Collins R J, Ngan H Y, Wong L C
Department of Pathology, University of Hong Kong.
Int J Gynecol Pathol. 1990;9(2):170-7. doi: 10.1097/00004347-199004000-00008.
Chorionic villi, whose presence in cases of trophoblastic disease is normally used to exclude both a choriocarcinoma and placental site trophoblastic tumor (PSTT), were present in the initial uterine curettage specimen of a trophoblastic tumor. The lesion shared morphologic features of both an exaggerated placental site reaction and a PSTT. There was infiltration of the posterior wall of the uterus by small clusters and isolated cells which had a prominent affinity for vessels and resembled a usual placental bed reaction. There was, however, deep involvement of myometrium with extension to the cervix, and the condition persisted for 5 months after uterine evacuation. Because different treatment is entailed, identification of this lesion as a tumor of nonvillous trophoblast is also of great importance in a region where the more usual forms of trophoblastic disease represent a declining but not infrequent event. When products of gestation are examined, the possibility of a PSTT should be considered and the clinician alerted if there is a suggestion of excessive intermediate trophoblastic activity, regardless of the presence of chorionic villi. While this may result in the unnecessary followup of some cases, it would permit, with the aid of serial beta-hCG and HPL levels, the earlier detection of PSTTs.
绒毛膜绒毛在滋养层疾病病例中通常用于排除绒毛膜癌和胎盘部位滋养层肿瘤（PSTT），而在一例滋养层肿瘤的初次刮宫标本中发现了绒毛膜绒毛。该病变具有过度胎盘部位反应和PSTT的形态学特征。子宫后壁有小簇状和散在的细胞浸润，这些细胞对血管有明显的亲和力，类似正常的胎盘床反应。然而，肌层有深部浸润并延伸至宫颈，且在子宫排空后该情况持续了5个月。由于需要不同的治疗方法，在该地区将这种病变识别为非绒毛滋养层肿瘤也非常重要，在该地区，更常见的滋养层疾病形式虽呈下降趋势但仍不罕见。当检查妊娠产物时，应考虑PSTT的可能性，如果有中间滋养层过度活跃的迹象，无论有无绒毛膜绒毛，都应提醒临床医生。虽然这可能会导致对一些病例进行不必要的随访，但借助连续的β - hCG和HPL水平，可更早地发现PSTT。
