Sato Asuka, Usui Hirokazu, Nakamura Natsuko, Katayama Eri, Shozu Makio, Koga Kaori
Department of Obstetrics and Gynecology, Chiba University Hospital, Chiba University, Chiba, Japan.
Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
Cancer Diagn Progn. 2024 Mar 3;4(2):193-197. doi: 10.21873/cdp.10307. eCollection 2024 Mar-Apr.
BACKGROUND/AIM: Single-agent chemotherapy typically has curative outcomes in patients with low-risk gestational trophoblastic neoplasia (GTN). Although surgical intervention is a potential alternative, its efficacy in these patients remains unclear. This report describes a case in which surgical excision of a uterine polypoid lesion resolved chemotherapy-resistant low-risk GTN.
A 43-year-old patient received pulse actinomycin D treatment for post-molar low-risk GTN without extrauterine metastasis. However, the patient showed resistance to the chemotherapy regimen. There was no initial evidence of protrusion of GTN into the uterine cavity; however, a polypoid lesion grew into the uterine cavity during therapy. This growth was successfully excised via a transvaginal approach using forceps with minimal blood loss. There was a postoperative decrease in human chorionic gonadotropin levels, which ultimately reached the predetermined threshold without the need for changing the therapeutic protocol.
Surgical resection should be considered a viable therapeutic strategy for uterine polypoid growth in chemotherapy-resistant low-risk GTN.
背景/目的：单药化疗通常对低风险妊娠滋养细胞肿瘤（GTN）患者有治愈效果。虽然手术干预是一种潜在的替代方法，但其在这些患者中的疗效仍不明确。本报告描述了一例通过手术切除子宫息肉样病变使化疗耐药的低风险GTN得到缓解的病例。
一名43岁患者因葡萄胎后低风险GTN且无子宫外转移接受了放线菌素D脉冲治疗。然而，该患者对化疗方案耐药。最初没有GTN突入子宫腔的证据；然而，在治疗期间一个息肉样病变长入了子宫腔。通过经阴道使用钳子成功切除了该肿物，失血极少。术后人绒毛膜促性腺激素水平下降，最终达到预定阈值，无需更改治疗方案。
对于化疗耐药的低风险GTN患者子宫息肉样生长，手术切除应被视为一种可行的治疗策略。
