双胎之一完全性葡萄胎妊娠并发侵蚀性葡萄胎1例

doi:10.3969/j.issn.1004-583X.2024.05.011

摘要/Abstract

摘要：

目的探讨双胎之一完全性葡萄胎妊娠的发病机制、临床特点及诊疗方法。方法回顾性分析1例双胎之一完全性葡萄胎妊娠并发侵蚀性葡萄胎病例的诊疗经过及妊娠结局,并复习相关文献。结果孕妇促排卵治疗后自然妊娠,孕期超声考虑双胎妊娠合并葡萄胎,经剖宫产获得足月新生儿。结合其临床表现、影像学检查、组织病理学特征及免疫组化,最终确诊为双胎之一完全性葡萄胎。剖宫产后随访2个月,产妇确诊为侵蚀性葡萄胎(Ⅲ:2),给予MTX单药化疗7个疗程后临床痊愈。结论双胎妊娠合并葡萄胎的处理,应综合考虑,对于双胎之一完全性葡萄胎并发侵蚀性葡萄胎更应制定个体化的诊疗方案。

关键词: 双胎妊娠, 完全性葡萄胎, 侵蚀性葡萄胎, 双胎之一完全性葡萄胎

Abstract:

Objective To explore the pathogenesis, clinical characteristics and treatment methods of complete hydatidiform mole with co-existing fetus (CHMCF). Methods A retrospective analysis was conducted on the diagnosis, treatment, and pregnancy outcome of a case involving CHMCF complicated by invasive mole, along with a review of related literature. Results The patient had a spontaneous pregnancy following ovulation induction treatment, with an ultrasound during pregnancy confirmed twin pregnancy complicated by hydatidiform mole. A full-term newborn was delivered by cesarean section. Combining clinical presentation, imaging examinations, histopathological characteristics and immunohistochemistry, the CHMCF diagnosis was confirmed. A 2-month follow-up after cesarean section revealed the diagnosis of an invasive mole (Ⅲ:2). Clinical remission was achieved after receiving 7 courses of single-agent methotrexate (MTX) chemotherapy. Conclusion Management of a twin pregnancy complicated by hydatidiform mole should be individualized, especially in cases involving CHMCF complicated by invasive mole.

Key words: twin pregnancy, complete hydatidiform mole, invasive mole, complete hydatidiform mole with co-existing fetus

中图分类号:

R737.33

刘立婷, 王健, 肖艳来, 张艺玮. 双胎之一完全性葡萄胎妊娠并发侵蚀性葡萄胎1例[J]. 临床荟萃, 2024, 39(5): 450-454.

Liu Liting, Wang Jian, Xiao Yanlai, Zhang Yiwei. The occurrence of complete hydatidiform mole with co-existing fetus complicated by invasive mole: A case report[J]. Clinical Focus, 2024, 39(5): 450-454.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.05.011

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I5/450

图/表 4

图1 孕妇孕36+周超声图像(矢状切面)

Fig. 1 Ultrasound image of a pregnant woman at 36+ weeks of pregnancy (sagittal section)

图2 孕妇分娩的胎儿 a.胎儿:体重2 810 g,Apgar评分均10分,外观无畸形;b. 胎盘大体观:大小18 cm×16 cm×2.5 cm,母面部分区域灰黄,范围5 cm×3 cm,脐带附着中;c. 葡萄胎样组织大体观:大小约14 cm×11 cm×7.5 cm,其上见数个水泡,直径0.5~2.0 cm

Fig. 2 Fetus delivered by a pregnant woman a. Fetus: weight 2, 810 g, Apgar score 10 points, no deformity in appearance; b. Gross appearance of the placenta: size 18 cm×16 cm×2.5 cm, part of the maternal surface grayish-yellow in color, ranging 5 cm×3 cm, with the umbilical cord attached; c. Gross appearance of hydatidiform tissue: size approximately 14 cm×11 cm×7.5 cm, with several blisters on it, 0.5~2.0 cm in diameter

图3 胎盘病理检查 a.胎盘组织局部梗死伴少量钙化;b.葡萄胎样组织,符合完全性葡萄胎伴多量坏死

Fig. 3 Pathological examination of the placenta a. Local infarction of the placental tissue with a small amount of calcification; b. Mole-like tissue, consistent with complete mole with a large amount of necrosis

图4 盆腔MRI 子宫肌层形态不规则,可见囊状及片状T2高信号,右侧为著,局部可见低信号,内膜显示不清,结构紊乱,信号不均匀(矢状位)

Fig. 4 Pelvic magnetic MRI The myometrium is irregular in shape, with cystic and lamellar T2 high signal, especially on the right side, and low signal in parts. The endometrium is unclearly displayed, with disordered structure and uneven signal (sagittal view)

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