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目的探讨胎盘部位结节或斑块(PSN/P)的临床表现、病理学特征,并研究其诊断和鉴别诊断要点及临床意义。方法收集北京市垂杨柳医院病理科2005-2016年间诊断的10例PSN/P病例进行回顾性研究,分析其临床资料特点、随访结果,镜下病理组织学观察,并进行免疫组织化学(组化)染色。结果患者年龄22~48岁,平均(32.90±8.52)岁;患者妊娠史1~2次,所有患者距上次妊娠间隔3~130个月,平均(43.90±44.64)个月,8例患者因阴道不规则出血就诊,其中1例患者伴有水泡状胎块病史,1例患者因宫颈低级别鳞状病变(LSIL)就诊,1例为剖宫产术中发现,随访6例患者均未再出现异常阴道出血情况。镜下特征:增殖期子宫内膜6例,子宫内膜增殖症1例,子宫内膜不规则增殖2例,蜕膜组织及浅层平滑肌组织1例;在内膜组织内可见到单发或多发的玻璃样变性的结节,境界清楚,结节内可见多少不等的绒毛膜中间型滋养细胞(IT);免疫组化染色结果较一致,10例PSN/P患者均CK8、P63、Inhibin-α(+),PLAP、hPL、CK5、CD146、HCG(-),Ki67增殖指数0%~3%。结论 PSN/P是一种来源于绒毛膜IT的良性非肿瘤性病变。
Objective To investigate the clinical manifestations and pathological features of placental nodules or plaques (PSN / P) and to study the main points of diagnosis and differential diagnosis and its clinical significance. Methods Ten cases of PSN / P diagnosed during the period of 2005-2016 in Weeping Yangliu Hospital of Beijing were retrospectively studied. The clinical features, follow-up results, microscopic histopathological observation and immunohistochemistry )dyeing. Results The patients were 22 to 48 years old with an average of (32.90 ± 8.52) years. The patients had a history of 1 ~ 2 pregnancies. All the patients had an average of (43.90 ± 44.64) months from the previous pregnancy with an interval of 3 to 130 months. One patient had a history of blister-like fetal block, one patient was treated by LSIL, one was found by cesarean section, and none of the 6 patients were followed up Abnormal vaginal bleeding occurred. Microscopic features: proliferative endometrium in 6 cases, 1 case of endometrial hyperplasia, endometrial irregular proliferation in 2 cases, decidual tissue and superficial smooth muscle tissue in 1 case; in the endometrial tissue can be seen single or Multiple nodules with degenerative vitreous degeneration clearly demarcated the number of tumoral mesenchymal cells (IT) in the nodules. The results of immunohistochemical staining were consistent. The levels of CK8, P63, Inhibin in 10 patients with PSN / P - (+), PLAP, hPL, CK5, CD146, HCG (-), Ki67 proliferation index 0% to 3%. Conclusion PSN / P is a benign non-neoplastic lesion originating from chorionic villi.