Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy.
Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.
J Matern Fetal Neonatal Med. 2023 Dec;36(2):2285238. doi: 10.1080/14767058.2023.2285238. Epub 2023 Nov 27.
Intraplacental choriocarcinoma is a gestational trophoblastic neoplasia located within the placenta. Due to the usual silent presentation, more than half of the cases are diagnosed incidentally. It has been demonstrated that this pathology is linked to feto-maternal hemorrhage (FMH), stillbirth, and intrauterine growth restriction. The aim of our review was to establish if there are recurrent signs that might lead to an early diagnosis and better management in cases complicated by FMH.
We performed a systematic review of the literature from 2000 up to March 2023. The adopted research strategy included the following terms: (gestational choriocarcinoma obstetrics outcome) AND (intraplacental choriocarcinoma) AND (gestational choriocarcinoma). The MEDLINE (PubMed), Google Scholar, and Scopus databases were searched.
The research strategy identified 19 cases of FMH coexisting with intraplacental choriocarcinoma (IC), as described in 17 studies. The perinatal mortality rate was 36.8%. In eight cases, histological diagnosis of IC was made post-delivery. Metastatic lesions were found in 75% (6/8) of described cases. One case of maternal death has been described. Chemotherapy was necessary in seven cases. Sporadical prenatal ultrasound signs were described.
The diagnosis of IC is usually delayed, mostly due to aspecific symptoms and signs. Histological analysis of the placenta, when not routinely performed, should be performed when warning symptoms are encountered. The maternal prognosis was good, with a mortality rate of 5.5%. A fertility-sparing approach is always possible even in the presence of metastasis. Chemotherapy seems to be useful in cases of maternal and neonatal metastasis.
胎盘内绒毛膜癌是一种位于胎盘内的妊娠滋养细胞肿瘤。由于其通常表现为无症状，超过一半的病例是偶然诊断出来的。已有研究表明，这种病理学与胎-母出血（FMH）、死胎和宫内生长受限有关。我们进行本次综述的目的是确定是否存在反复出现的迹象，这些迹象可能导致 FMH 合并病例的早期诊断和更好的管理。
我们对 2000 年至 2023 年 3 月的文献进行了系统回顾。采用的研究策略包括以下术语：（妊娠绒毛膜癌产科结局）和（胎盘内绒毛膜癌）和（妊娠绒毛膜癌）。检索了 MEDLINE（PubMed）、Google Scholar 和 Scopus 数据库。
研究策略共确定了 17 项研究中描述的 19 例 FMH 合并胎盘内绒毛膜癌（IC）的病例。围产儿死亡率为 36.8%。8 例产后行组织学诊断为 IC。描述的病例中有 75%（6/8）发现转移性病变。有 1 例产妇死亡的病例报道。7 例需要化疗。偶有产前超声异常的报道。
IC 的诊断通常会被延迟，主要是因为其症状和体征不具有特异性。当出现警告症状时，应进行胎盘的组织学分析，即使不是常规进行的。母体的预后良好，死亡率为 5.5%。即使存在转移，也始终可以采用保留生育能力的方法。对于存在母体和新生儿转移的病例，化疗似乎是有用的。
