Fukunaga M, Ushigome S
Department of Pathology, Jikei University School of Medicine, Tokyo, Japan.
Am J Surg Pathol. 1993 Oct;17(10):1003-10. doi: 10.1097/00000478-199310000-00005.
An immunohistochemical and flow cytometric DNA study of two cases of metastasizing placental site trophoblastic tumor are presented. One patient aged 29 died rapidly of widespread metastases despite hysterectomy and multiagent chemotherapy. The patient had a low level of serum HCG. The course was complicated by the presence of a nephrotic syndrome. The other patient aged 34 had a vaginal metastasis and high levels of serum HCG, and was alive without disease for 9 years after hysterectomy and chemotherapy. Histologically, these tumors were characterized by a monomorphic trophoblastic cell population, probably derived from intermediate trophoblast in the placental site. The mitotic rate in these tumors was 2-4/10 high-power fields. Immunohistochemically, many tumor cells contained human placental lactogen and placental alkaline phosphatase. Beta-unit chorionic gonadotropin was present in many cells of the second patient, and only focally in the first. All specimens including the curettaged and metastatic lesions revealed a diploid DNA content in both cases. Neither DNA ploidy nor S-phase fraction was associated with survival of patient. Since predicting the biologic behavior of placental site trophoblastic tumor is very difficult, making a correct diagnosis on endometrial curettings, hysterectomy, and monitoring serum HCG level is essential in patients with this tumor.
本文报告了两例转移性胎盘部位滋养细胞肿瘤的免疫组化及流式细胞术DNA研究。一名29岁患者尽管接受了子宫切除术和多药化疗，但仍因广泛转移而迅速死亡。该患者血清HCG水平较低。病程因肾病综合征的出现而复杂化。另一名34岁患者有阴道转移，血清HCG水平较高，在子宫切除术和化疗后9年无病存活。组织学上，这些肿瘤的特征是单一形态的滋养细胞群体，可能来源于胎盘部位的中间滋养细胞。这些肿瘤的有丝分裂率为2-4/10个高倍视野。免疫组化显示，许多肿瘤细胞含有人类胎盘催乳素和胎盘碱性磷酸酶。β-亚单位绒毛膜促性腺激素在第二名患者的许多细胞中存在，在第一名患者中仅局灶性存在。所有标本，包括刮宫标本和转移灶，在两例中均显示二倍体DNA含量。DNA倍体和S期分数均与患者的生存无关。由于预测胎盘部位滋养细胞肿瘤的生物学行为非常困难，因此对患有该肿瘤的患者进行子宫内膜刮宫、子宫切除的正确诊断以及监测血清HCG水平至关重要。
