Aminimoghaddam Soheila, Maghsoudnia Andisheh
Department of Obstetrics and Gynecology, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran.
Tarbiat Modares University, Tehran, Iran.
J Reprod Infertil. 2017 Jan-Mar;18(1):205-209.
Invasive mole is responsible for most cases of localized gestational trophoblastic neoplasia. Gestational trophoblastic disease describes a number of gynecologic tumors that originate in trophoblastic layer including hydatidiform mole (complete or partial), invasive mole, choriocarcinoma, placental site trophoblastic tumor and epitheloid trophoblastic tumor. Invasive mole may arise from any pregnancy event although in most cases is diagnosed after molar pregnancy. Overall cure rate in low risk patients is nearly 100% and in high-risk patient 90%. In rare cases, molar tissue traverses thickness of myometrium and leads to perforation and acute abdomen and invasive mole infrequently metastasis. The best treatment option is chemotherapy (according to stage and score with single or multiple agent) and in patients that fertility is not the matter, hysterectomy can be done.
A 41 years old G3P2ab1 woman referred to Firouzgar hospital 2 months after curettage of molar pregnancy with vaginal bleeding and acute abdomen. In workup, HCG 224000 and evidence of metastasis was detected. Chemotherapy due to stage 3 and score 9 and surgery due to acute abdomen was done. This case was reported for its rarity.
This case reported about ovarian metastasis and uterine rupture with acute abdomen and involvement of omentum in metastatic invasive mole. Lack of surveillance led to extensive morbidity. Management of this patient was successful. In follow up, she was free of disease without sequel of any kind for five years now.
侵蚀性葡萄胎是局部性妊娠滋养细胞肿瘤的主要病因。妊娠滋养细胞疾病是指起源于滋养层的一些妇科肿瘤，包括葡萄胎（完全性或部分性）、侵蚀性葡萄胎、绒毛膜癌、胎盘部位滋养细胞肿瘤和上皮样滋养细胞肿瘤。侵蚀性葡萄胎可发生于任何妊娠情况，不过多数情况下是在葡萄胎妊娠后被诊断出来。低危患者的总体治愈率接近100%，高危患者为90%。在罕见情况下，葡萄胎组织可穿透子宫肌层厚度，导致穿孔和急腹症，侵蚀性葡萄胎很少发生转移。最佳治疗选择是化疗（根据分期和评分采用单药或多药），对于不考虑生育的患者，可进行子宫切除术。
一名41岁、孕3产2流产1的女性，在葡萄胎妊娠刮宫术后2个月因阴道出血和急腹症转诊至菲鲁兹加尔医院。检查发现血绒毛膜促性腺激素（HCG）为224000，并有转移证据。因处于Ⅲ期、评分为9分进行了化疗，因急腹症进行了手术。该病例因其罕见性而被报道。
本病例报告了侵蚀性转移性葡萄胎发生卵巢转移、子宫破裂伴急腹症及大网膜受累情况。缺乏监测导致了严重的发病情况。该患者的治疗很成功。随访中，她目前已无病生存五年，无任何后遗症。
