目的:胎盘部位滋养细胞肿瘤(PSTT)和上皮样滋养细胞肿瘤(ETT)是罕见的妊娠滋养细胞肿瘤(GTN)。这些肿瘤不同于绒毛膜癌,因为它们是单相的,增长率较慢,有较低的β-hCG浓度,并且更具化学抗性。胎盘部位滋养细胞肿瘤和ETT可误诊,导致管理不当。.
目的:本研究的目的是回顾发病机制,介绍,病理结果,以及PSTT和ETT的治疗。
方法:进行了全面的文献综述,确定了相关的研究和综述文章。还审查了相关的教科书章节和准则。
结果:胎盘部位滋养细胞肿瘤和ETT可在发生子宫出血异常和β-hCG升高的任何前期妊娠事件后数月至数年出现。与其他GTNs相比,肿瘤通常局限于子宫并分泌较低水平的β-hCG。国际妇产科联合会的预后评分系统与预后并不相关。这些病变可误诊为平滑肌肿瘤,转移性黑色素瘤,和宫颈鳞状细胞癌。然而,它们可以通过其独特的组织学和免疫表型特征来区分。
结论:手术是早期PSTT和ETT的主要治疗方法。对于晚期疾病患者或预后指标较差的患者,例如先前的怀孕间隔超过48个月,建议采用含有高危GTN铂-依托泊苷的方案进行手术和化疗的多模式治疗.
结论:在任何前期妊娠事件后出现异常子宫出血和β-hCG升高的育龄期患者的鉴别诊断中,应考虑胎盘部位滋养细胞肿瘤和ETT。
OBJECTIVE: Placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT) are rare forms of gestational trophoblastic neoplasia (GTN). These tumors differ from choriocarcinoma as they are monophasic, have slower growth rates, have lower β-hCG concentrations, and are more chemoresistant. Placental site trophoblastic tumor and ETT can be misdiagnosed, leading to inappropriate management..
OBJECTIVE: The aim of this study was to
review the pathogenesis, presentation, pathologic findings, and treatment for PSTT and ETT.
METHODS: A comprehensive literature
review was performed identifying relevant research and
review articles. Relevant textbook chapters and guidelines were also reviewed.
RESULTS: Placental site trophoblastic tumor and ETT can present months to years after any antecedent pregnancy event with abnormal uterine bleeding and an elevated β-hCG. Tumors are typically confined to the uterus and secrete lower levels of β-hCG compared with other GTNs. The International Federation of Gynecology and Obstetrics prognostic scoring system does not correlate well with prognosis. These lesions can be misdiagnosed as smooth muscle tumors, metastatic melanoma, and cervical squamous cell carcinoma. However, they can be distinguished by their unique histologic and immunophenotypic features.
CONCLUSIONS: Surgery is the mainstay of treatment for early-stage PSTT and ETT. For patients with advanced disease or for those with poor prognostic indicators, such as an antecedent pregnancy interval of greater than 48 months, a multimodal treatment paradigm of surgery and chemotherapy using a high-risk GTN platinum-etoposide containing regimen is recommended.
CONCLUSIONS: Placental site trophoblastic tumor and ETT should be considered in the differential diagnosis in a reproductive age patient presenting with abnormal uterine bleeding and an elevated β-hCG after any antecedent pregnancy event.