McNally Leah, Rabban Joseph T, Poder Liina, Chetty Shilpa, Ueda Stefanie, Chen Lee-May
Division of Gynecologic Oncology, University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, United States.
Department of Pathology, University of California San Francisco, United States.
Gynecol Oncol Rep. 2021 Jun 10;37:100811. doi: 10.1016/j.gore.2021.100811. eCollection 2021 Aug.
To identify the differentiating features in clinical presentation, management, and maternal/fetal outcome in complete hydatidiform mole and coexistent fetus compared with placental mesenchymal dysplasia. Between 1997 and 2015, five women with complete hydatidiform mole and coexistent fetus and four women with placental mesenchymal dysplasia were managed at the University of California San Francisco. Clinical features were analyzed and compared with previously published data. Of the five cases of complete hydatidiform mole and coexistent fetus, two had live births. β-hCG levels were > 200,000 IU/L in all cases. On imaging, a clear plane between the cystic component and the placenta favored a diagnosis of complete hydatidiform mole and coexistent fetus. None of the patients went on to develop gestational trophoblastic neoplasia (GTN), with a range of follow-up from 2 to 38 months. Combining this data with previously published work, the live birth rate in these cases was 38.8%, the rate of persistent GTN was 36.2%, and the rate of persistent GTN in patients with reported live births was 27%. Of the four cases of placental mesenchymal dysplasia, all four had live births. One patient developed HELLP syndrome and intrauterine growth restriction; the remaining three were asymptomatic. Maternal symptoms, fetal anomalies, β-hCG level, and placental growth pattern on imaging may help differentiate between complete hydatidiform mole and coexistent fetus and placental mesenchymal dysplasia. There was not an increased risk of gestational trophoblastic neoplasia in patients with complete hydatidiform mole and coexistent fetus who opted to continue with pregnancy.
为了确定完全性葡萄胎合并胎儿与胎盘间质性发育异常在临床表现、管理及母胎结局方面的鉴别特征。1997年至2015年期间，加利福尼亚大学旧金山分校收治了5例完全性葡萄胎合并胎儿的患者以及4例胎盘间质性发育异常的患者。分析临床特征并与先前发表的数据进行比较。在5例完全性葡萄胎合并胎儿的病例中，2例活产。所有病例的β-hCG水平均>200,000 IU/L。影像学检查显示，囊性成分与胎盘之间有清晰界限支持完全性葡萄胎合并胎儿的诊断。所有患者均未发生妊娠滋养细胞肿瘤（GTN），随访时间为2至38个月。将这些数据与先前发表的研究相结合，这些病例的活产率为38.8%，持续性GTN的发生率为36.2%，有活产报道的患者中持续性GTN的发生率为27%。在4例胎盘间质性发育异常的病例中，4例均活产。1例患者发生了HELLP综合征和胎儿生长受限；其余3例无症状。母方症状、胎儿异常、β-hCG水平及影像学上的胎盘生长模式可能有助于鉴别完全性葡萄胎合并胎儿与胎盘间质性发育异常。选择继续妊娠的完全性葡萄胎合并胎儿患者发生妊娠滋养细胞肿瘤的风险并未增加。
