PDF(Pubmed)
Abstract：
The present study reports a rare case of an exaggerated placental site (EPS) in a caesarean scar that was misdiagnosed as gestational trophoblastic neoplasia (GTN) by imaging, resulting in unnecessary surgical treatment. A 38-year-old woman underwent hysteroscopic resection of a cesarean scar pregnancy (CSP). The patient\'s serum β-human chorionic gonadotropin (β-hCG) level was elevated (76,196 mIU/ml) at the 24-day postoperative follow-up visit. On postoperative day 51, the patient experienced vaginal bleeding for three days and β-hCG levels were 2,799 mIU/ml. Ultrasonography and MRI revealed a heterogeneous mass and hypervascularity. The patient was diagnosed with a GTN in a cesarean scar and treated with methotrexate (MTX). β-hCG levels decreased after 3 MTX doses, but the mass did not change in size and was still hypervascular on imaging. Total hysterectomy was performed due to the serious side effects of chemotherapy and the lack of desire to preserve fertility. The histological findings supported the diagnosis of an EPS reaction. The present case is unique because of the rare intrauterine mass and possibility of retained trophoblastic changes causing EPS. EPS differs from GTN both clinically and pathologically and should be considered a possible diagnosis in any woman who has irregular bleeding following CSP resection.
摘要：
本研究报告了一例罕见的剖腹产疤痕中胎盘部位（EPS）过度的病例，通过影像学误诊为妊娠滋养细胞瘤（GTN），导致不必要的手术治疗。一名38岁的妇女接受了剖宫产瘢痕妊娠（CSP）的宫腔镜切除术。患者的血清β-人绒毛膜促性腺激素（β-hCG）水平在术后24天随访时升高（76,196mIU/ml）。在术后第51天，患者经历了三天的阴道出血，β-hCG水平为2,799mIU/ml。超声和MRI检查显示不均匀的肿块和血管过多。该患者被诊断为剖宫产瘢痕中的GTN，并接受甲氨蝶呤（MTX）治疗。3MTX剂量后β-hCG水平下降，但肿块大小没有变化,影像学检查仍为高血管.由于化疗的严重副作用和缺乏保留生育能力的愿望，进行了全子宫切除术。组织学发现支持EPS反应的诊断。由于罕见的子宫内肿块以及保留的滋养细胞变化导致EPS的可能性，本病例是独特的。EPS在临床和病理上都与GTN不同，在CSP切除术后不规则出血的任何女性中，均应被视为可能的诊断。
