胎盘间叶发育不良5例临床病理分析

Clinicopathological analysis of 5 cases of placental mesenchymal dysplasia

目的探讨胎盘间叶发育不良(placental mesenchymal dysplasia,PMD)的临床病理学特征、诊断、鉴别诊断及预后。方法对5例PMD的临床、病理进行回顾性分析,并复习相关文献。结果 5例患者因自觉胎动消失或妊娠期常规超声检查时发现异常而就诊,可见患者胎盘增大,不同范围水肿、呈葡萄状。组织学表现为胎盘绒毛间质不同程度水肿,伴异常的厚壁小血管;绒毛膜板血管扩张并充血,部分绒毛间质成纤维细胞过度增生,无滋养细胞增生。免疫组化标记p57呈阳性,Ki-67增殖指数低。PMD需与葡萄胎进行鉴别诊断。2例伴有胎死宫内。结论 PMD确诊需经病理学检查,当超声检查发现囊性胎盘时,应在鉴别诊断中考虑PMD的可能。

Purpose To explore the clinieopathological features, diagnosis, differential diagnosis and prognosis of placental mesenchymal dysplasia. Method The clinicopathological data of 5 cases with placental mesenchymal dysplasia were retrospectively analysed and related literatures were also reviewed. Results All of 5 patients were consciously fetal move- ment disappeared or found abnormal ultrasound results at routine examination of the pregnancy. The placentas were enlarged, partly with oedematous ＇grape-like＇ cysts. On histologic examination, enlarged villi with varying degrees of edema contained abnormal thick walled fetal blood vessels. The chorionic vessels were expanded and congested, and some chorionie villi showed mesenchymal cell hyperplasia, In immunohistochemical staining, p57 was positive, and Ki-67 showed low expression. There was no the trophoblastic proliferation. It＇ s mainly differential diagnosis was hydatidiform mole. 2 cases were accompanied with stillbirth. Conclusion The diagnosis of placental mesenchymal dysplasia can be confirmed by pathology examination. When a cystic placenta is detected by ultrasound examina- tion, placental mesenchymal dysplasia should be considered in the differential diagnosis.