Hsieh F J, Wu C C, Lee C N, Chen T M, Chen C A, Chen F C, Chen C L, Hsieh C Y
Department of Obstetrics and Gynecology, National Taiwan University, College of Medicine, Taipei.
Cancer. 1994 Oct 15;74(8):2361-5. doi: 10.1002/1097-0142(19941015)74:8<2361::aid-cncr2820740822>3.0.co;2-g.
Destruction of uterine vasculature is a common phenomenon in gestational trophoblastic tumors. The authors categorized such uterine vasculature by color Doppler ultrasound and studied its clinical significance.
Color Doppler ultrasound was performed in 28 patients with gestational trophoblastic tumors. The vascular morphologic manifestations were recorded, and the peak systolic velocity and resistance index of uterine artery were calculated. Serum beta-human chorionic gonadotropin (hCG) levels were measured periodically to monitor chemotherapy response. Seventeen uneventful postmole uteri were used as controls. Two-tailed Student's t-test and Fisher's exact test were used for statistical analysis.
The gestational trophoblastic tumors were categorized as diffuse type (N = 7), lacunar type (N = 16), and compact type (n = 5) according to their vascular patterns. The mean serum beta-hCG level at diagnosis in diffuse type lesions (6608 +/- 6320 mIU/mL) was significantly lower than in the lacunar type (40462 +/- 39735 mIU/mL; P = 0.04) and compact type (212114 +/- 205126 mIU/mL; P = 0.02), whereas the level in compact type lesions was significantly higher than in the lacunar type (P = 0.003). Lacunar type lesions exhibited a significantly lower uterine artery resistance index (0.51 +/- 0.13) than diffuse type (0.66 +/- 0.10; P = 0.03) or compact type lesions (0.70 +/- 0.06; P = 0.02). All lesions exhibited significantly higher peak systolic velocity than control subjects (P < 0.001); however, no significant difference was observed among them. Brief courses (< 5 cycles) of chemotherapy cured more diffuse type (6 of 7) than lacunar type (3 of 15, P = 0.006) or compact type lesions (0 of 5, P = 0.008). Histopathologic diagnosis was available for 11 lesions. They were invasive mole in seven lacunar type lesions and choriocarcinoma in four compact type lesions.
Vascular morphologic patterns of gestational trophoblastic tumors by color Doppler ultrasound correlated well with beta-hCG levels, uterine hemodynamics, chemotherapy response, and possibly the histopathologic diagnosis.
子宫血管破坏是妊娠滋养细胞肿瘤中的常见现象。作者通过彩色多普勒超声对这类子宫血管进行分类，并研究其临床意义。
对28例妊娠滋养细胞肿瘤患者进行彩色多普勒超声检查。记录血管形态学表现，计算子宫动脉的收缩期峰值流速和阻力指数。定期测量血清β-人绒毛膜促性腺激素（hCG）水平以监测化疗反应。选取17例清宫术后情况良好的子宫作为对照。采用双侧t检验和Fisher精确检验进行统计学分析。
根据血管形态，妊娠滋养细胞肿瘤分为弥漫型（n = 7）、血窦样型（n = 16）和致密型（n = 5）。弥漫型病变诊断时的平均血清β-hCG水平（6608±6320 mIU/mL）显著低于血窦样型（40462±39735 mIU/mL；P = 0.04）和致密型（212114±205126 mIU/mL；P = 0.02），而致密型病变的水平显著高于血窦样型（P = 0.003）。血窦样型病变的子宫动脉阻力指数（0.51±0.13）显著低于弥漫型（0.66±0.10；P = 0.03）或致密型病变（0.70±0.06；P = 0.02）。所有病变的收缩期峰值流速均显著高于对照组（P < 0.001）；然而，它们之间未观察到显著差异。短疗程（< 5个周期）化疗治愈的弥漫型病变（7例中的6例）多于血窦样型（15例中的3例，P = 0.006）或致密型病变（5例中的0例，P = 0.008）。11例病变有组织病理学诊断结果。7例血窦样型病变为侵蚀性葡萄胎，4例致密型病变为绒毛膜癌。
彩色多普勒超声显示的妊娠滋养细胞肿瘤血管形态模式与β-hCG水平、子宫血流动力学、化疗反应以及可能的组织病理学诊断密切相关。
