Driscoll S G
Department of Pathology, Brigham and Women's Hospital, Boston, MA 02115.
J Reprod Med. 1987 Sep;32(9):623-8.
Proliferative lesions of gestational trophoblast pose problems of interpretation and pitfalls in differential diagnosis. Normally an actively proliferative and invasive tissue, healthy trophoblast shares cytologic features with malignant neoplasms. When trophoblastic hyperplasia accompanies macroscopic villous swelling, a diagnosis of hydatidiform mole (HM) is in order. Exuberant and atypical avillous trophoblast characterizes choriocarcinoma (CCA) and placental site trophoblastic tumor (PSTT). The distinction between them rests on the dimorphic composition of CCA as contrasted with the relative monomorphism of PSTT. Immunohistochemical studies contribute to the latter differential diagnosis. Unfortunately, two common conditions share morphologic features with the major lesions of gestational trophoblast. The hydropic abortus may resemble HM; the banal implantation site in normal early pregnancy and later spontaneous abortion may suggest either CCA or PSTT. Familiarity with the normal and benign variants of chorionic epithelium and thorough tissue sampling may be helpful in difficult cases. Ambiguous lesions that do not conform to conventional classification should be referred for consultation. A few, however, will not fit neatly into diagnostic categories. In such instances, a descriptive report and clear communication with the patient's physician provide the best current approach to clinical follow-up.
妊娠滋养细胞增生性病变在诊断解读方面存在问题，且在鉴别诊断中存在陷阱。正常情况下，健康的滋养细胞是一种活跃增殖和侵袭性的组织，其细胞学特征与恶性肿瘤有相似之处。当滋养细胞增生伴有肉眼可见的绒毛肿胀时，应诊断为葡萄胎（HM）。绒癌（CCA）和胎盘部位滋养细胞肿瘤（PSTT）的特征是旺盛且非典型的无绒毛滋养细胞。它们之间的区别在于CCA的双相组成与PSTT相对单一的形态形成对比。免疫组织化学研究有助于后者的鉴别诊断。不幸的是，有两种常见情况与妊娠滋养细胞的主要病变具有形态学特征。水肿性流产可能类似于HM；正常早期妊娠及后期自然流产时普通的着床部位可能提示CCA或PSTT。熟悉绒毛膜上皮的正常和良性变体并进行全面的组织采样，可能有助于处理疑难病例。不符合传统分类的不明确病变应转诊进行会诊。然而，有一些病变无法简单地归入诊断类别。在这种情况下，一份描述性报告以及与患者医生的清晰沟通是目前临床随访的最佳方法。
