CAJ | 학술논문

目的探讨子宫上皮样滋养细胞肿瘤(ETT)的临床病理特征及鉴别诊断,及其与预后相关因素.方法回顾浙江大学附属妇产科医院2000-2007年间共5例ETT病例,分析其临床病理及CK18、p63、α-抑制素、人绒毛膜促性腺激素(HCG)、人胎盘泌乳素(HPL)、胎盘碱性磷酸酶(PLAP)、Ki-67等免疫表型特征.对所有病例随访11～50个月,并简要分析预后相关因素.结果 5例ETT病例均为生育年龄妇女,平均年龄33岁,发生率占同期妊娠滋养细胞疾病0.48%(5/1037).镜下见肿瘤由相对一致的单核滋养细胞排列成结节状浸润生长,肿瘤细胞巢中可见玻璃样物质.肿瘤坏死较常见,典型者可呈地图状坏死.肿瘤细胞CKl8、p63弥漫阳性,HCG、HPL、PLAP灶性阳性或阴性.α-抑制素表现为阳性或阴性.随访期间,死亡2例:1例核分裂象达15/10 HPF,发病1年后死亡,另1例发生肺转移,2年后死亡.结论 ETT是一种罕见的滋养细胞疾病,具有独特的组织形态和免疫表型特征,核分裂象高与发生肺转移的病例预后可能较差.
목적 탐토자궁상피양자양세포종류(ETT)적림상병리특정급감별진단,급기여예후상관인소.방법 회고절강대학부속부산과의원2000-2007년간공5례ETT병례,분석기림상병리급CK18、p63、α-억제소、인융모막촉성선격소(HCG)、인태반비유소(HPL)、태반감성린산매(PLAP)、Ki-67등면역표형특정.대소유병례수방11～50개월,병간요분석예후상관인소.결과 5례ETT병례균위생육년령부녀,평균년령33세,발생솔점동기임신자양세포질병0.48%(5/1037).경하견종류유상대일치적단핵자양세포배렬성결절상침윤생장,종류세포소중가견파리양물질.종류배사교상견,전형자가정지도상배사.종류세포CKl8、p63미만양성,HCG、HPL、PLAP조성양성혹음성.α-억제소표현위양성혹음성.수방기간,사망2례:1례핵분렬상체15/10 HPF,발병1년후사망,령1례발생폐전이,2년후사망.결론 ETT시일충한견적자양세포질병,구유독특적조직형태화면역표형특정,핵분렬상고여발생폐전이적병례예후가능교차.
Objective To study the clinicopathologic features,immunophenotype,differential diagnosis and prognosis of uterine epithelioid trophoblastic tumor(ETT).Methods From 2000 to 2007,5 ETTs cases were diagnosed in the affiliated Women's Hospital,School of Medicine,Zhejiang University.The pathologic characteristics and immunophenotype of the tumors were analyzed by histological examination and immunohistochemistry of CK18,p63,inhibin-α,HCG,HPL,PLAP and Ki-67.The clinical prognostic factors were evaluated based on a following-up data with a period of 11-SO months.Results The overall prevalence of ETT was 0.48% among all the gestational trophoblastic diseases patients received in the same period.Five ETT patients were in the reproductive ages with a median of 33 years.Histologically,the tumor showed an invasive,nodular growth consisting of uniform mononuclear trophoblastic cells.There were zones of hyaline material in the tumour nests.Necrosis was commonly seen with a characteristic geographic pattern.Immunohistochemically,all cases displayed a diffuse CK18 and p63 positivity,to be either positive focally or negative for HCG,HPL and PLAP staining.Inhibin-a staining was positive or negative either in the 5 cases.Two patients died of the tumour relapse:one died after 1 year with the tumor having a high mitotic activity(averagely 15 mitotic figures per 10 high-power fields),and the other died of lung metastasis 2 years after the diagnosis.Conclusions ETT is a rare trophoblastic disease with distinct clinicopathological features and immunostaining patterns.A high mitotic index and lung metastasis are indicators for an unfavorable prognosis.