Cramer Stewart F, Heller Debra S
1 Department of Pathology, Rochester General Hospital, University of Rochester School of Medicine, Rochester, New York, USA.
2 Pathology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
Pediatr Dev Pathol. 2017 Mar-Apr;20(2):152-157. doi: 10.1177/1093526616681939. Epub 2017 Jan 25.
Exaggerated placental site (EPS) is usually an incidental finding seen in curettings after an abortion. Placenta increta is, by definition, a disease that damages and destroys myometrium; however, prior literature has not paid sufficient attention to the role of myometrium in its pathogenesis and diagnosis. We present an unusual case of placenta increta in a hysterectomy performed for uterine perforation after curettage for the termination of pregnancy at 18 weeks. The initial histologic section of the implantation site suggested EPS. Actin stains showed degenerated inflamed muscle at the EPS-like site, keratin stains showed interstitial trophoblast in the zone of myometrial damage, and the wall of the corpus was grossly thinned under the placenta. The myometrial damage may have softened the wall, predisposing to uterine perforation by the curettage procedure.
胎盘部位超常增生（EPS）通常是流产后刮宫标本中的偶然发现。根据定义，胎盘植入是一种损害和破坏子宫肌层的疾病；然而，既往文献对子宫肌层在其发病机制和诊断中的作用关注不足。我们报告一例罕见的胎盘植入病例，患者因妊娠18周行刮宫术终止妊娠后子宫穿孔而接受子宫切除术。植入部位的初始组织学切片提示为EPS。肌动蛋白染色显示在EPS样部位有变性发炎的肌肉，角蛋白染色显示子宫肌层损伤区域有间质滋养细胞，胎盘下方子宫体壁明显变薄。子宫肌层损伤可能使子宫壁变软，易因刮宫操作导致子宫穿孔。
