子宫绒毛膜癌？讨论病例【中美加子宫内膜病理交流群536】

刘伟

孔祥田
A case share with you! 50s yo F, 20 cm endometrial mass with peritoneal masses. No bx was done. Hysterectomy and omental mass excision.
Here some pictures from endometrial 20 cm mass


孔祥田
You can see extensive LVI. Tumor invading myometrium approximately 60%. Omental bx intraoperatively called high grade carcinoma. What’s your Dx?

莲子
可见子宫内膜异位症的区域，过渡到癌，乳头状，与子宫内膜异位症相关的病变，首先考虑透明细胞癌，另可见细胞异型性很大的区域，去分化癌？鉴别：伴滋养细胞分化？伴肉瘤变？MMMT?

杨鹏
滋养细胞肿瘤，绒癌,？@孔祥田(Max)*Sacramento*CA]

孔祥田
@李素红 山西省妇幼保健院 @杨鹏 淄博市妇幼保健院 Yes. It’s choriocarcinoma of uterus, a very rare entity in endometrium. Her bilateral ovaries are not involved. Her serum HCG was 20k. Here are some IHCS we performed.

莲子
果真是绒癌，罕见好病例

邢德印
@孔祥田(Max)*Sacramento*CA] 有没有看到非绒癌的成分？

莲子
乳头状区域也是绒癌？

邢德印
@李素红 山西省妇幼保健院 同问. 低倍看像SEIC

白草糖
乳头的好像SALL4也阳了

孔祥田
@李素红 山西省妇幼保健院 @邢德印(妇科病理) @王昀 301 the specimen was extensively sampled. We don’t see non-choriocarcinoma component. We thought about HGSC, but cannot approve it. This is the first choriocarcinoma case I encountered in endometrium. It’s so rare! You can see the decidulization in normal endometrial stroma. @张询（医科院肿瘤医院） @深圳市人民医院病理科郭晓静群管 


孔祥田
I had a typo in her HCG. Her serum HCG should be 220k before surgery. Now the serum HCG levels is 42k(normal <=8 mIU/ml). Still high. They will start chemotherapy on her soon.

孔祥田
Her serum CA125 and CEA was normal.
TNM stage pT3b pNx pM1, FIGO stage IVB.