Lobo Antunes Isabel, Curado Joana, Quintas Ana, Pereira Alcides
Gynaecology and Obstetrics Department. Hospital Garcia de Orta. Almada. Portugal.
Acta Med Port. 2017 Sep 29;30(9):656-658. doi: 10.20344/amp.8603.
Molar pregnancy, included in gestational trophoblastic disease, is a benign pathology with ability to metastasize, usually occurring with excessively high βhCG levels. Clinical scenario is usually a woman in extremes of reproductive age presenting with amenorrhoea, pain and vaginal blood loss; signs derived from high βhCG levels may be present (hyperthyroidism, hyperemesis). Diagnosis is based on a positive pregnancy test - usually a qualitative urinary test. The limitation of this test results from its inability to become positive in presence of markedly high levels of βhCG, saturating the antigens used - known as the 'hook effect'. With the widespread use of gynaecological ultrasound cases of molar pregnancy have been diagnosed in timely fashion. We describe a case referred as a degenerating fibroid, with a negative urinary pregnancy test. Transvaginal ultrasound was highly suggestive of molar pregnancy, which was confirmed with a quantitative βhCG test, allowing for timely treatment. The importance of a high index of suspicion for this pathology is tremendous to avoid the devastating consequences of a delayed diagnosis.
葡萄胎属于妊娠滋养细胞疾病，是一种具有转移能力的良性病变，通常发生于βhCG水平异常升高时。临床症状通常表现为处于生育年龄 extremes 的女性出现闭经、疼痛和阴道出血；可能会出现由高βhCG水平引起的体征（甲状腺功能亢进、妊娠剧吐）。诊断基于妊娠试验阳性——通常是定性尿液检测。该检测的局限性在于，当βhCG水平显著升高，使所用抗原饱和时，它无法呈阳性，即所谓的“钩状效应”。随着妇科超声的广泛应用，葡萄胎病例得以及时诊断。我们描述了一例最初被诊断为变性肌瘤且尿液妊娠试验阴性的病例。经阴道超声高度提示为葡萄胎，定量βhCG检测得以确诊，从而实现了及时治疗。对于这种病变保持高度怀疑指数对于避免延迟诊断带来的灾难性后果极为重要。
