Meddeb Sawsen, Rhim Mohamed Salah, Zarrouk Wissal, Bibi Mohamed, Yacoubi Mohamed Tahar, Khairi Hedi
Department of Gynecology and Obstetrics, Farhat Hached University Hospital, Sousse, Tunisia; Research Laboratory in Quality of Maternal Health Care in Tunisia.
Department of Gynecology and Obstetrics, Farhat Hached University Hospital, Sousse, Tunisia.
Int J Surg Case Rep. 2014;5(11):787-8. doi: 10.1016/j.ijscr.2014.08.025. Epub 2014 Sep 16.
Choriocarcinoma is a highly malignant trophoblastic neoplasm. Its association with ectopic pregnancy is very rare and usually with aggressive behavior.
We report a new case arising in an interstitial pregnancy occurring in a 46-year-old woman. The patient was admitted for severe pelvic pain and abundant metrorrhagia. One month ago, she had had a laparoscopic resection of an interstitial pregnancy subsequent to failure of chemotherapy by methotrexate. The raise of serum βhCG level and the hyperechoic intrauterine mass were in favor of gestational trophoblastic disease. Urgent laparotomy was performed for circulatory collapse. Hysterectomy was done. Histological examination revealed a choriocarcinoma. The patient underwent chemotherapy. Two years later, neither metastasis nor recurrence was detected.
Clinical diagnosis of primary interstitial choriocarcinoma is difficult, since it is rare and manifesting by non-specific abnormal vaginal bleeding. Imaging findings are also not helpful in ectopic location. The frequency of metastasis is related to the delayed diagnosis. Serial measurement of βhCG level was the most useful marker of diagnosis and follow up. Histopathological examination remains the only tool of the precise diagnosis. Choriocarcinoma has a very good prognosis even in advanced stages, since it is very chemosensitive.
The current trend of the treatment of ectopic pregnancy by conservative surgery requires adequate monitoring of βhCG and careful examination of pathologic specimens to avoid misdiagnosis of ectopic gestational trophoblastic disease.
绒毛膜癌是一种高度恶性的滋养层肿瘤。其与异位妊娠的关联非常罕见，且通常具有侵袭性。
我们报告一例发生在一名46岁女性间质部妊娠中的新病例。患者因严重盆腔疼痛和大量子宫出血入院。一个月前，她在甲氨蝶呤化疗失败后接受了腹腔镜下间质部妊娠切除术。血清βhCG水平升高和子宫内高回声团块提示妊娠滋养层疾病。因循环衰竭进行了急诊剖腹手术，实施了子宫切除术。组织学检查显示为绒毛膜癌。患者接受了化疗。两年后，未发现转移或复发。
原发性间质部绒毛膜癌的临床诊断困难，因为其罕见且表现为非特异性的异常阴道出血。影像学检查结果对异位部位也无帮助。转移频率与诊断延迟有关。连续测量βhCG水平是诊断和随访最有用的标志物。组织病理学检查仍然是精确诊断的唯一工具。绒毛膜癌即使在晚期预后也非常好，因为它对化疗非常敏感。
目前通过保守手术治疗异位妊娠的趋势要求对βhCG进行充分监测并仔细检查病理标本，以避免误诊异位妊娠滋养层疾病。
