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@#Gestational trophoblastic diseases (GTDs) represent a unique group of lesions with an abnormal proliferation of trophoblasts. GTD can be divided into molar lesions and nonmolar lesions. Partial and complete hydatidiform moles and invasive moles are under molar lesions, whereas non‑molar lesions include choriocarcinomas and lesions that are derived from intermediate trophoblasts (ITs). These IT can be from the implantation site (exaggerated placental site [EPS] and placental site trophoblastic tumor) or from the chorionic type (placental site nodule and epithelioid trophoblastic tumor). EPS is a relatively uncommon form of GTD. It is a challenging condition for clinicians to diagnose because of the limited number of reported cases. From 1990 to April 2022, there were only 25 case reports published internationally, and this is the first local case report. Implantation site ITs (ISITs) are difficult to distinguish histologically. Immunohistochemical staining such as Ki‑67 can improve diagnostic accuracy by differentiating ISIT. Ki 67 will show staining of <1% in EPS. This is the case of a 25‑year‑old patient, G6P5 (5005), who experienced vaginal bleeding associated with pelvic and hypogastric pain after 13 weeks of missed menses. She was diagnosed with a molar pregnancy and underwent an emergency total abdominal hysterectomy with bilateral salpingectomy due to severe uterine bleeding. Histopathologic studies in this case showed diffuse and infiltrative growth of atypical monomorphic ITs arranged in sheets and cords, infiltrating and separating myometrial fibers. The uterine blood vessel wall was replaced with fibrinoid deposition, with areas of hemorrhages and necrosis. There were also chorionic villi. The histopathological findings revealed GTD arising from ITs, specifically EPS. This article describes the clinical presentation, diagnostic procedure, and management, together with histopathological observations and a review of related literature, of this rare GTD.
Subject(s)
Gestational Trophoblastic DiseaseABSTRACT
Purpose To investigate the clinical manifesta-tions and morphologic features of placental site nodules (PSNs), and its clinical significance. Methods Twenty patients diag-nosed as PSNs were collected, then a retrospective analysis was conducted, and the characteristics of clinical data and follow-up results were analyzed,including of clinical manifestations, ultra-sonographic evaluation, morphologic and immunohistochemical features. Results The age of patients ranged from 25 to 41 years (32. 48 ± 4. 77 years in average). Three fifths of patients had pregnancy history for at least two times and the interval time to the last pregnancy ranged from 5 to 37 months (15. 33 ± 8. 05 months on average). 15 (75% ) patients went to the hospital because of abnormal vaginal bleeding. In our study, most of the samples showed a membrane-like structure without definite nod-ule. Microscopically, single or multiple, well-circumscribed and oval small nodules were found in endometrial tissue. In most ca- ses, the hyalinization was generally uniform in the center of the nodules, more or less intermediate trophoblasts appeared on the edge of the nodules. Immunohistochemically, the strong diffuse expressed CK (AE1/AE3), CAM5. 2, EMA, GATA-3, Cyclin E and p63 were detected in most of all cases, and PLAP showed strong focal expression, α-inhibin and hPL showed faint focal expression, Ki-67 staining for proliferative index was less than 4% . Conclusion PSN is a benign lesion of the intermediate trophoblast at the chorionic leave. Some diseases including hya-linized decidua, epithelioid trophoblastic tumor, and squamous cell carcinoma with hyalinization need to be identified. Some im-munohistochemical markers may be certain helpful in distinguis-hing as necessary.
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Purpose To investigate clinical and pathological features,diagnosis and differential diagnosis,treatment and prognosis of the atypical placental site nodules (APSN).Methods 8 cases of APSN were analyzed retrospectively.Their gross and microscopic features and immune phenotypes were observed,and the clinical histories and followed up were also reviewed.Results The patients were 26 to 42 years old (mean 32.8 years old).Clinical symptoms included occupation disease in uterine cavity,irregular vaginal bleeding,etc.Some patients were checked by hysteroscope and showed pale-yellow space-occupying lesions.Microscopically,the lesions consisted of single to multiple nodules or plaques of hyalinized extracelluar matrix,in which chorionic-type intermediate trophoblasts with mild atypia were haphasardly distributed.All the lesions were without myometrial invasion.Chorionic-type intermediate trophoblasts of the 3 cases expressed CK (AEI/AE3),p63,HLA-G,β-catenin,GATA-3 and the Ki-67 labelling index was 8％ ～ 15％.One of the 8 patients had a hysterectomy.Other seven patients were managed by lesionectomy under the hysteroscopy.8 patients were followed up with ultrasonography,curetting endometrium and endocervical mucosa and all of the patients were alive without the progress of the lesion.Conclusion APSN is easily misdiagnosed as squamous cell carcinoma,epithelioid leiomyosarcoma and other gestational trophoblastic diseases.It is important to understand the pathological features of APSN and we can avoid misdiagnosing for other benign or malignant tumours.Misdiagnosis will influence the clinical treatment.
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Placental site nodules and plaques have been recently described to designated single or multiple, well-circumscribed, rounded lesions at the placental site, composed of viable or degenerating intermediate trophoblastic cells and extensive hyalinization between the cells. We described clinicopathologic findings of 14 cases of placental site nodules and plaques. The age of 14 patients ranged from 25 to 39(average 33) years and all of them had been pregnant in the past. Ten of them presented with vaginal spotting, which was preceded by recent pregnancy in only 3 cases. Three patients presented with secondary infertility and one with secondary infertility and vaginal spotting. Urine pregnancy tests were negative in all 14 cases at the time of presentation. Ultrasonographic examination disclosed abnormalities in only 3 cases and the remaining cases were normal. Hysterosalpingography was performed in 3 patients who presented with 2 degrees infertility and revealed moderate to severe intrauterine adhesions. Microscopically, chronic endometritis of varying degrees evidenced by plasma cells and eosinophiles were present in all cases and these were more prominent in the vicinity of the lesions. It is presumed that the placental site nodules and plaques are not sloughed at the time of menstruation and it may cause chronic endometritis or intrauterine adhesions at any time after previous delivery.
Subject(s)
Pregnancy , Female , HumansABSTRACT
This report presents microscopic observation on morphological and immuno- cytochemical characteristics of the trophoblast cells of the human decidua at the implantation site in the first trimester pregnancy .The infiltration of a unique type of large cells different from cytotrophoblast (CT) and syncytotrophoblast (ST) was found in the decidua at the implantation site. These unique cells are termed inter- mediate trophoblast (IT). They are typically mononucleate, but may be binucleate or multinucleate. The mononucleate cells vary in shape from round, polyhedral spindle shaped. Their cytoplasm is typically abundant and eosinophilic or amphophilic. The nuclei may vary in size and shape. These cells usually distribute around the spiral arterioles, differse blood vessel wall, penetrate into the lumen, and even replace the blood vessel wall totally. Immunocytochemically, both these cells and ST are stained positive for HCG and HPL. However, the HCG-stained Cell population of IT.is much lower than that of ST,while the of HPL stained cell population of IT is significantly higher than that of ST.On the other hand,neither HCG nor HPL are positive in CT. The results of SP-1 ?-HCG usually go with those of HCG.in CT, ST and IT.The PAPP-A gives non specific staining result. It is believed that IT,with its distinct morphological and immunocytochemical feats,is regarded as a transitional form in the shift from CT to ST.
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Objective To explore the relationship between Mel-CAM and adherence and invasion of trophoblastic cells and proliferation of Mel-CAM defined intermediate trophoblast.Methods Double immunohistochemical staining technique was used to detect the expression of Ki-67 in Mel-CAM defined intermediate trophoblast in human villi during the first trimester and hydatidiform mole.Results In this study there was a significantly stronger expression of Mel-CAM in hydatidiform mole than that in first-trimester villi (P