Jones W B, Romain K, Erlandson R A, Burt M E, Lewis J L
Gynecology Service, Memorial Sloan Kettering Cancer Center, New York, New York.
Cancer. 1993 Oct 1;72(7):2175-81. doi: 10.1002/1097-0142(19931001)72:7<2175::aid-cncr2820720718>3.0.co;2-k.
Pulmonary metastases occur frequently in patients with gestational choriocarcinoma and most of these patients achieve remission with chemotherapy alone. Thus, the indications for surgical intervention are limited, but in appropriately selected patients, resection of a chemotherapy-resistant lung lesion can be curative.
Nine patients with choriocarcinoma metastatic to the lung underwent 11 thoracotomies. The procedure was done in two patients for diagnosis and in seven to remove a resistant focus of tumor in the lung. The excised resistant tumors in six patients were studied histopathologically, immunohistochemically, and by electron microscopic examination (one patient).
Six (66.6%) patients achieved complete remission for periods ranging from 3 months to 18 years, and three patients died of their disease. The residual lung nodules in these patients with chemotherapy-resistant tumors were characterized by the presence of large mononucleated tumor cells that showed features intermediate between those of cytotrophoblasts and syncytiotrophoblasts but lacking ultrastructural and immunohistochemical features of the intermediate trophoblasts seen in placental site tumors.
A major role for operative treatment of chemotherapy-resistant choriocarcinoma in the lung is suggested by the observation that some of the resistant tumors contain a unique variant of trophoblastic cells that show a decreased sensitivity to chemotherapy but are amenable to surgical resection.
妊娠性绒毛膜癌患者肺部转移很常见，大多数患者仅通过化疗就能缓解。因此，手术干预的指征有限，但在适当选择的患者中，切除化疗耐药的肺部病灶可能治愈。
9例绒毛膜癌肺转移患者接受了11次开胸手术。2例手术用于诊断，7例用于切除肺部耐药肿瘤病灶。对6例患者切除的耐药肿瘤进行了组织病理学、免疫组织化学及电镜检查（1例患者）。
6例（66.6%）患者获得完全缓解，缓解期为3个月至18年，3例患者死于该病。这些化疗耐药肿瘤患者残留的肺结节特征为存在大的单核肿瘤细胞，其表现介于细胞滋养层细胞和合体滋养层细胞之间，但缺乏胎盘部位肿瘤中所见中间型滋养层细胞的超微结构和免疫组织化学特征。
观察发现一些耐药肿瘤含有独特的滋养层细胞变体，对化疗敏感性降低但可手术切除，提示手术治疗肺部化疗耐药性绒毛膜癌具有重要作用。
