背景:葡萄胎在胎盘中表现出多个囊泡的独特总体外观。细胞遗传学技术的进步帮助发现了葡萄胎的新实体,并进行了详尽的诊断。然而,与共存的活胎儿一起处理水泡胎盘除了葡萄胎外,还面临更大的挑战。
方法:一名33岁女性在妊娠24周时因疑似葡萄胎与活胎而被转诊到我们部门。患者通过双胚胎移植受孕,妊娠早期超声显示一个囊。正常胎盘实质与多个囊泡和带有胎儿的单个羊膜腔混合的中期成像结果导致怀疑单胎部分磨牙妊娠。在通过羊膜穿刺术和密切监测确认正常二倍体后,病人分娩了一个健康的新生儿。胎盘的初步显微镜检查未能明确诊断,直到荧光原位杂交显示大部分XXY性染色体。患者发展为疑似绒毛膜癌,化疗后5个月达到缓解,但怀疑中间滋养细胞肿瘤复发.
结论:我们报告了一例罕见的双胎妊娠病例,包括一个部分葡萄胎和一个类似于单胎部分葡萄胎妊娠的正常胎儿。在囊泡胎盘与胎儿共存的情况下,个性化护理很重要。在这种情况下,除了传统的形态学评估外,我们强烈建议进行辅助检查。
BACKGROUND: Hydatidiform moles exhibit a distinctive gross appearance of multiple vesicles in the placenta. The advances in cytogenetic technologies have helped uncover novel entities of hydatidiform moles and enabled elaborate diagnoses. However, management of a vesicular placenta with a coexistent live fetus poses a bigger challenge beyond hydatidiform moles.
METHODS: A 33-year-old woman was referred to our department for suspected hydatidiform mole coexistent with a live fetus at 24 weeks\' gestation. The patient had conceived through double embryo transplantation, and first-trimester ultrasonography displayed a single sac. Mid-trimester imaging findings of normal placenta parenchyma admixed with multiple vesicles and a single amniotic cavity with a fetus led to suspicion of a singleton partial molar pregnancy. After confirmation of a normal diploid by amniocentesis and close surveillance, the patient delivered a healthy neonate. Preliminary microscopic examination of the placenta failed to clarify the diagnosis until fluorescence in situ hybridization showed a majority of XXY sex chromosomes. The patient developed suspected choriocarcinoma and achieved remission for 5 months after chemotherapy, but relapsed with suspected intermediate trophoblastic tumor.
CONCLUSIONS: We report a rare case of twin pregnancy comprising a partial mole and a normal fetus that resembled a singleton partial molar pregnancy. Individualized care is important in conditions where a vesicular placenta coexists with a fetus. We strongly recommend ancillary examinations in addition to traditional morphologic assessment in such cases.