Anwar Ruswana, Tjandraprawira Kevin Dominique, Irawan Budi
Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Jendral Soedirman - Prof. Dr. Margono Soekarjo Hospital, Purwokerto, Indonesia.
Ann Med Surg (Lond). 2022 Apr 21;77:103659. doi: 10.1016/j.amsu.2022.103659. eCollection 2022 May.
The management of a large uterine fibroid concurrent with gestational trophoblastic disease (GTD) in a nullipara is complicated, challenging yet should focus on conserving fertility. We would like to share our experience.
A 28-year-old G1P0A0 of 10-11 weeks' gestation presented with a profuse vaginal bleeding with a history of passing swollen, grape-like tissues from the vagina. Since 7 months prior, a large uterine fibroid >10 cm had been diagnosed on ultrasound. Patient was diagnosed with GTD with β-human chorionic gonadotropin (hCG) levels exceeding 1,000,000 mIU/mL. No pulmonary metastases were detected. She underwent a vacuum curettage for her complete hydatidiform mole.Six days later, she underwent an elective myomectomy. Her nulliparity precluded hysterectomy. Post-discharge, her β-hCG levels plateaued and were consistently high over 3 consecutive measurements. A diagnosis of gestational trophoblastic neoplasia (GTN) was established. Patient is currently undergoing a methotrexate-folinic acid rescue chemotherapy regimen due to her having a low risk, stage 1 GTN.
Uterine fibroid may reach exceptional sizes. There is so far no link between GTD and uterine fibroids but their concurrent presence is extremely rare. The definitive management for a large fibroid is hysterectomy but considering the patient's nulliparity, a myomectomy was appropriate. GTD's definitive management is vacuum curettage.Periodical β-hCG measurement should follow discharge. Plateauing β-hCG levels indicated GTN and due to her low-risk GTN, she required a single-agent methotrexate chemotherapy. Most patients with low-risk GTN make a complete recovery.
Fertility after myomectomy and GTN generally has an excellent prognosis.
未育女性合并巨大子宫纤维瘤及妊娠滋养细胞疾病（GTD）的管理复杂且具有挑战性，但应注重保留生育能力。我们希望分享我们的经验。
一名妊娠10 - 11周的28岁初孕妇（G1P0A0）出现大量阴道出血，有从阴道排出肿胀、葡萄样组织的病史。自7个月前超声检查诊断出一个直径大于10 cm的巨大子宫纤维瘤。患者被诊断为GTD，β-人绒毛膜促性腺激素（hCG）水平超过1,000,000 mIU/mL。未检测到肺转移。她因完全性葡萄胎接受了刮宫术。六天后，她接受了择期子宫肌瘤切除术。她未育，因此不能进行子宫切除术。出院后，她的β-hCG水平稳定且连续三次测量一直居高不下。确诊为妊娠滋养细胞肿瘤（GTN）。由于她患有低风险的1期GTN，目前正在接受甲氨蝶呤 - 亚叶酸解救化疗方案。
子宫纤维瘤可能长得非常大。到目前为止，GTD与子宫纤维瘤之间没有关联，但它们同时存在极为罕见。巨大纤维瘤的确定性治疗方法是子宫切除术，但考虑到患者未育，子宫肌瘤切除术是合适的。GTD的确定性治疗是刮宫术。出院后应定期测量β-hCG。β-hCG水平稳定表明患有GTN，由于她的GTN风险低，她需要单药甲氨蝶呤化疗。大多数低风险GTN患者可完全康复。
子宫肌瘤切除术后和GTN后的生育能力一般预后良好。
