Gruber K, Gelven P L, Austin R M
Departments of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, 29425-0955, USA.
Int J Gynecol Pathol. 1997 Jan;16(1):28-32. doi: 10.1097/00004347-199701000-00005.
The diagnosis of early ectopic pregnancy remains challenging for the gynecologist. Although early detection of a suspected pregnancy has been facilitated by quantitative beta human chorionic gonadotropin studies and ultrasonography, a patient subgroup remains with an ambiguous presentation. In this group of patients, the clinician must rely on microscopic examination of products of conception in a uterine curettage specimen to rule out the presence of an extrauterine pregnancy. The presence of an implantation site, chorionic villi, or trophoblastic tissue in uterine curettage samples is conventionally held as definitive evidence of an intrauterine pregnancy. We present a series of four cases that challenge this convention. In these cases, chorionic villi or an implantation site were identified in uterine samples of pregnant women who each ultimately proved to have an ectopic pregnancy. If clinical suspicion is high, the finding of either chorionic villi or an implantation site should not preclude further workup of a possible ectopic pregnancy. In cases where only a few villi or a single chorionic villus are identified, other signs of intrauterine implantation such as intermediate trophoblastic cells, hyalinized vessels, and a fibrinoid matrix should be sought to establish firmly the diagnosis of an intrauterine pregnancy.
对于妇科医生而言，早期异位妊娠的诊断仍然具有挑战性。尽管定量β-人绒毛膜促性腺激素研究和超声检查有助于早期发现疑似妊娠，但仍有一部分患者表现不明确。对于这组患者，临床医生必须依靠对子宫刮宫标本中的妊娠产物进行显微镜检查，以排除宫外孕的存在。子宫刮宫样本中存在着床部位、绒毛或滋养层组织通常被视为宫内妊娠的确切证据。我们报告了一系列4例挑战这一传统观念的病例。在这些病例中，在最终被证实为宫外孕的孕妇子宫样本中发现了绒毛或着床部位。如果临床怀疑程度较高，发现绒毛或着床部位不应排除对可能的宫外孕进行进一步检查。在仅发现少数绒毛或单个绒毛的情况下，应寻找其他宫内着床迹象，如中间滋养层细胞、玻璃样变血管和纤维蛋白样基质，以明确诊断宫内妊娠。
