Yang Chunfeng, Li Jianqi, Zhang Yuanyuan, Xiong Hanzhen, Sheng Xiujie
Department of Obstetrics and Gynecology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China.
Department of Gynecologic Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Panjiayuan, Chaoyang District, 100021, Beijing, People's Republic of China.
J Med Case Rep. 2020 Oct 5;14(1):178. doi: 10.1186/s13256-020-02485-8.
Mixed gestational trophoblastic neoplasms are extremely rare and comprise a group of fetal trophoblastic tumors including choriocarcinomas, epithelioid trophoblastic tumors, and placental site trophoblastic tumors. We present a case of a patient with extrauterine mixed gestational trophoblastic neoplasm adjacent to the abdominal wall cesarean scar. On the basis of a literature review, this type of case has never been reported before due to the unique lesion location and low incidence.
Our patient was a 39-year-old Chinese woman who had a history of two cesarean sections and one miscarriage. She had a recurrent anterior abdominal wall mass around her cesarean scar, and the mass was initially suspected of being choriocarcinoma of unknown origin. The patient had concomitant negative or mildly increased serum β-human chorionic gonadotropin at follow-up and no abnormal vaginal bleeding or abdominal pain. However, she underwent local excision twice and had two courses of chemotherapy with an etoposide and cisplatin regimen. She finally opted for exploratory laparotomy with abdominal wall lesion removal, subtotal hysterectomy, bilateral salpingectomy, and left ovarian cyst resection, which showed the abdominal wall lesion, whose components were revealed by microscopy and immunohistochemical staining to be approximately 90% epithelioid trophoblastic tumors and 10% choriocarcinomas from a solely extrauterine mixed gestational trophoblastic neoplasm around an abdominal wall cesarean scar.
It is worth noting whether epithelioid trophoblastic tumor exists in the setting of persistent positive low-level β-human chorionic gonadotropin. More studies are required to provide mechanistic insights into these mixed gestational trophoblastic neoplasms.
混合性妊娠滋养细胞肿瘤极为罕见，包括一组胎儿滋养细胞肿瘤，如绒毛膜癌、上皮样滋养细胞肿瘤和胎盘部位滋养细胞肿瘤。我们报告一例腹壁剖宫产瘢痕旁子宫外混合性妊娠滋养细胞肿瘤患者。经文献检索，由于病变位置独特且发病率低，此前从未有过此类病例的报道。
我们的患者是一名39岁的中国女性，有两次剖宫产和一次流产史。她剖宫产瘢痕周围的前腹壁肿物反复出现，最初怀疑肿物来源不明的绒毛膜癌。患者随访时血清β-人绒毛膜促性腺激素呈阴性或轻度升高，无异常阴道出血或腹痛。然而，她接受了两次局部切除，并采用依托泊苷和顺铂方案进行了两个疗程的化疗。她最终选择了剖腹探查术，切除腹壁病变、次全子宫切除术、双侧输卵管切除术和左侧卵巢囊肿切除术，结果显示腹壁病变，显微镜检查和免疫组化染色显示其成分约90%为上皮样滋养细胞肿瘤，10%为绒毛膜癌，来自腹壁剖宫产瘢痕周围单纯子宫外混合性妊娠滋养细胞肿瘤。
值得注意的是，在持续性低水平β-人绒毛膜促性腺激素阳性的情况下是否存在上皮样滋养细胞肿瘤。需要更多研究来深入了解这些混合性妊娠滋养细胞肿瘤的发病机制。
