保守手术治疗的10例Ⅰ期胎盘部位滋养细胞肿瘤病例报告及文献复习

陈金娟; 王星然; 李文质; 程煜; 孙艺华; 陶祥; 马凤华; 孙莉; 赵洪波; 鹿欣

doi:10.19401/j.cnki.1007-3639.2023.09.006

您当前的位置：

首页 >

文章列表页 >

保守手术治疗的10例Ⅰ期胎盘部位滋养细胞肿瘤病例报告及文献复习

论著 | 更新时间：2025-12-31

- 保守手术治疗的10例Ⅰ期胎盘部位滋养细胞肿瘤病例报告及文献复习
- Conservative surgery in stage I placental site trophoblastic tumor: a report of 10 cases and literature review
- 中国癌症杂志 2023年33卷第9期页码：857-865
- 作者机构：
  
  1. 复旦大学附属妇产科医院妇瘤科，上海 200090
  2. 复旦大学附属妇产科医院病理科，上海 200090
  3. 复旦大学附属妇产科医院放射科，上海 200090
  4. 复旦大学附属妇产科医院超声科，上海 200090
  5. 复旦大学附属妇产科医院组织库，上海 200090
  6. 上海市女性生殖内分泌相关疾病重点实验室，上海 200090
- 作者简介：
  
  [ "陈金娟（ORCID：0000-0001-6097-9968），硕士，主治医师。" ]
  鹿欣（ORCID: 0000-0001-8054-6940），博士后，主任医师。
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2023.09.006
  中图分类号： R737.33
- 收稿：2023-07-31，
  
  修回：2023-09-07，
  
  纸质出版：2023-09-30
- 稿件说明：
移动端阅览
陈金娟, 王星然, 李文质, 等. 保守手术治疗的10例Ⅰ期胎盘部位滋养细胞肿瘤病例报告及文献复习[J]. 中国癌症杂志, 2023,33(9):857-865.

Jinjuan CHEN, Xingran WANG, Wenzhi LI, et al. Conservative surgery in stage I placental site trophoblastic tumor: a report of 10 cases and literature review[J]. China Oncology, 2023, 33(9): 857-865.
陈金娟, 王星然, 李文质, 等. 保守手术治疗的10例Ⅰ期胎盘部位滋养细胞肿瘤病例报告及文献复习[J]. 中国癌症杂志, 2023,33(9):857-865. DOI： 10.19401/j.cnki.1007-3639.2023.09.006.

Jinjuan CHEN, Xingran WANG, Wenzhi LI, et al. Conservative surgery in stage I placental site trophoblastic tumor: a report of 10 cases and literature review[J]. China Oncology, 2023, 33(9): 857-865. DOI： 10.19401/j.cnki.1007-3639.2023.09.006.

摘要

背景与目的：

胎盘部位滋养细胞肿瘤（placental site trophoblastic tumor，PSTT）是罕见的妇科恶性肿瘤，由于PSTT在子宫内独特的浸润方式和对化疗不敏感特性，全子宫切除是首选的手术方式。本研究旨在探讨Ⅰ期PSTT患者保守手术治疗的可行性和安全性。

方法：

纳入2015年1月—2021年12月复旦大学附属妇产科医院收治的Ⅰ期PSTT病例，同时分别以“placental site trophoblastic tumor”和“case”、“胎盘部位滋养细胞肿瘤”和“例”为关键词在PubMed和中国知网（CNKI）中检索1990年1月—2021年12月发表的接受保守手术治疗的Ⅰ期PSTT个案报道和系统病例报告，收集患者的临床病理学资料，并进行回顾性分析。

结果：

共纳入复旦大学附属妇产科医院收治的符合标准的病例10例，中位年龄为27岁，最常见的症状为不规则阴道出血（70.0%），中位诊断距离前次妊娠时间间隔（interval since antecedent pregnancy，ISAP）为14.5个月，中位β-绒毛膜促性腺激素（β-human chorionic gonadotrophin，β-hCG）水平为124.51 mU/mL，病灶直径为0.8 ~ 8.0 cm。复旦大学附属妇产科医院收治的10例患者经初始治疗后均获得完全缓解，平均随访时间为48.1个月，均未复发。3例患者治疗后自然受孕，其中2例足月妊娠分娩，1例因计划外妊娠行人工流产。文献复习PSTT病例显示出类似的临床病理学分布特征和疾病转归。

结论：

保守手术可以作为部分Ⅰ期PSTT患者的一种替代治疗方法，但需更多研究提供证据。

Abstract

Background and purpose:

Placental site trophoblastic tumor (PSTT) is a rare type of malignant tumor. Because of its unique mode of invasion in the uterus and its insensitivity to chemotherapy

total hysterectomy is the primary recommendation. The purpose of this study was to investigate the feasibility and safety of conservative surgical treatment in patients with stage Ⅰ PSTT.

Methods:

The patients with stage Ⅰ PSTT admitted to Obstetrics and Gynecology Hospital of Fudan University from January 2015 to December 2021 were included

and those published on Pubmed and China National Knowledge Infrastructure (CNKI) from January 1990 to December 2021 were searched with the keywords of “placental site trophoblastic tumor” and “case”

“placental trophoblastic tumor” and “case” respectively. The clinic

opathological data of the patients were collected and retrospectively analyzed.

Results:

A total of 10 cases admitted to Obstetrics and Gynecology Hospital of Fudan University were enrolled. The median age was 27 years. The most common symptom was irregular vaginal bleeding (70.0%). The median time of interval since antecedent pregnancy (ISAP) was 14.5 months. The median level of β-human chorionic gonadotrophin (β-hCG) was 124.51 mU/mL

and the diameter of the focus was 0.8-8.0 cm. All 10 patients admitted to Obstetrics and Gynecology Hospital of Fudan University achieved complete remission after initial treatment. The average follow-up time was 48.1 months and there was no recurrence. Three patients became pregnant naturally after treatment

including 2 cases of full-term pregnancy and delivery and 1 case of induced abortion because of unplanned pregnancy. Literature review of PSTT cases showed similar clinicopathological distribution and disease outcome.

Conclusion:

Conservative surgery could be an alternative choice for selected patients with stage Ⅰ PSTT

but more research is needed to provide evidence.

关键词

Keywords

references

YAMAMOTO E , NISHINO K , NIIMI K , et al . Epidemiologic study on gestational trophoblastic diseases in Japan [J ] . J Gynecol Oncol , 2022 , 33 ( 6 ): e72 . DOI: 10.3802/jgo.2022.33.e72 http://doi.org/10.3802/jgo.2022.33.e72

LYBOL C , THOMAS C M , BULTEN J , et al . Increase in the incidence of gestational trophoblastic disease in the Netherlands [J ] . Gynecol Oncol , 2011 , 121 ( 2 ): 334 - 338 . DOI: 10.1016/j.ygyno.2011.01.002 http://doi.org/10.1016/j.ygyno.2011.01.002

ZHAO J , LV W G , FENG F Z , et al . Placental site trophoblastic tumor: a review of 108 cases and their implications for prognosis and treatment [J ] . Gynecol Oncol , 2016 , 142 ( 1 ): 102 - 108 . DOI: S0090-8258(16)30685-0 http://doi.org/S0090-8258(16)30685-0

LIU W , ZHAO W , HUANG X . Outcomes and prognostic factors of placental-site trophoblastic tumor: a retrospective study of 58 cases [J ] . Arch Gynecol Obstet , 2022 , 306 ( 5 ): 1633 - 1641 . DOI: 10.1007/s00404-022-06502-7 http://doi.org/10.1007/s00404-022-06502-7

SHIH I M , KURMAN R J . The pathology of intermediate trophoblastic tumors and tumor-like lesions [J ] . Int J Gynecol Pathol , 2001 , 20 ( 1 ): 31 - 47 . DOI: 10.1097/00004347-200101000-00004 http://doi.org/10.1097/00004347-200101000-00004

BAERGEN R N , RUTGERS J L , YOUNG R H , et al . Placental site trophoblastic tumor: a study of 55 cases and review of the literature emphasizing factors of prognostic significance [J ] . Gynecol Oncol , 2006 , 100 ( 3 ): 511 - 520 . DOI: 10.1016/j.ygyno.2005.08.058 http://doi.org/10.1016/j.ygyno.2005.08.058

GADDUCCI A , CARINELLI S , GUERRIERI M E , et al . Placental site trophoblastic tumor and epithelioid trophoblastic tumor: clinical and pathological features, prognostic variables and treatment strategy [J ] . Gynecol Oncol , 2019 , 153 ( 3 ): 684 - 693 . DOI: S0090-8258(19)30184-2 http://doi.org/S0090-8258(19)30184-2

ALEXANDER A L , STROHL A E , MANIAR K P , et al . Placental site trophoblastic tumor: successful treatment of 13 cases [J ] . Gynecol Oncol Rep , 2020 , 32 : 100548 .

CHIOFALO B , PALMARA V , LAGANÀ A S , et al . Fertility sparing strategies in patients affected by placental site trophoblastic tumor [J ] . Curr Treat Options Oncol , 2017 , 18 ( 10 ): 58 . DOI: 10.1007/s11864-017-0502-0 http://doi.org/10.1007/s11864-017-0502-0 http://link.springer.com/10.1007/s11864-017-0502-0 http://link.springer.com/10.1007/s11864-017-0502-0

ASHTON E , SZUTOWSKA M , SHAFER A , et al . Attempted conservative management of a placental site trophoblastic tumor: a case report [J ] . Conn Med , 2014 , 78 ( 8 ): 475 - 477 .

TAYLOR J S , VIERA L , CAPUTO T A , et al . Unsuccessful planned conservative resection of placental site trophoblastic tumor [J ] . Obstet Gynecol , 2013 , 121 ( 2 Pt 2 Suppl 1 ): 465 - 468 . DOI: http://10.1097/AOG.0b013e31826d7da6 http://doi.org/http://10.1097/AOG.0b013e31826d7da6

SHEN X Y , XIANG Y , GUO L N , et al . Fertility-preserving treatment in young patients with placental site trophoblastic tumors [J ] . Int J Gynecol Cancer , 2012 , 22 ( 5 ): 869 - 874 . DOI: 10.1097/IGC.0b013e31824a1bd6 http://doi.org/10.1097/IGC.0b013e31824a1bd6

LISZKA L , WILK M , WODOLAZSKI A , et al . Successful treatment of placental site trophoblastic tumor in twin pregnancy without hysterectomy [J ] . Tumori , 2009 , 95 ( 1 ): 108 - 111 . DOI: 10.1177/030089160909500120 http://doi.org/10.1177/030089160909500120 http://journals.sagepub.com/doi/10.1177/030089160909500120 http://journals.sagepub.com/doi/10.1177/030089160909500120

PFEFFER P E , SEBIRE N , LINDSAY I , et al . Fertility-sparing partial hysterectomy for placental-site trophoblastic tumour [J ] . Lancet Oncol , 2007 , 8 ( 8 ): 744 - 746 .

NUMNUM T M , KILGORE L C , CONNER M G , et al . Fertility sparing therapy in a patient with placental site trophoblastic tumor: a case report [J ] . Gynecol Oncol , 2006 , 103 ( 3 ): 1141 - 1143 .

LEISEROWITZ G S , WEBB M J . Treatment of placental site trophoblastic tumor with hysterotomy and uterine reconstruction [J ] . Obstet Gynecol , 1996 , 88 ( 4 Pt 2 ): 696 - 699 .

苏代芬 , 胡玉泉 , 刘劭华 , 等 . 宫角妊娠合并胎盘部位滋养细胞瘤1例 [J ] . 中国计划生育学杂志 , 1998 , 6 ( 3 ): 135 - 136 .

SU D F , HU Y Q , LIU S H , et al . A case of cornual pregnancy complicated with placental site trophoblastoma [J ] . J Cap Univ Med Sci , 1998 , 6 ( 3 ): 135 - 136 .

张平 . 胎盘部位滋养细胞肿瘤2例病理报告 [J ] . 宁夏医学杂志 , 1999 , ( 12 ): 753 .

ZHANG P . Placental site trophoblastic tumor: a pathological report of 2 cases [J ] . Ningxia Med J , 1999 , ( 12 ): 753 .

TSUJI Y , TSUBAMOTO H , HORI M , et al . Case of PSTT treated with chemotherapy followed by open uterine tumor resection to preserve fertility [J ] . Gynecol Oncol , 2002 , 87 ( 3 ): 303 - 307 .

MACHTINGER R , GOTLIEB W H , KORACH J , et al . Placental site trophoblastic tumor: outcome of five cases including fertility preserving management [J ] . Gynecol Oncol , 2005 , 96 ( 1 ): 56 - 61 .

虞海燕 . 足月妊娠合并胎盘部位滋养细胞肿瘤3例误诊分析 [J ] . 实用妇产科杂志 , 2006 , 22 ( 9 ): 548 - 549 .

YU H Y . Misdiagnosis analysis of 3 cases of full-term pregnancy complicated with placental trophoblastic tumors [J ] . J Prac Obste Gynecol , 2006 , 22 ( 9 ): 548 - 549 .

NAGAI Y , KAMOI S , MATSUOKA T , et al . Impact of p53 immunostaining in predicting advanced or recurrent placental site trophoblastic tumors: a study of 12 cases [J ] . Gynecol Oncol , 2007 , 106 ( 3 ): 446 - 452 .

厉霞玲 , 钱建华 . 胎盘部位滋养细胞肿瘤12例临床分析 [J ] . 现代妇产科进展 , 2007 , 16 ( 12 ): 948 - 950 .

LI X L , QIAN J H . Clinical analysis of 12 cases of trophoblastic tumor in placenta [J ] . Prog Obstet Gynecol , 2007 , 16 ( 12 ): 948 - 950 .

刘红 , 张国楠 , 樊英 . 胎盘部位滋养细胞肿瘤保留生育功能治愈1例 [J ] . 实用妇产科杂志 , 2009 , 25 ( 4 ): 245 - 246 .

LIU H , ZHANG G N , FAN Y . A case of placental trophoblastic tumor with preserved fertility function cured [J ] . J Prac Obste Gynecol , 2009 , 25 ( 4 ): 245 - 246 .

SASO S , HADDAD J , ELLIS P , et al . Placental site trophoblastic tumours and the concept of fertility preservation [J ] . BJOG , 2012 , 119 ( 3 ): 369 - 374 . DOI: 10.1111/bjo.2011.119.issue-3 http://doi.org/10.1111/bjo.2011.119.issue-3 http://doi.wiley.com/10.1111/bjo.2011.119.issue-3 http://doi.wiley.com/10.1111/bjo.2011.119.issue-3

ZHENG Y X , BAO L J , NING Y , et al . Retrospective analysis of the clinicopathologic and prognostic characteristics of stage I placental site trophoblastic tumor in China [J ] . Int J Gynaecol Obstet , 2015 , 129 ( 1 ): 67 - 70 . DOI: 10.1016/j.ijgo.2014.10.027 http://doi.org/10.1016/j.ijgo.2014.10.027

CHOI M C , JUNG S G , PARK H , et al . Placental site trophoblastic tumors: analysis of the clinicopathologic characteristics of 20 cases in Korea [J ] . Int J Gynecol Cancer , 2016 , 26 ( 8 ): 1515 - 1520 . DOI: 10.1097/IGC.0000000000000799 http://doi.org/10.1097/IGC.0000000000000799

陈思思 , 张虹 . 中间型滋养细胞肿瘤8例并文献回顾 [J ] . 国际妇产科学杂志 , 2017 , 44 ( 6 ): 709 - 712 .

ZHANG S S , ZHANG H . Diagnosis, treatments and prognosis of intermediate trophoblastic tumors [J ] . J Int Obstet Gynecol , 2017 , 44 ( 6 ): 709 - 712 .

ZHANG Y , ZHANG S Q , HUANG W Q , et al . Intermediate trophoblastic tumor: the clinical analysis of 62 cases and prognostic factors [J ] . Arch Gynecol Obstet , 2019 , 299 ( 5 ): 1353 - 1364 . DOI: 10.1007/s00404-018-05037-0 http://doi.org/10.1007/s00404-018-05037-0

刘佳 , 李丽 . 胎盘部位滋养细胞肿瘤九例临床病理报告 [J ] . 中华肿瘤防治杂志 , 2019 , 26 ( 23 ): 1805 - 1809 .

LIU J , LI L . Clinicopathologic report of nine placental site trophoblastic tumors [J ] . Chin J Cancer Prev Treat , 2019 , 26 ( 23 ): 1805 - 1809 .

赵小晓 , 石玉香 , 倪海春 , 等 . 胎盘部位滋养细胞肿瘤一例报告 [J ] . 新医学 , 2020 , 51 ( 3 ): 231 - 234 . DOI: 10.3969/j.issn.0253-9802.2020.03.015 http://doi.org/10.3969/j.issn.0253-9802.2020.03.015

ZHAO X X , SHI Y X , NI H C , et al . Placental site trophoblastic tumor: a case report [J ] . New Med , 2020 , 51 ( 3 ): 231 - 234 .

LEE H J , SHIN W , JANG Y J , et al . Clinical characteristics and outcomes of placental site trophoblastic tumor: experience of single institution in Korea [J ] . Obstet Gynecol Sci , 2018 , 61 ( 3 ): 319 - 327 . DOI: 10.5468/ogs.2018.61.3.319 http://doi.org/10.5468/ogs.2018.61.3.319 http://ogscience.org/journal/view.php?doi=10.5468/ogs.2018.61.3.319 http://ogscience.org/journal/view.php?doi=10.5468/ogs.2018.61.3.319

MANGILI G , BERGAMINI A , GIORGIONE V , et al . [ 18 F ] fluorodeoxyglucose positron emi ssion tomography/computed tomography and trophoblastic disease: the gynecologist perspective [J ] . Q J Nucl Med Mol Imaging , 2016 , 60 ( 2 ): 103 - 116 .

KAUR B . Pathology of gestational trophoblastic disease (GTD) [J ] . Best Pract Res Clin Obstet Gynaecol , 2021 , 74 : 3 - 28 . DOI: 10.1016/j.bpobgyn.2021.02.005 http://doi.org/10.1016/j.bpobgyn.2021.02.005

National Comprehensive Cancer Network . NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines ® ) gestational rophoblastic neoplasia version 1.2023 [EB/OL ] . ( 2023-08-30 )[ 2022-12-20 ] . https://www.nccn.org/professionals/physician_gls/pdf/gtn.pdf https://www.nccn.org/professionals/physician_gls/pdf/gtn.pdf https://www.nccn.org/professionals/physician_gls/pdf/gtn.pdf.

浏览量

2032

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

SMARCA4缺失型肺恶性肿瘤的临床病理学特征及患者预后分析

87例唾液腺导管癌患者的治疗策略与预后分析：一项回顾性队列研究

肢端型黑色素瘤组织中MITF的表达及其与临床、病理学特征及预后的相关性研究

放射性淋巴细胞减少对局限期小细胞肺癌患者预后的影响：一项队列研究

¹⁸F-FDG PET/CT代谢参数对接受CAR-T治疗的弥漫大B细胞淋巴瘤患者预后价值的队列研究