Manivel J C, Niehans G, Wick M R, Dehner L P
Am J Surg Pathol. 1987 Sep;11(9):693-701. doi: 10.1097/00000478-198709000-00005.
One-hundred-twenty-four germ cell tumors and 11 gestational choriocarcinomas were assessed immunohistochemically for the presence of the following placental markers: human chorionic gonadotrophin, human placental lactogen, and pregnancy-specific beta-1 glycoprotein, and for the expression of cytokeratin. A total of 40 cases contained syncytial trophoblastic cells, large mononuclear cells, or both. These cases included all gestational choriocarcinomas and choriocarcinomatous foci in 11 mixed germ cell tumors, 14 embryonal carcinomas, and four seminomas. Syncytial trophoblastic cells reactive for cytokeratin were identified in all choriocarcinomas, 12 embryonal carcinomas, and two seminomas. Human placental lactogen-reactive syncytial trophoblastic cells were observed in nine gestational choriocarcinomas, 10 choriocarcinomatous foci in mixed germ cell tumors, four embryonal carcinomas, and one seminoma. Pregnancy-specific beta-1 glycoprotein-reactive syncytial trophoblastic cells were seen in 10 gestational choriocarcinomas, all choriocarcinomatous foci in mixed germ cell tumors, 11 embryonal carcinomas, and one seminoma. Cytotrophoblasts, as expected, were identified only in choriocarcinomas. Cytokeratin-reactive cytotrophoblast was seen in all gestational choriocarcinomas and 10 choriocarcinomatous foci in mixed germ cell tumors. Human chorionic gonadotrophin-reactive cytotrophoblast was observed in two gestational choriocarcinomas and three choriocarcinomatous foci in mixed germ cell tumors. Cytotrophoblast was uniformly nonreactive for human placental lactogen and pregnancy-specific beta-1 glycoprotein. Cytokeratin-reactive large mononuclear cells were observed in 10 gestational choriocarcinomas, all choriocarcinomatous foci in mixed germ cell tumors, five embryonal carcinomas, and three seminomas. Human placental lactogen-reactive large mononuclear cells were identified in nine gestational choriocarcinomas, seven choriocarcinomatous foci in mixed germ cell tumors, one embryonal carcinoma, and one seminoma. Pregnancy-specific beta-1 glycoprotein-reactive large mononuclear cells were present in 10 gestational choriocarcinomas, 10 choriocarcinomatous foci in mixed germ cell tumors, two embryonal carcinomas, and two seminomas. Because of morphologic and immunohistochemical similarities of large mononuclear cells with intermediate trophoblast of the normal placenta and gestational trophoblastic neoplasms, we propose that the large mononuclear cells in gonadal and extragonadal germ cell neoplasms are equivalent to the intermediate trophoblast.
对124例生殖细胞肿瘤和11例妊娠性绒毛膜癌进行免疫组织化学评估，以检测以下胎盘标志物的存在：人绒毛膜促性腺激素、人胎盘催乳素和妊娠特异性β1糖蛋白，并检测细胞角蛋白的表达。共有40例含有合体滋养层细胞、大单核细胞或两者皆有。这些病例包括所有妊娠性绒毛膜癌以及11例混合性生殖细胞肿瘤、14例胚胎癌和4例精原细胞瘤中的绒毛膜癌灶。在所有绒毛膜癌、12例胚胎癌和2例精原细胞瘤中均鉴定出对细胞角蛋白呈反应性的合体滋养层细胞。在9例妊娠性绒毛膜癌、混合性生殖细胞肿瘤中的10个绒毛膜癌灶、4例胚胎癌和1例精原细胞瘤中观察到对人胎盘催乳素呈反应性的合体滋养层细胞。在10例妊娠性绒毛膜癌、混合性生殖细胞肿瘤中的所有绒毛膜癌灶、11例胚胎癌和1例精原细胞瘤中可见对妊娠特异性β1糖蛋白呈反应性的合体滋养层细胞。如预期的那样，仅在绒毛膜癌中鉴定出细胞滋养层细胞。在所有妊娠性绒毛膜癌和混合性生殖细胞肿瘤中的10个绒毛膜癌灶中可见对细胞角蛋白呈反应性的细胞滋养层细胞。在2例妊娠性绒毛膜癌和混合性生殖细胞肿瘤中的3个绒毛膜癌灶中观察到对人绒毛膜促性腺激素呈反应性的细胞滋养层细胞。细胞滋养层细胞对人胎盘催乳素和妊娠特异性β1糖蛋白均无反应。在10例妊娠性绒毛膜癌、混合性生殖细胞肿瘤中的所有绒毛膜癌灶、5例胚胎癌和3例精原细胞瘤中观察到对细胞角蛋白呈反应性的大单核细胞。在9例妊娠性绒毛膜癌、混合性生殖细胞肿瘤中的7个绒毛膜癌灶、1例胚胎癌和1例精原细胞瘤中鉴定出对人胎盘催乳素呈反应性的大单核细胞。在10例妊娠性绒毛膜癌、混合性生殖细胞肿瘤中的1个绒毛膜癌灶、2例胚胎癌和2例精原细胞瘤中存在对妊娠特异性β1糖蛋白呈反应性的大单核细胞。由于大单核细胞在形态学和免疫组织化学上与正常胎盘和妊娠滋养层肿瘤的中间滋养层相似，我们提出性腺和性腺外生殖细胞肿瘤中的大单核细胞等同于中间滋养层。
