背景:绒毛膜癌是一种高度恶性的妊娠相关滋养细胞肿瘤,以早期转移到肺部为特征。因此,由于远处转移,患者可能会出现非神经系统症状。足月妊娠后绒毛膜癌的发生率非常罕见(1/160,000妊娠)。
方法:我们报告一例20岁的伊朗妇女,gravida2para1活1流产1,她在分娩后第二天因突然发作的呼吸困难和左半胸疼痛而被转诊到我们的妇科。指数妊娠无任何并发症。在最初的检查之后,β-人绒毛膜促性腺激素(HCG)水平的升高(>1,000,000)以及远处转移的临床(阴道病变)和放射学证据(双侧肺结节)的鉴定指导我们对肺转移性绒毛膜癌的诊断。肿瘤学会诊后,依托泊苷,甲氨蝶呤,放线菌素D,环磷酰胺,并对患者开始长春新碱化疗方案。她对治疗反应良好,目前正在继续她的化疗过程。
结论:如果按时开始治疗,绒毛膜癌的预后非常好。我们建议临床医生在产后并发症的鉴别诊断中应考虑妊娠滋养细胞瘤。尤其是在足月和非磨牙妊娠后。
BACKGROUND: Choriocarcinoma is a highly malignant pregnancy-related trophoblastic neoplasm, characterized by early metastasis to the lungs. Therefore, patients may manifest nongynecological symptoms owing to distant metastases. The incidence of choriocarcinoma after a term pregnancy is really rare (1/160,000 pregnancies).
METHODS: We report a case of a 20-year-old Iranian woman, gravida 2 para 1 live 1 abortion 1, who was referred to our gynecology department with sudden onset dyspnea and pain in the left hemithorax the day after her labor. The index pregnancy was without any complications. After the initial workup, the elevation of β-human chorionic gonadotropin (HCG) levels (> 1,000,000) along with the identification of clinical (vaginal lesions) and radiological evidence of distant metastases (bilateral pulmonary nodes) directed us toward pulmonary metastatic choriocarcinoma diagnosis. After the oncology consult, the etoposide,
methotrexate, actinomycin D, cyclophosphamide, and vincristine chemotherapy regimen was started for the patient. She responded well to the treatment and is currently continuing her chemotherapy process.
CONCLUSIONS: The prognosis of choriocarcinoma is very good if the treatment is started on time. We suggest that clinicians should consider gestational trophoblastic neoplasia in their differential diagnosis of the post-natal period complications, especially after a term and nonmolar pregnancy.