完全缓解后的胎盘部位滋养细胞肿瘤免疫治疗后足月妊娠

Term Pregnancy After Complete Response of Placental Site Trophoblastic Tumor to Immunotherapy.

机构信息

Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, Saint Louis, Missouri.

出版信息

Obstet Gynecol. 2021 Jul 1;138(1):115-118. doi: 10.1097/AOG.0000000000004434.

DOI:10.1097/AOG.0000000000004434

PMID:34259474

Abstract

BACKGROUND

Standard treatment for placental site trophoblastic tumor is hysterectomy. This may be unacceptable to women desiring fertility. Cells aberrant in placental site trophoblastic tumor display an ability to invade normal tissue while evading the immune system.

CASE

We present a case of a 23-year-old woman with stage I placental site trophoblastic tumor who declined hysterectomy. Tumor assay for program cell death-ligand 1 staining was performed and suggestive of an immune-responsive tumor. The patient initiated intravenous pembrolizumab 200 mg every 2 weeks, and by cycle 3 her β-hCG level fell to undetectable. She subsequently conceived and went on to have an uncomplicated term vaginal birth after cesarean. At 6 weeks postpartum, she remained without evidence of disease.

CONCLUSION

Immunotherapy can eliminate early program cell death-ligand 1-positive placental site trophoblastic tumor with subsequent normal pregnancy.

摘要

背景

胎盘部位滋养细胞肿瘤的标准治疗方法是子宫切除术。但对于希望生育的女性来说，这可能难以接受。胎盘部位滋养细胞肿瘤中的异常细胞具有侵犯正常组织的能力，同时逃避免疫系统的能力。

病例

我们报告了一例 23 岁的Ⅰ期胎盘部位滋养细胞肿瘤患者，她拒绝接受子宫切除术。对肿瘤程序性死亡配体 1 染色进行了检测，提示为免疫反应性肿瘤。该患者开始每 2 周静脉注射 200mg 帕博利珠单抗，到第 3 周期时β-hCG 水平降至不可检测。随后她怀孕，并成功经剖宫产分娩。产后 6 周时，她仍未发现疾病迹象。