Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung, Taiwan.
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung, Taiwan; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Taiwan J Obstet Gynecol. 2021 Nov;60(6):1098-1102. doi: 10.1016/j.tjog.2021.09.024.
We present a case of choriocarcinoma in a viable pregnancy with the rare presentation of intractable lower back pain.
The patient is a 34-year-old multiparous woman with her second pregnancy, and a history of scoliosis with spinal fixation. Her first pregnancy was uneventful, with a term vaginal delivery. She was hospitalized four times due to intractable back pain from 25 to 31 weeks, and terminated at 31 weeks. The placenta was unremarkable on gross examination. Postpartum, the patient developed obstructive ileus, requiring a rectosigmoid resection. She was diagnosed with metastatic choriocarcinoma to the liver, para-aortic lymph nodes, and mesentery. A week later, she developed micro-thrombosis of all limbs, massive ascites, pleural effusion. Patient refused chemotherapy and died on post-operative Day 15.
Presentation of choriocarcinoma in pregnancy varies widely. Clinicians should consider the differential diagnosis of choriocarcinoma when faced with abnormal unexplained symptoms during pregnancy.
我们报告了一例妊娠活胎绒毛膜癌，其罕见表现为顽固性下腰痛。
患者为 34 岁多产妇，有脊柱侧弯伴脊柱固定史。她第一次妊娠顺利，足月经阴道分娩。在 25 周到 31 周期间，她因顽固性背痛住院 4 次，并于 31 周时终止妊娠。大体检查胎盘无明显异常。产后，患者出现肠梗阻，需要行直肠乙状结肠切除术。她被诊断为肝、腹主动脉旁淋巴结和肠系膜转移绒毛膜癌。一周后，她出现四肢微血栓形成、大量腹水、胸腔积液。患者拒绝化疗，术后第 15 天死亡。
妊娠绒毛膜癌的表现差异很大。当妊娠期间出现不明原因的异常症状时，临床医生应考虑绒毛膜癌的鉴别诊断。
