Departments of Obstetrics and Gynecology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.
Obstet Gynecol. 2017 Feb;129(2):281-284. doi: 10.1097/AOG.0000000000001808.
Pregnancy of unknown location presents a diagnostic challenge, in rare occasions leading to the diagnosis of malignancy. We describe a case of β-hCG-secreting nongestational primary gastric choriocarcinoma presenting as a pregnancy of unknown location.
A 37-year-old woman, gravida 4 para 3013, presented with several days of vaginal bleeding and rising β-hCG level without ultrasound localization of pregnancy. The diagnosis of pregnancy of unknown location was made and methotrexate administered at a β-hCG level of 7,779 milli-international units/mL. A 40% decrease in β-hCG level was noted between days 4 and 7. One week later, an inappropriate β-hCG level rise to 10,937 milli-international units/mL was noted, prompting a second dose of methotrexate and computed tomography imaging, leading to the discovery of gastric and liver lesions. Pathology from gastric biopsies revealed nongestational choriocarcinoma. The patient was treated with chemotherapy, with death from cardiac arrest 7 months after diagnosis.
Malignancies that can secrete β-hCG include gestational trophoblastic disease, gonadal and extragonadal germ cell tumors, and malignancies with choriocarcinoma differentiation. Although ectopic pregnancy compromises approximately 2% of first-trimester pregnancy, gestational trophoblastic neoplasia and gestational choriocarcinoma can be seen in 1 of 1,500 and 1 of 20,000 pregnancies, respectively. When β-hCG levels do not fall appropriately in women undergoing medical management for pregnancy of unknown location, ectopic β-hCG secretion by a malignancy must be considered.
不明部位妊娠具有诊断挑战性，在极少数情况下会导致恶性肿瘤的诊断。我们描述了一例β-hCG 分泌的非妊娠性原发性胃绒毛膜癌，表现为不明部位妊娠。
一名 37 岁女性，G4P3013，因阴道出血数日和β-hCG 水平升高就诊，但超声未定位妊娠。诊断为不明部位妊娠，并在β-hCG 水平为 7779 毫国际单位/毫升时给予甲氨蝶呤治疗。在第 4 天至第 7 天期间，β-hCG 水平下降了 40%。一周后，β-hCG 水平升高至 10937 毫国际单位/毫升，提示再次给予甲氨蝶呤治疗，并进行计算机断层扫描成像，发现胃和肝的病变。胃活检的病理结果显示为非妊娠性绒毛膜癌。患者接受化疗治疗，但在诊断后 7 个月因心脏骤停死亡。
能够分泌β-hCG 的恶性肿瘤包括妊娠性滋养细胞疾病、性腺和性腺外生殖细胞肿瘤，以及具有绒毛膜癌分化的恶性肿瘤。虽然异位妊娠约占早期妊娠的 2%，但妊娠性滋养细胞肿瘤和妊娠性绒毛膜癌的发病率分别为每 1500 次妊娠和每 20000 次妊娠中出现 1 次。当接受不明部位妊娠的药物治疗的女性β-hCG 水平没有适当下降时，必须考虑恶性肿瘤异位分泌β-hCG 的可能性。
