Mousavi S A, Behnamfar F
Gynecology Oncology Department, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Arch Gynecol Obstet. 2009 Apr;279(4):587-90. doi: 10.1007/s00404-008-0756-7. Epub 2008 Sep 2.
Early elective medical abortion is performed frequently in different countries of the world. Serious complications like gestational trophoblastic neoplasia (GTN) are uncommon and mostly nonmetastatic. High risk metastatic GTN following medical abortion is a rare event which may occur coincidentally.
A 26 year-old-woman, gravida 2 para 1, 6 weeks after misoprostol abortion presented with sever nausea, vomiting, and right upper abdominal pain. Human chorionic gonadotropin (hCG) level was 2,500,000 mIU/ml and metastatic work up revealed multiple liver metastases. She totally received nine cycles of EMA-CO (ethoposide- methotrexate- actinomycin- cyclophosphamide, vincristine) regimen for treatment and consolidation. Six months after treatment she is in complete remission.
Follow up of patients after medical abortion by means of single serum hCG measurement is highly recommended for early diagnosis of complications including gestational trophoblastic tumor. EMA-CO regimen seems to be an effective and safe treatment for liver metastatic gestational trophoblastic neoplasia.
早期选择性药物流产在世界不同国家频繁进行。妊娠滋养细胞肿瘤（GTN）等严重并发症并不常见，且大多为非转移性。药物流产后发生高风险转移性GTN是一种罕见事件，可能偶然发生。
一名26岁女性，孕2产1，米索前列醇流产6周后出现严重恶心、呕吐和右上腹疼痛。人绒毛膜促性腺激素（hCG）水平为2500000 mIU/ml，转移检查发现多处肝转移。她总共接受了9个周期的EMA-CO（依托泊苷-甲氨蝶呤-放线菌素-环磷酰胺、长春新碱）方案进行治疗和巩固。治疗6个月后她完全缓解。
强烈建议通过单次血清hCG检测对药物流产后的患者进行随访，以便早期诊断包括妊娠滋养细胞肿瘤在内的并发症。EMA-CO方案似乎是治疗肝转移性妊娠滋养细胞肿瘤的一种有效且安全的方法。
