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Intermediate trophoblastic tumor clinicopathological study

Author: DengZhiJuan
Tutor: GuoLiNa
School: Beijing Union Medical College
Course: Pathology and Pathophysiology
Keywords: Intermediate trophoblastic tumor Pathological features Prognosis HSD3B1 HLA-G
CLC: R737.33
Type: Master's thesis
Year: 2011
Downloads: 26
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Abstract


Objective: To investigate the intermediate trophoblastic tumor (ITT) placental site trophoblastic tumor, (PSTT) and epithelioid trophoblastic tumor (ETT) clinicopathological features and prognostic factors. Method: collect the Beijing Union Medical College Hospital from January 2001 to January 2011, the middle of surgery trophoblastic tumors in 27 cases (including one case with autopsy material), analysis of the clinical and pathological features and immunohistochemical expression characteristics, combined with clinical prognosis analysis of its high-risk prognostic factors. Results: 27 cases of the ITT including 22 cases of placental site trophoblastic tumor (PSTT) and five cases of epithelioid trophoblastic tumor (ETT), divided into the low installments the group (FIGOI period, according to the FIGO staging 15 cases) and high-stage group (FIGO Ⅲ - Ⅳ period, 12 cases). Clinical: the average age of onset of the high-staging group, with last pregnancy average time interval, the average probability of full-term pregnancy and serum β-HCG extremum than a large group of low installments. High-staging group of four cases of poor prognosis (4/12 cases, including recurrence, progression and death), 2 patients died; 2 cases of recurrence (2/15) of the low-staging group (ETT), no deaths. Gross pathology: 1.PSTT tumor staging group average maximum diameter (3.21cm) is slightly larger than the low-staging group (2.99cm), while the average size of ETT high installments cases smaller than low installments, and the death of a cases of tumor maximum diameter of only 2.5cm, less than the other four cases; the 2PSTT edge of the tumor to the surrounding infiltration, and the surrounding community is unclear, while the ETT more than for expansion outward growth of the nodules, still clear and the surrounding tissue boundaries. Histopathology: PSTT polygonal tumor cells the nest flake or cords to the invasion and growth around a more consistent form of visible tumor cells and fibrin-like substance in most cases, replace the vessel wall but not destroy the vascular central cavity, mitotic 0 -10/10HPFs (the average 1.6/10HPFs), of the PSTT high-staging group myometrial infiltration is greater than 1/2 (10/13 cases) than the low-stage (5/9) more by which death cases invading muscle layer gt; 1/2, nuclear fission 5/10HPFs; ETT nest sheet of uniform small round cells surrounded by the visible map necrosis, tumor cell invasion and replace the vessel wall is not obvious, the the ETT cases of myometrial invasion greater than 1/2 myometrium the mitotic 0-36/lOHPFs (the average 8.8/10HPFs), and 1 died of mitotic 36/10HPFs. Immunohistochemistry: In this study, cases HSD3B1 are diffuse and strong staining (28/28 cases); HLA-G expression in 100% the PSTT (23/23 patients) and 80% of the the ETT cases (4/5), which 78% the PSTT (18/23 patients) and 20% of the ETT (1/5 cases), diffuse and strong staining; of the PSTT Case me1-cam and HPL positive degree is significantly higher than that of the ETT cases; β-HCG only in part ( 9/23 cases) PSTT cases showed focal positive ETT (5/5 cases) were negative; P63 is expressed in the the ETT cases (5/5 cases), not expressed in PSTT cases (23/23 cases). Ki-67 index in PSTT and ETT deaths were higher than the average level of the tumor. Older (≥ 30 years), with the last pregnancy interval (≥ 12 months), serum β-HCG the extremum high (≥ 1000miu/ml, p = 0.024 lt; 0.05) term pregnancy increase the risk of malignancy. Myometrial invasion gt; 1/2, large tumor size, depth of invasion, hemorrhagic necrosis and mitotic prognosis and clinical stage relationship is not obvious. Ki-67 index and clinical stage are high, but the deaths of the Ki-67 index. Immunohistochemistry in the diagnosis and differential diagnosis with a secondary diagnosis.

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CLC: > Medicine, health > Oncology > Genitourinary tumors > Female genital tumors > Uterine tumors
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