Bradley C S, Benjamin I, Wheeler J E, Rubin S C
Department of Obstetrics and Gynecology, University of Pennsylvania Health System, Philadelphia 19104, USA.
Gynecol Oncol. 1998 Apr;69(1):74-7. doi: 10.1006/gyno.1998.4969.
To report a case of stage IIIc poorly differentiated endometrial adenocarcinoma with trophoblastic differentiation and to review previously reported cases.
The clinical course and histopathology of the case were reviewed, and a literature search for other reported cases was performed.
The tumor contained syncytiotrophoblast-like giant cells that stained positively for the beta subunit of human chorionic gonadotropin (beta-hCG), and the patient's serum beta-hCG level was elevated (95 mIU/ml), but became undetectable after treatment. Beta-hCG was used as a tumor marker during further therapy. At 16 months' survival, she remains without evidence of disease and with a beta-hCG (level < 5 mIU/ml). Nine other cases of trophoblastic differentiation in gynecologic nontrophoblastic tumors have been reported, five in endometrial carcinomas which we review.
Trophoblastic differentiation in gynecologic nontrophoblastic tumors is rare. Beta-hCG may be useful as a tumor marker in these cases. The clinical behavior of these tumors has been aggressive, with advanced stages at diagnosis, early widespread metastases or recurrences and poor patient outcomes. The patient presented in this report, however, remains without evidence of disease 16 months following diagnosis and may be the longest survivor with this tumor reported to date.
报告一例伴有滋养层分化的Ⅲc期低分化子宫内膜腺癌病例，并回顾既往报道的病例。
回顾该病例的临床病程和组织病理学情况，并对其他报道病例进行文献检索。
肿瘤含有对人绒毛膜促性腺激素β亚基（β-hCG）呈阳性染色的合体滋养层样巨细胞，患者血清β-hCG水平升高（95 mIU/ml），但治疗后检测不到。在后续治疗中，β-hCG被用作肿瘤标志物。存活16个月时，她仍无疾病证据，β-hCG水平<5 mIU/ml。另外还报道了9例妇科非滋养层肿瘤中滋养层分化的病例，其中5例为子宫内膜癌，我们对其进行了回顾。
妇科非滋养层肿瘤中的滋养层分化罕见。β-hCG在这些病例中可能作为肿瘤标志物有用。这些肿瘤的临床行为具有侵袭性，诊断时多为晚期，早期广泛转移或复发，患者预后较差。然而，本报告中的患者在诊断后16个月仍无疾病证据，可能是迄今为止报道的该肿瘤最长存活者。
