背景:上皮样滋养细胞肿瘤(ETT)是最罕见的妊娠滋养细胞肿瘤(GTT)类型。据报道,超过50%的ETT出现在子宫颈或子宫下段。这里,我们报告一例子宫下段和宫颈管内的ETT,并讨论其表现,可能的原因,及相关影响因素。
方法:一名35岁妇女(妊娠7,流产3,引产2,其中1对双胞胎,剖宫产的第2段,live2),谁有闭经9个月后母乳喂养22个月后最后一次剖宫产,被诊断患有ETT。病变存在于子宫下段和宫颈管内,并严重累及剖宫产切口的子宫下段前壁和子宫下段前壁。实验室测试显示血清β-人绒毛膜促性腺激素略有升高。术中探查显示存在正常大小的子宫体,子宫下段肿瘤增大。子宫下段表面呈浅蓝色,整个病变约8cm×8cm×9cm,周围组织的压缩和位移。组织学检查诊断为ETT。免疫组织化学分析显示p63阳性表达,Ki-67增殖指数为40%。
结论:使用搜索词“剖宫产”和“上皮样滋养细胞肿瘤”搜索PubMed数据库,检索到9篇文章,包括13例ETT和ETT相关病变,13例均有剖宫产史,病灶均位于子宫下段前壁剖宫产切口处。本病例是第14例报道的剖宫产术后ETT病例。因此,我们推断剖宫产创伤对该部位ETT的发生有重要影响.
BACKGROUND: Epithelioid trophoblastic tumor (ETT) is the rarest type of gestational trophoblastic tumor (GTT). It has been reported that more than 50% of ETTs arise in the uterine cervix or the lower uterine segment. Here, we report a
case of ETT within the lower uterine segment and cervical canal and discuss its manifestations, possible causes, and related influencing factors.
METHODS: A 35-year-old woman (gravida 7, miscarriage 3, induction 2 with 1 being twins, para 2 of cesarean section, live 2), who had amenorrhea for 9 mo after breastfeeding for 22 mo after the last cesarean section, was diagnosed with ETT. The lesion was present in the lower uterine segment and endocervical canal with severe involvement of the anterior wall of the lower uterine segment and the front wall of the lower uterine segment where the cesarean incisions were made. Laboratory tests showed slight elevation of serum beta-human chorionic gonadotropin. Intraoperative exploration showed the presence of a normal-sized uterus body with an enlarged tumor in the lower uterine segment. The surface of the lower uterine segment was light blue, the entire lesion was approximately about 8 cm × 8 cm × 9 cm, with compression and displacement of the surrounding tissue. Histological examination diagnosed ETT. Immunohistochemical analysis showed positive expression of p63, with a Ki-67 proliferation index of 40%.
CONCLUSIONS: A search of the PubMed database using the search terms \"cesarean section\" and \"epithelioid trophoblastic tumor\" retrieved nine articles, including 13 cases of ETT and ETT-related lesions, all 13 cases had a history of cesarean section, and the lesions were all located at the cesarean section incision on the anterior wall of the lower uterine segment. The present
case is the 14th reported
case of ETT after cesarean section. Therefore, we deduced that cesarean section trauma had an important effect on the occurrence of ETT at this site.