Yamamoto Y, Otsuka H, Numoto S, Kinoshita T, Doi T
Second Department of Pathology, University of Tokushima School of Medicine, Japan.
Acta Pathol Jpn. 1987 Dec;37(12):1979-86. doi: 10.1111/j.1440-1827.1987.tb03312.x.
The clinicopathological features of a 28-year-old woman with placental-site trophoblastic tumor (PSTT) are described. The patient presented with severe proteinuria and was found to have a cystic uterine tumor. The serum beta-human chorionic gonadotropin (hCG) level was only slightly elevated. The tumor extended to the serosa without gross metastasis, and was resected. The specimen was composed of active intermediate trophoblasts (IT) and degenerative or inactive ITs. The former component had round to oval and vesicular nuclei, and abundant amphophilic or lightly eosinophilic cytoplasm. The latter component had irregular-shaped pyknotic nuclei and deeply eosinophilic cytoplasm. However, the tumor lacked the bilaminar (cyto- and syncytiotrophoblastic) structure that is a characteristic feature of choriocarcinoma. Immunohistochemical evaluation with human placental lactogen (hPL) and hCG antisera revealed that most of the tumor cells contained abundant hPL, whereas only a small number of cells contained hCG. This method seemed to be most helpful for the differential diagnosis of PSTT from other trophoblastic tumors or non-trophoblastic uterine tumors, and also to be useful for determining the prognostic behavior of PSTT.
本文描述了一名28岁胎盘部位滋养细胞肿瘤（PSTT）患者的临床病理特征。该患者表现为严重蛋白尿，经检查发现患有囊性子宫肿瘤。血清β-人绒毛膜促性腺激素（hCG）水平仅略有升高。肿瘤侵犯至浆膜层，但无明显转移，遂行手术切除。标本由活跃的中间型滋养细胞（IT）和退变或不活跃的IT组成。前者细胞核呈圆形至椭圆形，核仁明显，胞质丰富，呈嗜双色性或轻度嗜酸性。后者细胞核固缩，形状不规则，胞质呈深嗜酸性。然而，该肿瘤缺乏绒毛膜癌特有的双相（细胞滋养层和合体滋养层）结构。用人胎盘催乳素（hPL）和hCG抗血清进行免疫组化评估显示，大多数肿瘤细胞含有丰富的hPL，而只有少数细胞含有hCG。该方法似乎对PSTT与其他滋养细胞肿瘤或非滋养细胞性子宫肿瘤的鉴别诊断最有帮助，也有助于判断PSTT的预后。
