浸润性葡萄胎患者保留生育功能问题

恶性滋养细胞肿瘤包括浸润性葡萄胎(以下简称浸葡)和绒毛膜癌(以下简称绒癌),大都发生在生育年龄的妇女,其中又有相当一部分为年轻的未产妇,她们迫切希望保留子宫,保留生育机能。以往的处理原则是凡诊断恶性滋养细胞肿瘤者均行子宫切除术,从而丧失了生育机能。自60年代Hertz首创单纯化学药物治疗本病以来,各国均有应用化疗保留子宫,保存生育机能成功的报道。国内宋鸿钊教授等报道159例青年患者均获保留子宫成功,其中119例治疗后又怀孕。我院自1971年起对年轻患者试行保留生     

滋养细胞疾患治疗后妇女的生殖机能

自1962年至1972年共治疗滋养细胞疾患258例其中63例治疗后妊娠,占24.4％。取36例曾用化(?)的病例,并以36例葡萄胎自然流产后未用化疗者及36例产科门诊病人作为对照,以观察化疗对妊娠及胎儿之影响。36例用化疗者:4例绒癌、4例恶葡、28例组织学不清属临床诊断。化疗用氨甲喋呤、放线菌素D、6巯—基嘌呤及氮杂脲嘧啶核苷(6-Azauridine)。经详细询问病史作对比。化疗后病人妊娠分娩合并症升高:5例妊娠中毒症、1例早产、2例产后出血、2例前置胎盘、4例产钳分娩、5例剖腹产。     

国产氨甲喋呤加甲酰四氢叶酸治疗恶性滋养细胞肿瘤22例疗效随访

<正> 1956年Lime等首次报告用氨甲喋呤(MTX)治疗恶性滋养细胞肿瘤有效,Goldstein于1976—1980年先后报告用MTX加甲酰四氢叶酸(CVF)治疗恶性葡萄胎和绒毛膜癌(以下简称恶葡与绒癌),有效率达91％,且药物毒性反应小。然而,至今国内尚未见成组病例报道,为了解国产MTX治疗恶性滋养细胞肿瘤的疗效及其毒性反应,本文对17例恶葡5例绒癌的治疗进行定期观察随访,现报告如下:     

侵蚀性葡萄胎和绒癌的临床与病理诊断

本文通过２２７例恶性妊娠性滋养叶细胞肿瘤的病理学诊断，评价了侵蚀性葡萄胎和绒癌的临床诊断标准。根据末次妊娠性质，①足月产组：４１例（１００％）均为绒癌；②流产值：５１／５４例（９４．４％）为绒癌；③葡萄胎组：自葡萄胎排出至病理确诊时间，６个月以内，７１／８０例（８８．８％）为恶葡；１２个月以上，３４／３５例（９７．１％）为绒癌；６￣１２个月，１４／１７例（８２．４％）为绒癌。     

恶性滋养细胞肿瘤死亡27例分析

绒癌和侵蚀性葡萄胎(恶葡)是妇女较为常见的恶性肿瘤,自采用以化疗为主的治疗方法后已取得巨大成就,绒癌死亡率由过去的90%下降至20%左右,恶葡由过去的25%左右下降接近于零.我院近14年共收治恶性滋养细胞肿瘤214例,死亡27例,本文就27例死亡病例总结分析如下.临床资料1 资料来源我院自1975年至1989年共收治恶性滋养细胞肿瘤214例,其中绒癌110例,死亡22例,病死率为20%(22/110);恶葡104例,死亡5例,病死率4.8%(5/104).27例入院时的临床分期为:绒癌Ⅲa18例,Ⅳ4例,恶葡Ⅱb1例,Ⅲb4例(按宋鸿钊诊断标准分类).6例死于住院期间,21例出院后随访1～4个月死亡.     

人绒毛膜促性腺激素放射免疫测定的进展及临床应用

检查妇女血尿中的人绒毛膜促性腺激素(hCG)可诊断妊娠,并作为恶葡和绒癌化疗及随访的指标.多年来,临床上测定hCG的方法有雄蛙排精法、快速乳胶法和血凝法。     

必须重视妊娠滋养细胞肿瘤的规范化治疗

自大剂量短疗程化疗为主的疗法应用于恶性滋养细胞肿瘤取得成功以来,绒毛膜癌(绒癌)和侵蚀性葡萄胎(侵葡)的治愈率显著提高。绒癌的死亡率从89％下降为11％,侵葡死亡率从25％下降为1％以下。采用多途径给药,辅以适当或必要的手术治疗的综合疗法,患者不但可达到根治,而且可能保留子宫并生育,开创了妇科恶性实体瘤保留器官功能的先例。迄今,国内外报道,早期恶性滋养细胞肿瘤治愈率达95％以上,而耐药患者仅为30％-40％。因此,提高耐药患者的治愈率,已成为研究热点。     

有关滋养叶肿瘤预后的一些因素

在1956年以前患滋养叶病预后都很差,而且发展甚快。1956年Li等报告的3例转移病例经过氨甲喋呤治疗后得到完全缓解。这是成功地应用化疗治疗实质性肿瘤的一个转折点。在最近20年里,滋养叶疾病有了更多的有效药物并在研究及治疗中积累了丰富的经验使得其预后更有所改善。有转移的患者持续缓解率可达90%,而病灶局限者实际上已达100%。以前对这种疾患的治疗通常都用子宫切除,现在可以说化疗不仅可以改善预后而且几乎可使所有希望保留生育机能的病人只用化疗。从很多报告大量病人治疗后成功的妊娠事例中说明这种方法是可靠的。一、滋养叶的生物学方面问题 Hertz提出妊娠滋养叶疾病是反映胎儿、绒毛的生物动力学过程。从形态学上讲良葡、恶葡及绒癌是一个疾病连续发展的不     

绒癌和侵蚀性葡萄胎患者化疗后一年内妊娠结局的分析

目的　探讨绒癌和侵蚀性葡萄胎患者多疗程化学治疗（ 化疗） 后,１ 年内妊娠的结局。方法　分析绒癌和侵蚀性葡萄胎患者化疗后在１ 年内妊娠的２２ 例发生异常妊娠、废胎率的情况及其与化疗停药的间隔的关系。结果　２２ 例中,足月分娩９ 例,废胎６ 例,废胎率为２７．３％ 。其中停止化疗半年内妊娠者废胎率高于半年以上者（ Ｐ＜ ０．０５）。患者发生产后绒癌１ 例,发生重复性葡萄胎１ 例,此２ 例均发生在停药５ 个月内妊娠。结论　绒癌和侵蚀性葡萄胎经化疗保留子宫是可行的。但多疗程化疗后,妊娠不宜太早,应至少避孕半年,最好避孕１ 年。     

B超探测恶性滋养细胞肿瘤子宫内病灶的意义

滋养细胞肿瘤即使已有广泛转移,对化疗仍十分敏感。但在处理本病之前,必须对肿瘤的范围作出正确的估价,明确子宫内有无病灶存在,以便决定子宫切除与否,尤其年轻而未生育的患者可否保留生育机能更为重要。为此目的,我们对B超探测恶性滋养细胞肿瘤子宫内病灶的情况作了初步探讨,并将超声图与子宫造影、腹腔镜检查、手术标本病理检查进行对照,对各种检查作出初步评价。资料与方法我院1983年2月至1984年1月对38例恶性滋养细胞肿瘤(绒癌6例,恶葡32例)做了B超探测子宫,其中21例行子宫碘油造影术,17例做腹腔镜检查,20例做子宫切除术或子宫内病灶挖出术。本组做上述两项检查者21例,3项检查者16例,4项检查者4例。     

Gestational trophoblastic disease in women aged 50 or more

Twenty cases of gestational trophoblastic disease in women aged 50 or more are reported. The lesions were 7 hydatidiform mole (35%), 8 invasive mole (40%), and 5 choriocarcinoma (25%). The most common presenting symptom was abnormal vaginal bleeding. Three choriocarcinoma patients were postmenopausal and all of them had choriocarcinoma. None of the patients with hydatidiform mole or invasive mole died of the disease, but 4 of 5 choriocarcinoma patients died of the disease. Because of the high rate (56.3%) of malignant sequelae after molar evacuation, a primary hysterectomy for the treatment of hydatidiform mole in this age group is recommended. It is important to maintain a high level of suspicion for the diagnosis of gestational trophoblastic disease in the elderly women.     

滋养细胞肿瘤几种细胞因子的变化

目的 研究滋养细胞肿瘤患者血清中的细胞因子水平、探讨与病因的关系。方法 以双抗体、夹心ＥＬＩＳＡ法检测３０例滋养细胞肿瘤患者血清中肿瘤坏死因子白细胞介素－６、８、１０的水平。其中绒毛膜癌１８例,侵蚀性葡萄胎１２例,并以正常早、中期妊娠女２８例、晨孕妇２０例作为对照组。结果 正常孕妇组ＩＬ－６．８、１０均高于正常非孕妇组,其中正常孕妇组ＩＬ－６和ＩＬ－８水平明显升高,而ＩＬ－１０水平略升高,无统计学     

Pelvic angiography in malignant trophoblastic disease

Pelvic angiography was analyzed in 24 patients with malignant trophoblastic disease. Abnormal findings such as prominent uterine arteries, hypervascularity of the uterus, arteriovenous shunts, tumor staining and pooling were observed. Translucency was observed in all patients with choriocarcinoma. This finding was observed in only 3 of 11 patients (27.3%) with invasive mole and was not apparent in patients with an undetermined group. These differences were statistically significant. Translucency of pelvic angiography in malignant trophoblastic disease was more suggestive of choriocarcinoma than of invasive mole. Thus, translucency in pelvic angiography may be a distinctive finding with which to differentiate choriocarcinoma from invasive mole, without resection of the uterus.     

Choriocarcinoma diagnostic score: A scoring system to differentiate choriocarcinoma from invasive mole

Okamoto T, Nomura S, Nakanishi T, Goto S, Tomoda Y, Mizutani M. Choriocarcinoma diagnostic score: A scoring system to differentiate choriocarcinoma from invasive mole. Int J Gynecol Cancer 1998; 8 : 128–132.
The histologic diagnosis of choriocarcinoma has been reported to be one of the prognostic factors for the treatment outcome of gestational trophoblastic tumors (GTT). A scoring system, called the choriocarcinoma diagnostic score (CD score), which had been devised to differentiate choriocarcinoma from invasive mole, was reevaluated in patients with GTT treated at Nagoya University Hospital from 1964 to 1996. There were 134 cases with pathologic documentation of choriocarcinoma and 155 cases of invasive mole. Sensitivity of the CD score (ie the true positive rate for the histologic diagnosis of choriocarcinoma) was 94.0%, and specificity of the score (ie true positive rate for the histologic diagnosis of invasive mole) was 97.4%. Thus, the accuracy of the score was very high (95.8%). Seventy-two (91.2%) of 79 cases with high CD scores (10 points or more) were categorized into high-risk or very high-risk groups according to the World Health Organization (WHO) prognostic index score. This unique scoring system should be included in the management of patients with GTT.     

Serum SP1 and hCGβ-subunit (hCGβ) levels in choriocarcinoma, invasive mole, and hydatidiform mole—Clinical significance of ratio

Serum SP₁ (pregnancy-specific β₁, glycoprotein) levels in patients with choriocarcinoma, invasive mole, and hydatidiform mole were radioimmunoassayed and compared with simultaneously measured serum hCGβ-subunit (hCGβ) levels in order to evaluate the clinical significance of SP₁ determination. Serum SP₁ levels at the time of admission ranged from 6.4 to 1660 ng/ml in choriocarcinoma patients, 16.3 to 540 ng/ml in invasive mole, and 720 to 58,000 ng/ml in hydatidiform mole. ratios were under 1.0 in choriocarcinoma (0.3 ± 0.2, mean ± SD), over 1.0 in hydatidiform mole (10.9 ± 8.3), and intermediate in invasive mole (1.5 ± 0.3). In normal pregnancy, the ratio increases as pregnancy progresses, that is, from 15.25 in 7-week gestation to 14,090.90 in 40-week gestation. The mean ratio differs significantly among choriocarcinoma, invasive mole, and hydatidiform mole. ratio is likely to represent the degree of differentiation of trophoblastic cells. The ratio may be useful in differentiating between choriocarcinoma and invasive mole.     

The Japanese trophoblastic disease classification

OBJECTIVE: To evaluate the clinical usefulness of the "diagnostic score"for the detection of choriocarcinoma in persistent gestational trophoblastic disease without histologic findings. STUDY DESIGN: We reviewed the clinical records of and histologic reports on all 809 patients with persistent gestational trophoblastic disease treated with surgery and chemotherapy in Japan. There were 347 cases of choriocarcinoma and 462 cases of invasive mole with histologic confirmation. We retrospectively applied the diagnostic score to all the patients. RESULTS: The sensitivity of the score for choriocarcinoma (the true positive rate of the score for histologic diagnosis of choriocarcinoma) was 91.4%. The specificity of the score (the true positive rate of the score for the histologic diagnosis of invasive mole) was 94.1%. The accuracy of the score was 92.8%. CONCLUSION: The diagnostic score is a unique scoring system for differentiating choriocarcinoma clinically from persistent gestational trophoblastic disease without histologic findings and for selecting the most appropriate chemotherapy. Proper management in the early stages strongly influences the outcome of these diseases. The scoring system should be very useful for comparing the nearly true incidence and treatment results with choriocarcinoma between nations.     

The clinical significance of OFA-I in the immunological rejection mechanism in trophoblasts

Oncofetal Antigen-I is a membrane antigen of melanoma cells that cross-reacts with human fetal brain tissues. In this paper, from the point of view of fetal antigen, we investigated the immune response of pregnant women and the role of OFA-I in pregnancy. The results obtained are as follows. A higher prevalence of anti-OFA-I with the IA method was obtained in sera from pregnant women (50% in the 1st, 48% in 2nd and 55% in 3rd trimester). The prevalence of anti-OFA-I with the IA method was 78% (21/27) in total hydatidiform mole, 80% (8/10) in invasive mole and 86% (28/32) in choriocarcinoma patients. OFA-I was not detected in thirteen normal trophoblasts and five total mole ones by means of the IA absorption assay. With the indirect immunofluorescence method, OFA-I was found in 40% of incomplete abortions (4/10) and 28% of inevitable ones (5/18) but not found in normal trophoblasts (0/5). Specific fluorescence of OFA-I was found mainly in the syncytiotrophoblast. From these findings, we are tempted to conclude that OFA-I is not expressed on normal trophoblasts but expressed on aborted ones and that OFA-I may induce a rejection reaction in vivo to the trophoblast cells of the immunological front in aborted pregnancy.     

Ultrasonographic study of trophoblastic neoplasms. A report of 185 cases]

B-scan ultrasonography was used in 94 cases of hydatidiform mole (benign group), 62 cases of invasive mole and 29 cases of choriocarcinoma (malignant group). A correct diagnosis was made in 91.5% of cases of the benign group and 91.3% of the malignant group. Chemotherapy was given to all patients with invasive mole or choriocarcinoma, and hysterectomy was done in 47 cases after chemotherapy. During chemotherapy a gradual regression of the intramural lesions was demonstrated by ultrasonography with fall of hCG titer. The authors suggest that the B-scan ultrasonography is a safe and useful method in monitoring the response of the trophoblastic tumors to chemotherapy.     

Result of registration and follow-up system of gestational trophoblastic disease in Shizuoka Prefecture (from 1977 to 1988)--recent trend and choriocarcinoma following term gestation

The remission rate of choriocarcinoma has greatly improved since the introduction of effective multiagent chemotherapy combined with aggressive surgical therapy and radiotherapy. In addition to these, the registration and follow-up of gestational trophoblastic disease (GTD) also has been playing an important role in the early detection and treatment of choriocarcinoma following hydatidiform mole. The system for the registration and follow-up of GTD was started in 1977 in Shizuoka Prefecture. In the present series, the results obtained with this registration and follow-up system from 1977 to 1988 in Shizuoka Prefecture were reviewed and analysed. 1) One thousand, nine hundred and twenty-five cases of hydatidiform mole, 68 cases of invasive mole, 70 cases of persistent trophoblastic disease and 48 cases of choriocarcinoma were registered in 12 years. The overall registration rate was 97.4%. 2) The number of cases of hydatidiform mole registered has decreased from about 180 cases to about 140 cases per year, probably due to the decreasing birth rate. 3) The number of cases of choriocarcinoma registered has recently been decreasing significantly and the number of cases of registered invasive mole and persistent trophoblastic disease has decreased slightly. 4) Antecedent pregnancy with choriocarcinoma including clinical choriocarcinoma has been changing from "post-molar" to "post-term" in the past 12 years. The prognosis of the patient with choriocarcinoma following hydatidiform mole has improved by the early detection and treatment since the introduction of the registration and follow-up system. More attention should be paid to choriocarcinoma following term gestation not yet included in the registration and follow-up system to facilitate early detection and treatment.