子宫胎盘部位超常反应8例临床病理分析_临床医学论文.docVIP

子宫胎盘部位超常反应8例临床病理分析_临床医学论文 子宫胎盘部位超常反应8例临床病理分析_临床医学论文 【关键词】 胎盘；滋养叶细胞；病理 　　［摘要］ 目的：探讨子宫胎盘部位超常反应(EPS)的临床病理特征，并讨论与其他易混淆的中间滋养叶细胞肿瘤及瘤样病变的鉴别诊断、免疫组化特点。方法： 收集我院2000年至2006年间诊断的EPS病变8例，观察和分析其临床和病理组织学特点、预后分析及相关免疫组化标记。结果：EPS组织学特征为以中间型为主的滋养细胞向蜕膜及平滑肌层浸润，不破坏原有组织结构，不形成肿块，并保留部分胎盘床特点。临床表现多有妊娠后及产后阴道出血，预后良好。结论： EPS是一种较少见的与妊娠有关的滋养叶细胞病变，是一种良性非肿瘤性病变，常导致产后大出血，仔细寻找EPS形态学,组织学特点、免疫组化标记，有助于确定EPS的诊断，对临床治疗意义重大。 　　［关键词］ 胎盘；滋养叶细胞；病理 　　　Abstract： Objectives　To study the pathological and clinical features of exaggerated placental site (EPS) and to propose its diagnostic criteria and differential diagnosis. Methods The pathological features,immunohistochemical marks, clinical characteristics and prognosis of 8 cases with EPS were studied and analysed.Results　The histological feature of EPS was that trophoblasts mainly intermediate trophoblast (IT), infitrated into decidua and myometrium layers, while original histological structure was not destroyed, and placental site features remained partially.Dont become a lump. The immunohistochemical marks of EPS, HPL, were positive or strongly positive. The primary clinical presentation of EPS was postpartum hemorrhage and the prognosis was good in 5 years. Conclusions　EPS is a kind of gestational trophoblastic disease primarily involving IT.It is a kind of positive not tumor pathological changes ,and often cause the postnatal period bleed greatly. Its differential diagnosis depend on combining histological, immunohistochemical findings, and clinical features. Attentions should be paid to EPS in cases with postpartum hemorrhage. 　　Key words： Placenta；Trophoblast；Pathology 　　子宫胎盘部位超常反应(EPS)是一种比较少见的非肿瘤性病变,1991年，WHO将其列入中间滋养叶细胞源性疾病。但目前国内外对该病的诊断尚无统一标准，名称也不统一，特别是与胎盘部位(placental site, PS)反应和胎盘部位滋养细胞肿瘤(placental site trophoblastic tumor, PSTT)的鉴别还存在一定困难，对EPS的病理特点及患者的预后了解不够。又因为本病具有一定的侵袭性，可浸润肌层及血管壁，常易误诊为恶性肿瘤，所以正确诊断就非常重要。本文总结了8例EPS的病理特点及临床进行分析，以期提高对EPS疾病的认识。 　　1　材料与方法 　　收集我院2000年1月至2006年6月，328例妊娠后诊刮或子宫切除病例其中诊断为EPS病变8例。标本经10％甲醛溶液或中性甲醛液固定，石蜡包埋，常规切片，HE染色。 　　2　结果 　　2.1　患者的一般资