Ariel Ilana, Boldes Raphael, Weintraub Amir, Reinus Constantin, Beller Uzi, Arbel Revital
Perinatal Pathology Unit, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel.
Int J Gynecol Pathol. 2009 May;28(3):267-71. doi: 10.1097/PGP.0b013e31818f127f.
Chorangiocarcinoma is the name designated to a chorangioma with trophoblastic proliferation manifesting increased proliferative activity. Only 3 such cases have been published so far. Other studies challenged this entity by demonstrating that proliferation of the trophoblast around chorangioma is a common phenomenon. We present a case of a unique vascular lesion in a term placenta with a malignant trophoblastic component. Microscopic examination of a well-demarcated placental mass revealed a chorangioma with multiple nodules composed of pleomorphic cells displaying focal multinucleation, large areas of necrosis, and high mitotic activity. Immunohistochemical stains of these cells were strongly positive for pancytokeratin and the beta subunit of human chorionic gonadotropin and focally positive for HSD3B1. There was no invasion of the basement membrane, and no free-floating tumor cells in the intervillous space. No evidence of metastasis was found on follow-up of the mother and newborn. It is concluded that the tumor presented herein, displaying a histologically unequivocal malignant trophoblastic component in a benign chorangioma, is a true chorangiocarcinoma, and should be included within the category of gestational neoplasia as a tumor closely related to choriocarcinoma.
绒毛膜癌是指具有滋养层细胞增殖且增殖活性增加的绒毛膜血管瘤。迄今为止，仅发表过3例此类病例。其他研究对这一实体提出质疑，表明绒毛膜血管瘤周围的滋养层细胞增殖是一种常见现象。我们报告一例足月胎盘中具有恶性滋养层成分的独特血管病变病例。对一个界限清楚的胎盘肿物进行显微镜检查，发现一个绒毛膜血管瘤，有多个结节，由多形性细胞组成，显示局灶性多核、大片坏死和高有丝分裂活性。这些细胞的免疫组化染色对全细胞角蛋白和人绒毛膜促性腺激素β亚基呈强阳性，对HSD3B1呈局灶性阳性。未见基底膜侵犯，绒毛间隙也无游离的肿瘤细胞。对母亲和新生儿进行随访，未发现转移证据。结论是，本文所呈现的肿瘤，在良性绒毛膜血管瘤中显示出组织学上明确的恶性滋养层成分，是一种真正的绒毛膜癌，应作为与绒毛膜癌密切相关的肿瘤纳入妊娠性肿瘤类别。
