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B511子宫肿块伴肺结节

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楼主 发表于 2007-01-17 20:04|举报|关注(2)
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姓    名: ××× 性别:  女 年龄:  31岁
标本名称:  “子宫肌瘤”,子宫全切标本,肺病灶标本
简要病史:  月经紊乱,B超示“子宫肌瘤”,子宫全切术后HCG升高,CT示肺结节。详见下文。
肉眼检查:  “子宫肌瘤”剔除标本:灰红、灰褐色破碎软组织,2.5 cm×2.5 cm×0.6cm, 质软。
子宫全切标本:子宫左前壁肌壁间肿块4cm×2.5cm×2cm,切面灰红,灰黄,有坏死,质软。内膜及宫颈无殊。
肺病灶标本:肺组织1.4 cm×1 cm×0.6cm,切面见一直径0.5cm的灰白灰红色结节,质稍软,边界较清。
图1-4子宫病灶,图5-6肺病灶,图7CK,图8EMA,图9HCG,图10HPL,图11Ki67
1992年:侵蚀性葡萄胎伴肺转移,化疗后子宫及肺部病灶消失。
1998年:顺产一孩。
2003年:1月因不全流产在当地先后三次刮宫治疗。
2004年:上半年起月经紊乱。当地医院B超提示:子宫肌瘤,直径约3cm。12月行腹腔镜下“子宫肌瘤”剔除术。检查人绒毛膜促性腺激素(β-HCG)为46U/L。
2005年:1月行子宫全切术,术后HCG降至正常。4月底血β-HCG升高至13.3U/L,以后缓慢上升。6月3日复查β-HCG为107.3U/L,收住院。肺CT示右下肺单个结节,直径6mm。6月22日行肺病灶切除术。术后辅以化疗,血HCG降至正常。至今一般情况尚好。
致谢:病例由浙江大学附属妇产科医院病理科某老师提供,仅用于学习交流,特此致谢!
  • 子宫肿块伴肺结节图1
    图1
  • 子宫肿块伴肺结节图2
    图2
  • 子宫肿块伴肺结节图3
    图3
  • 子宫肿块伴肺结节图4
    图4
  • 子宫肿块伴肺结节图5
    图5
  • 子宫肿块伴肺结节图6
    图6
  • 子宫肿块伴肺结节图7
    图7
  • 子宫肿块伴肺结节图8
    图8
  • 子宫肿块伴肺结节图9
    图9
  • 子宫肿块伴肺结节图10
    图10
  • 子宫肿块伴肺结节图11
    图11
标签:子宫 肺转移 上皮样滋养细胞肿瘤 ETT
本帖最后由 于 2007-08-15 22:24:00 编辑
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华夏病理/粉蓝医疗

为基层医院病理科提供全面解决方案,

努力让人人享有便捷准确可靠的病理诊断服务。


×参考诊断
上皮样滋养细胞肿瘤

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21 楼    发表于2009-09-20 09:54:00举报|引用
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 考虑绒癌
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22 楼    发表于2009-09-20 06:20:00举报|引用
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 谢谢了学习了

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23 楼    发表于2009-09-18 22:09:00举报|引用
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 谢谢了学习了
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24 楼    发表于2009-09-14 14:08:00举报|引用
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 学习
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xiaogang 离线

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25 楼    发表于2009-09-14 13:43:00举报|引用
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以下是引用月新 在2007-1-19 20:31:00的发言:

 本例可能在2006年临床实验病理杂志上刊登过,上皮样滋养细胞肿瘤.

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腾飞 离线

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26 楼    发表于2009-09-13 08:42:00举报|引用
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 学习了
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27 楼    发表于2009-09-05 19:19:00举报|引用
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太恶了,太可怕了!

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28 楼    发表于2009-09-02 23:17:00举报|引用
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 好病例,谢谢各位老师的讲解
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29 楼    发表于2009-09-01 09:39:00举报|引用
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 首先考虑为绒癌
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陈秀明

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30 楼    发表于2009-09-01 08:20:00举报|引用
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 好病例,谢谢各位老师的讲解
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31 楼    发表于2009-08-28 21:19:00举报|引用
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 好病例,谢谢各位老师的讲解
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32 楼    发表于2009-08-21 13:53:00举报|引用
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 好病例!学习了。
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33 楼    发表于2009-08-19 15:25:00举报|引用
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 学习
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34 楼    发表于2009-08-15 23:10:00举报|引用
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 谢谢Dr.cqzhao提供丰富详尽的资料!
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华夏病理/粉蓝医疗

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绝世好片 离线

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 好病例,学习了!
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 学习
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37 楼    发表于2009-08-13 23:04:00举报|引用
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 学习了

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38 楼    发表于2009-08-13 18:18:00举报|引用
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 Strongly recommend this web for people who are interested to the trophoblast lesions.

http://pathology2.jhu.edu/trophoblast/index.cfm

Dr. Shih (Chinese, from Taiwan) from John Hopkins cooperated with Dr. Kurman did A a lot of research study in trophoblast diseases. His work is in leading position in this area. Basically many original antibodies and classification were from his lab.

From above web you can see classification, typical photos and immunostains basis for these trophoblasts diseases.

For example:

Differential Diagnosis- Immunostaining Basis



Information for the antibodies we used

Table 1. Dilutions and Sources of Antibody Panel Used in the Immunohistochemistry

Antigen Antibody* Dilution Source
p63 4A4 1:100 Neomarker
Cytokeratin 18 DC10 1:10 Dako
hPL HPL 1:6,000 Dako
Ki-67 MIB-1 1:1,000 Dako
HLA-G MEM-G/1 1:200 abcam
hCG hCG 1:2,000 Dako
Mel-CAM (CD146) NCL-CD146 1:50 Novo Castra

* All the antibodies are commercially available and work on paraffin sections.

Cytokeratin 18 staining in ETT

Cytokeratin 18 staining in squamous carcinomas

Inhibin-a staining in ETT


Inhibin-a staining in squamous carcinoma


HLA-G immunoreactivity



Chorion laeve

Placental site nodule

ETT
HLA-G immunoreactivity



Trophoblastic column

Choriocarcinoma
HLA-G immunoreactivity


p63 staining in ETT


A mixed case of PSTT and ETT


Double Staining for Mel-CAM and Ki-67


The presence of proliferation activity distinguishes an EPS from a PSTT- a double staining using IT specific marker and Ki-67



Information for the antibodies we used

Table 1. Dilutions and Sources of Antibody Panel Used in the Immunohistochemistry

Antigen Antibody* Dilution Source
p63 4A4 1:100 Neomarker
Cytokeratin 18 DC10 1:10 Dako
hPL HPL 1:6,000 Dako
Ki-67 MIB-1 1:1,000 Dako
HLA-G MEM-G/1 1:200 abcam
hCG hCG 1:2,000 Dako
Mel-CAM (CD146) NCL-CD146 1:50 Novo Castra

* All the antibodies are commercially available and work on paraffin sections.

Cytokeratin 18 staining in ETT

Cytokeratin 18 staining in squamous carcinomas

Inhibin-a staining in ETT


Inhibin-a staining in squamous carcinoma


HLA-G immunoreactivity



Chorion laeve

Placental site nodule

ETT
HLA-G immunoreactivity



Trophoblastic column

Choriocarcinoma
HLA-G immunoreactivity


p63 staining in ETT


A mixed case of PSTT and ETT


Double Staining for Mel-CAM and Ki-67


The presence of proliferation activity distinguishes an EPS from a PSTT- a double staining using IT specific marker and Ki-67

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cqzhao 离线

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39 楼    发表于2009-08-13 18:07:00举报|引用
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  Am J Surg Pathol. 2004 Sep;28(9):1177-83.

p63 expression is useful in the distinction of epithelioid trophoblastic and placental site trophoblastic tumors by profiling trophoblastic subpopulations.

Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD 21231, USA. ishih@jhmi.edu

Human trophoblast is composed of a heterogeneous population of cells, which give rise to a variety of trophoblastic tumors and tumor-like lesions. In this report, we analyzed the expression pattern of the p63 gene, a transcription factor belonging to the p53 family, in different trophoblastic subpopulations and in trophoblastic lesions. p63 has various isoforms that are classified into two groups designated TA and DeltaNp63 isoforms. The TA isoforms have a p53-like suppressor function, whereas the DeltaNp63 isoforms exert an oncogenic effect. Based on immunohistochemistry and RT-PCR, it appears that cytotrophoblast expresses the DeltaNp63 isoform whereas chorionic-type intermediate trophoblast in the fetal membranes, placental site nodules, and epithelioid trophoblastic tumors expresses the TAp63 isoform. Intermediate trophoblast in the implantation site and placental site trophoblastic tumors does not express p63. Based on the expression patterns of p63 and the previously described expression patterns of other trophoblastic markers, including HLA-G, cytokeratin 18, hPL, and Ki-67, we developed an immunohistochemical algorithm to diagnose trophoblastic lesions. A validation set of 22 trophoblastic lesions and 34 nontrophoblastic tumors were classified correctly using this algorithm. In conclusion, the findings in this study demonstrate that different trophoblastic subpopulations and their related trophoblastic lesions are characterized by distinctive patterns of p63 expression. Recognizing these distinctive expression patterns helps to further elucidate the biology of trophoblast and can also provide a useful tool for the differential diagnosis of trophoblastic lesions.

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cqzhao 离线

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40 楼    发表于2009-08-13 18:06:00举报|引用
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 As Dr. Liu mentioned above ETT可以很好地表达p63。P63 is a good marker to distingusish ETT from PSTT. Even though both PSTT and ETT have some different morphologic features, it is difficult to distingguish there two based on the morphology. Good part is that it is no much difference in prognosisi and clinical treatment between these two tumors.
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