Jiang Fang, Xiang Yang, Guo Li-Na
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Department of Pathology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
J Obstet Gynaecol Res. 2018 May;44(5):960-965. doi: 10.1111/jog.13593. Epub 2018 Feb 13.
A 30-year-old Chinese woman with irregular vaginal bleeding was admitted to our department. Serum β-human chorionic gonadotropin (β-hCG) was moderately elevated, and ultrasound and magnetic resonance imaging revealed an irregular, retro-uterine lesion without intrauterine pregnancy. Ectopic pregnancy was the primary consideration, with trophoblastic tumor being another possibility. Laparoscopy revealed a 2 × 3 × 3 cm irregular, infiltrating, yellow-white lesion in the left recto-uterine pouch, which was completely resected without rectal damage. Final pathological/immunohistochemical analyses revealed an epithelial trophoblastic tumor (ETT) (Ki-67 reactive index~45%). Postoperative recovery was smooth, and the patient received three chemotherapy courses (etoposide, methotrexate and actinomycin, alternating weekly with cyclophosphamide and vincristine) beginning 6 days postsurgery (β-hCG = 46.4 mIU/mL). β-hCG returned to an undetectable level after one chemotherapy course. Herein, we describe a rare case of isolated ETT that was difficult to differentiate from other pregnancy-related diseases. Laparoscopy could be an effective, safe diagnostic method in select patients.
一名30岁的中国女性因阴道不规则出血入院。血清β-人绒毛膜促性腺激素（β-hCG）中度升高，超声和磁共振成像显示子宫后方有一不规则病灶，宫内未见妊娠。初步考虑为异位妊娠，也有可能是滋养细胞肿瘤。腹腔镜检查发现左侧直肠子宫陷凹有一个2×3×3cm大小的不规则、浸润性、黄白色病灶，将其完整切除，未损伤直肠。最终病理/免疫组化分析显示为上皮样滋养细胞肿瘤（ETT）（Ki-67增殖指数约为45%）。术后恢复顺利，患者术后6天（β-hCG = 46.4 mIU/mL）开始接受三个疗程的化疗（依托泊苷、甲氨蝶呤和放线菌素，与环磷酰胺和长春新碱交替使用，每周一次）。一个疗程化疗后β-hCG降至无法检测水平。在此，我们报告一例罕见的孤立性ETT病例，该病例难以与其他妊娠相关疾病相鉴别。对于部分患者，腹腔镜检查可能是一种有效、安全的诊断方法。
