摘要目的 探讨剖官产术后不典型上皮样滋养细胞病变伴囊肿或瘘管形成的临床病理学特征,以进一步认识此类病变.方法 收集2007年4月至2018年6月浙江大学医学院附属妇产科医院4例子宫下段瘢痕处的剖官产术后不典型上皮样滋养细胞病变伴囊肿或瘘管形成的患者临床病理学资料,免疫组织化学染色采用EnVision二步法,观察病变的组织学特征并总结临床病理学特点.结果 4例患者均为女性,发病年龄为32～ 41岁(平均36.5岁).4例患者中,3例为包块切除标本,另1例为子宫次切标本.4例病变边界清楚,囊肿壁内衬4～ 10层单核滋养细胞,细胞膜清楚,核染色质略增粗,可见1～2个不明显的核仁,具有丰富的透明或嗜酸性细胞质,细胞周围可见纤维素样或透明变性物质沉积.免疫组织化学证实其具有典型的绒毛膜型中间型滋养细胞特点(CK18+,p63+,CD146-).4例患者均有随访资料,随访时间1～40个月(平均22个月),均无复发.结论 剖官产术后不典型上皮样滋养细胞病变伴囊肿或瘘管形成具有独特的组织学特征,其生物学行为及预后尚不明确,有待进一步探索.

abstractsObjective To elucidate the clinicopathologic characteristics of atypical epithelioid trophoblastic lesions with cyst and fistula formation after cesarean section.Methods The clinical and pathological data of 4 cases of post-cesarean atypical epithelioid trophoblastic lesions with cyst and fistula formation diagnosed at Women's Hospital,School of Medicine,Zhejiang University during April 2007 to June 2018 were evaluated by hematoxylin and eosin stain and EnVision two-step immunohistochemical staining technique.Results The age of the 4 patients ranged from 32 to 41 years,with a mean age of 36.5 years.Three patients recieved cystectomy and one underwent subtotal hysterectomy.Histologically,the lesions were well circumscribed and consisted of uniform cells of medium size,irregularly enlarged with hyperchromatic nuclei and 1 to 2 inconspicuous nucleoli embedded in abundant hyalinized matrix with fibrinoid material in the center.The cells exhibited immunohistochemical feature of chorionic-type intermediate trophoblastic cells (CK18+,p63+ and CD146-).All patients were alive without recurrence during follow-up of 1 to 40 months (mean=22 months).Conclusion Atypical epithelioid trophoblastic lesion with cyst and fistula formation after cesarean section has unique histological features,and its biological behavior and prognosis are still unclear,which need further exploration.