Mangla Mishu, Rahiman Emine A, Kaur Harpreet, Kanikaram Poojitha
Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India.
Division of Pediatric Hematology-Oncology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India.
J Turk Ger Gynecol Assoc. 2023 Sep 7;24(3):206-219. doi: 10.4274/jtgga.galenos.2023.2023-5-2.
Gestational trophoblastic neoplasia (GTN) arising in the placenta and presenting as a metastatic disease concurrently in the mother and the baby is extremely rare. GTN poses a diagnostic dilemma to the treating clinicians. In the current review, an electronic search of Scopus, PubMed, Embase and other databases was conducted for case reports and case series of GTN co-existing or metastatic to both the mother and the baby, published to date. Globally, a total of twenty-two cases of GTN with metastasis to both the mother and baby was found. The previous history of histopathology confirmed molar pregnancy was present in 4/22 cases. The median time to diagnose GTN in the mother was six weeks post-partum. In the majority of cases, diagnosis of maternal disease was made after the infant presented with clinical manifestation. Overall survival was reported in 17/22 mothers up to varying latest follow-up and in 6/22 infants. A knowledge of the varied clinical presentation, eliciting a history of previous pregnancy loss/term pregnancy and serum beta human chorionic gonadotrophin (β-hCG) estimations were helpful for early diagnosis. The concurrent presence of GTN in the mother and baby is a rare entity and poses a diagnostic dilemma. Diagnosis in the mother often follows diagnosis in the baby after an infant presents with clinical manifestations. GTN is a highly chemo-sensitive tumour, but the main prognostic factors determining survival are the time to diagnosis following previous pregnancy and serum β-hCG levels.
起源于胎盘并同时在母婴体内表现为转移性疾病的妊娠滋养细胞肿瘤（GTN）极为罕见。GTN给治疗的临床医生带来了诊断难题。在本次综述中，对Scopus、PubMed、Embase和其他数据库进行了电子检索，以查找迄今已发表的GTN在母婴体内共存或转移的病例报告和病例系列。在全球范围内，共发现22例GTN转移至母婴双方的病例。22例中有4例既往组织病理学确诊为葡萄胎妊娠。母亲诊断为GTN的中位时间为产后6周。在大多数病例中，母亲疾病的诊断是在婴儿出现临床表现之后。在不同的最新随访中，22位母亲中有17位报告了总生存期，22位婴儿中有6位报告了总生存期。了解不同的临床表现、询问既往流产/足月妊娠史以及测定血清β-人绒毛膜促性腺激素（β-hCG）有助于早期诊断。GTN在母婴体内同时存在是一种罕见情况，会带来诊断难题。母亲的诊断通常在婴儿出现临床表现后进行。GTN是一种对化疗高度敏感的肿瘤，但决定生存的主要预后因素是上次妊娠后至诊断的时间以及血清β-hCG水平。
