目的:本研究旨在探讨非磨牙妊娠合并异位妊娠(EP)后妊娠滋养细胞肿瘤(GTN)的临床病理特征。
方法:选取2015年1月至2022年9月浙江大学医学院附属妇女医院收治的83例非磨牙妊娠后疑似GTN患者的临床资料进行分析。
结果:总计,41例确诊为非磨牙GTN,包括31个绒毛膜癌,9PSTT(胎盘部位滋养细胞肿瘤),和1ETT(上皮样滋养细胞肿瘤),42例确诊为EP。与异位妊娠相比,非磨牙GTN患者的血清孕酮水平低于EP(3.81nmol/Lvs17.70nmol/L,P=0.001)。根据超声波,与EP相比,非磨牙GTN患者的子宫内膜厚度较薄(0.565cmvs0.70cm,P=0.018)。通过组织病理学检查,与EP相比,非磨牙GTN的内皮显示出较少的蜕膜样变化(64.3%vs14.6%,P=0.001)。
结论:血清孕酮水平的组合,子宫内膜厚度,子宫内膜的组织病理学特征有助于区分非磨牙GTN和EP。需要进行包括宫腔镜和刮宫和/或腹腔镜在内的手术。
OBJECTIVE: This study was presented to investigate the clinical-pathological characteristics of gestational trophoblastic neoplasia (GTN) following non-molar pregnancy and differentiated with ectopic pregnancy (EP).
METHODS: The clinical data of 83 patients who were admitted for suspected GTN after non-molar pregnancy at the Women\'s Hospital School of Medicine Zhejiang University from January 2015 to September 2022 were selected for analysis.
RESULTS: In total, 41 cases were confirmed non-molar GTN, including 31 choriocarcinoma, 9 PSTT (placental site trophoblastic tumor), and 1 ETT (epithelioid trophoblastic tumor), while 42 cases were confirmed EP. Compared with ectopic pregnancy, non-molar GTN patients had lower levels of serum progesterone compared with EP (3.81 nmol/L vs 17.70 nmol/L, P = 0.001). Based on the ultrasound, the thickness of the endometrium was thinner in patients with non-molar GTN compared with EP (0.565 cm vs 0.70 cm, P = 0.018). By histopathologic examination, the endothelium of non-molar GTN showed less decidual-like changes compared with EP (64.3% vs 14.6%, P = 0.001).
CONCLUSIONS: A combination of serum progesterone levels, endometrium thickness, and histopathologic features of the endometrium can help to differentiate non-molar GTN and EP. Surgeries including hysteroscopy with curettage and/or laparoscopy are needed.