胎盘部位滋养细胞肿瘤一例报告

Placental site trophoblastic tumor: a case report

胎盘部位滋养细胞肿瘤(PSTT)是一种罕见的妊娠滋养细胞疾病。该文报道了1例罕见的PSTT,该例为29岁女性患者,因停经52 d、异常阴道出血2 d前来就诊,予清宫术,宫腔刮出物送病理检查,其镜下瘤细胞为大、多角,胞质嗜酸,形态似中间滋养细胞,局部查见小片游离肿瘤细胞往肌组织之间穿插,可见肿瘤细胞从血管外向血管腔内浸润,并取代血管壁。免疫组织化学染色示广谱细胞角蛋白、细胞角蛋白8/18、GATA-3、CyclinE阳性,CD10、胎盘催乳素部分阳性,人绒毛膜促性腺激素主要表达于多核中间滋养细胞,余指标均阴性,Ki-67标记指数20%。患者术后恢复良好。该例诊治提示,育龄期女性停经或异常阴道出血要高度警惕PSTT,结合组织学形态及免疫组织化学检测,可以对PSTT做出正确诊断,PSTT的鉴别诊断需排除胎盘部位过度反应等滋养细胞疾病。

Placental site trophoblastic tumor(PSTT) is a rare form of gestational trophoblastic disease(GTD). In this article, we reported one rare case of PSTT. The female patient, aged 29-year old, was admitted to our hospital due to menopause for 52 d and abnormal vaginal bleeding for 2 d. She received curettage and the uterine specimen was collected for pathological examination. Microscopically, the tumor was composed of a relatively monotonous population of polygonal cells with moderately abundant cytoplasm consistent with the appearance of extravillous(intermediate) trophoblast. A small mass of free tumor cells were observed to penetrate into muscular tissues in partial areas. The tumors cells were infiltrated from the outside into the vascular lumen and replaced the vascular wall. Immunohistochemical staining revealed that the tumor cells were positive for PCK, CK8/18, GATA-3 and CyclinE, and partially positive for CD10 and HPL. HCG was mainly expressed in multicore intermediate trophoblast. And the other parameters were negative. Ki-67 Li was 20% positive. The patient was recovered well after surgery. The diagnosis and treatment of this case prompt that the possibility of PSTT should be considered for young women presenting with menopause or abnormal vaginal bleeding. Histological morphology combined with immunohistochemical detection can make an accurate diagnosis of PSTT. PSTT should be distinguished from other GTDs, such as exaggerated placental site(EPS).