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目的探讨中间型滋养细胞(IT)源性肿瘤即胎盘部位滋养叶细胞肿瘤(PSTT)及上皮样滋养细胞肿瘤(ETT)临床病理特征及免疫表型表达特点、诊断与预后。方法北京妇产医院1959—2005年中,因恶性滋养叶疾病住院治疗患者共1012例,从中筛选6例PSTT及1例ETT,对其临床特征、病理诊断要点及免疫组织化学(SP法)结果进行分析,抗体包括CK18、胎盘催乳素(hPL)、人绒毛膜促性腺激素(hCG)、Mel-CAM(CD146)及胎盘碱性磷酸酶(PLAP)。对照组为20例附有底蜕膜的早期绒毛及20例见有着床部位反应的葡萄胎。结果平均年龄PSTT为32·4岁,ETT为36岁;症状主要为阴道不规则出血和闭经;术前检查hCG呈正常→轻度→中度增高趋势,1例睾酮明显增高。5例PSTT术前行刮宫及宫腔镜切取标本之确诊率为3/5。镜下PSTT瘤细胞呈单个、条索状或片状浸润于肌纤维间,将单个或一束肌纤维分离;ETT则显示岛屿状细胞群位于玻璃样物及坏死物中,呈地图样结构。治疗手段以子宫切除术或术后辅以化疗为主。随访时间14个月至19年,其中1例PSTT术后5个月发生胰腺转移,单纯化疗PSTT患者疗效尚不能肯定,其余均无复发。结论PSTT与ETT分别为发生于着床部位IT及绒毛膜类型IT,二者有不同病理形态学,免疫组织化学特征性表达可辅助诊断和鉴别诊断;术前诊断性刮宫病理诊断具有重要临床意义;PSTT与ETT显示相同的生物学行为和预后。
Objective To investigate the clinicopathological characteristics, immunophenotype, diagnosis and prognosis of trophoblastic (IT) -derived tumor, placenta-derived trophoblastic tumor (PSTT) and epithelial-like trophoblastic tumor (ETT) Methods Beijing Obstetrics and Gynecology Hospital from 1959 to 2005, a total of 1012 hospitalized patients with malignant trophoblastic disease, screening of 6 cases of PSTT and 1 case of ETT, its clinical features, pathological diagnosis and immunohistochemistry (SP method) results Antibodies included CK18, hPL, hCG, Mel-CAM (CD146) and placental alkaline phosphatase (PLAP). The control group consisted of 20 cases of early decidual villi with decidua and 20 cases of hydatidiform mole with site reaction. Results The average age of PSTT was 32.4 years. The ETT was 36 years old. The main symptoms were irregular vaginal bleeding and amenorrhea. The preoperative hCG showed a tendency of normal, mild to moderate increase, and one case of testosterone was significantly higher. 5 cases of PSTT curettage and hysteroscopic specimens were confirmed by the rate of 3/5. Microscopically, the tumor cells of PSTT showed a single, cord-like or lamellar infiltration of muscle fibers, separated single or a bundle of muscle fibers; ETT showed that the island-shaped cell population was located in the glass-like and necrotic, map-like structure. Treatment of hysterectomy or postoperative adjuvant chemotherapy based. The follow-up time ranged from 14 months to 19 years. One of them had pancreas metastasis 5 months after the operation of PSTT. The curative effect of chemotherapy alone in patients with PSTT was not yet certain, and the rest had no recurrence. Conclusions PSTT and ETT are IT and chorion-type IT at the site of implantation, respectively. Both of them have different pathomorphology and immunohistochemical expression can be used to diagnose and differentiate the diagnosis. The diagnostic value of preoperative diagnostic curettage is of great clinical significance ; PSTT and ETT showed the same biological behavior and prognosis.