摘要目的 探讨子宫胎盘部位中间型滋养细胞疾病的临床病理特点,归纳鉴别诊断要点.方法 收集15例胎盘部位过度反应(EPS)和1例胎盘部位滋养细胞肿瘤(PSTT),分析临床资料、病理学形态及免疫组化标记:胎盘碱性磷酸酶(PLAP)、人胎盘催乳素(HPL)、人绒毛膜促性腺激素(HCG)、细胞角蛋白(CK)、癌胚抗原(CEA)和细胞增殖指数(Ki-67),并结合文献.结果 15例EPS与1例PSTY均以中间型滋养细胞为主,向蜕膜、子宫平滑肌和血管浸润,EPS浸润肌层<1/3,坏死较轻,细胞异型性不明显,极少核分裂;PSTT浸润肌层>1/3,可见出血、坏死,细胞异型性明显,核分裂易见.两者在PLAP、HPL、HCG、CK18和CEA的表达相似,而Ki67有明显差异.结论 EPS和PSTT诊断及与其他滋养细胞疾病的鉴别主要依据临床病史、病理学形态和免疫组化.

abstractsObjective To study the clinicopatholgical features of placental site intermediate trophoblast diseases and tumors,and to highlight their differential diagnosis.Methods The clinical characteristics and the pathological features were analyzed in 15 case of exaggerated placental site(EPS)and one case of placental site trophoblastic tumor(PSTT),and a panel of immunohistochemical markers including PLAP,HPL,HCG,CK,CEA and Ki-67 wag determined,and related literatures were reviewed.Results Morpholocally,all 15 cases of EPS and one case of PSTT mainly consists of intermediate trophoblastic cells which infiltrate into the decidua,myometrium and the walls of blood vessels.The depth of muscular layers infiltrated by EPS were less than 1/3 of myometrium,with Inild necrosis,few nuclear dysplasia and mitosis;however,that by PSTT were more than 1/3 of myometrium,with large areas of haemorrhage and necrosis,evident dysplasia and mitosis.Immunohistochemically,CK,HPL,HCG,PLAP and CEA are not useful for differentiation,while Ki67 can be helpful.Conclusion The diagnosis of EPS and PSTT and the differential diagnosis with other GTDs are based on clinical history,pathological morphology and immunohistochemical staining