the clinical manifestations and pathological features of placental site nodules and plaques（ PSN/P）,research the key points of diagnosis and differential diagnosis and the clinical significance. Methods Ten patients diagnosed as PSN/P in Department of Pathology in the hospital from 2015 to 2016 were collected,then a retrospective analysis was conducted,the characteristics of clinical data and follow-up results were analyzed,pathohistological changes were observed under microscope,immunohistochemical staining was performed. Results The age of patients ranged from 22 to 48 years,（ 32. 90± 8. 52） years on average. All the patients had pregnancy history for one or two times,the interval time to the last pregnancy ranged from 3 to 130 months,（ 43. 90±44. 64） months on average. Eight patients went to the hospital because of abnormal vaginal bleeding,one patient had medical history of hydatidiform mole,one patient went to the hospital because of low-grade squamous intraepithelial lesion（ LSIL）,one patient was found during cesarean section. During follow-up,six patients were not found with abnormal vaginal bleeding. The characteristics under microscope： proliferative stage of endometrium（ six patients）,endometrial hyperplasia（ one patient）,irregular endometrial proliferation（ two patients）,decidual tissue and superficial layer smooth muscle tissue（ one patient）. Single or multiple small hyaline degeneration nodular lesions were found in endometrial tissue,which were well demarcated,in which intermediate trophoblasts were found. The results of immunohistochemical staining were in agreement. CK8,P63,inhibin-α（ ＋）,PLAP,hPL,CK5,CD146,HCG（-）,Ki67 were found among the ten patients,proliferation index was less than 3%. Conclusion PSN/P is a kind of benign lesion,which is derived from chorionic intermediate trophoblasts.