Abstract：
OBJECTIVE: The term of placenta accreta spectrum (PAS) disorder includes all grades of abnormal placentation. It is crucial for pathologist provide standardized diagnostic assessment to evaluate the outcome of management strategies. Moreover, a correct and safe diagnosis is useful in the medico-legal field when it becomes difficult for the gynecologist to demonstrate the suitability and legitimacy of demolitive treatment. The purposes of our study were: (1) to assess histopathologic features according to the recent guidelines; (2) to determine if immunohistochemistry can be useful to identify extravillous trophoblast (EVT) and to measure the depth of infiltration into the myometrium to improve the diagnosis of PAS.
METHODS: The retrospective study was conducted on 30 cases of gravid hysterectomy with histopathologic diagnosis of PAS. To identify the depth of EVT, immunohistochemical stainings were performed using anti MNF116 (cytokeratins 5, 6, 8, 17, 19), actin-SM, HPL (Human Placental Lactogen), vimentin and GATA3 antibodies.
RESULTS: Our cases were graded based on the degree of invasion of the myometrium. Ten were grade 1 (33.3%), 12 grade 2 (40%) and 8 grade 3A (26.7%). EVT invasion was best seen and evident by double immunostainings with actin-SM and cytokeratins, actin-SM and HPL, actin-SM and GATA3.
CONCLUSIONS: The role of pathologist is decisive to determine the different grades of PAS. A better understanding of the depth of myometrial invasion can be achieved by the use of immunohistochemistry affording an important tool to obtain reproducible grading of PAS. This purpose is crucial in the setting of postoperative quality reviews and particularly in the forensic medicine field.
METHODS: The retrospective study was conducted on 30 cases of gravid hysterectomy with histopathologic diagnosis of PAS. To identify the depth of EVT, immunohistochemical stainings were performed using anti MNF116 (cytokeratins 5, 6, 8, 17, 19), actin-SM, HPL (Human Placental Lactogen), vimentin and GATA3 antibodies.
RESULTS: Our cases were graded based on the degree of invasion of the myometrium. Ten were grade 1 (33.3%), 12 grade 2 (40%) and 8 grade 3A (26.7%). EVT invasion was best seen and evident by double immunostainings with actin-SM and cytokeratins, actin-SM and HPL, actin-SM and GATA3.
CONCLUSIONS: The role of pathologist is decisive to determine the different grades of PAS. A better understanding of the depth of myometrial invasion can be achieved by the use of immunohistochemistry affording an important tool to obtain reproducible grading of PAS. This purpose is crucial in the setting of postoperative quality reviews and particularly in the forensic medicine field.
摘要：
目的：胎盘植入谱（PAS）障碍的术语包括胎盘异常的所有等级。病理学家提供标准化的诊断评估以评估管理策略的结果至关重要。此外，当妇科医生难以证明拆除治疗的适宜性和合法性时，正确和安全的诊断在医学法律领域是有用的。我们研究的目的是：（1）根据最近的指南评估组织病理学特征；（2）确定免疫组织化学是否可用于识别绒毛外滋养层（EVT）并测量子宫肌层的浸润深度以提高PAS的诊断。
方法：对30例经组织病理学诊断为PAS的妊娠子宫切除术进行回顾性研究。为了确定EVT的深度，使用抗MNF116（细胞角蛋白5、6、8、17、19）进行免疫组织化学染色，肌动蛋白-SM，HPL（人胎盘催乳素），波形蛋白和GATA3抗体。
结果：我们的病例根据子宫肌层的浸润程度进行分级。十个是一年级(33.3%)，12级2（40％）和8级3A（26.7％）。通过肌动蛋白-SM和细胞角蛋白的双重免疫染色，可以最好地看到和明显的EVT侵袭，肌动蛋白-SM和HPL，肌动蛋白-SM和GATA3。
结论：病理学家的作用对于确定PAS的不同等级是决定性的。通过使用免疫组织化学可以更好地了解子宫肌层浸润的深度，这为获得可重复的PAS分级提供了重要的工具。此目的对于术后质量审查的设置至关重要，尤其是在法医学领域。
方法：对30例经组织病理学诊断为PAS的妊娠子宫切除术进行回顾性研究。为了确定EVT的深度，使用抗MNF116（细胞角蛋白5、6、8、17、19）进行免疫组织化学染色，肌动蛋白-SM，HPL（人胎盘催乳素），波形蛋白和GATA3抗体。
结果：我们的病例根据子宫肌层的浸润程度进行分级。十个是一年级(33.3%)，12级2（40％）和8级3A（26.7％）。通过肌动蛋白-SM和细胞角蛋白的双重免疫染色，可以最好地看到和明显的EVT侵袭，肌动蛋白-SM和HPL，肌动蛋白-SM和GATA3。
结论：病理学家的作用对于确定PAS的不同等级是决定性的。通过使用免疫组织化学可以更好地了解子宫肌层浸润的深度，这为获得可重复的PAS分级提供了重要的工具。此目的对于术后质量审查的设置至关重要，尤其是在法医学领域。
