水泡状胎块与胎儿共存妊娠4例临床病理分析

Hydatidiform mole with coexisting fetus: a clinicopathologic analysis of 4 cases

目的探讨水泡状胎块与胎儿共存妊娠的临床病理学特征。方法收集4例水泡状胎块与胎儿共存病例,总结其临床病史及病理学特征,并进行p57免疫组化标记和荧光原位杂交(fluorescence in situ hybridization,FISH)及核型分析。结果 4例中3例为完全性水泡状胎块与胎儿共存的双胎妊娠,其中1例妊娠14周,胎儿宫内尚存活,利凡诺引产,2例妊娠29周,胎儿均存活,行剖宫产术取出,此3例均伴侵袭性葡萄胎合并肺转移;另1例为部分性水泡状胎块伴单胎妊娠,胎儿宫内死亡。3例完全性水泡状胎块绒毛滋养叶细胞p57均阴性,与之相连的正常胎盘中p57阳性;其中2例行绒毛FISH检测及核型分析,均为46XX。1例部分性水泡状胎块p57阳性。结论完全性水泡状胎块可合并正常妊娠,胎儿可存活;部分性水泡状胎块常合并畸形胎儿或胎儿宫内死亡。与胎儿共存的完全性水泡状胎块发展速度,引起临床症状的时间因人而异,可发生于妊娠早期,也可为中晚期,发生于中晚期者胎儿常能存活分娩;伴正常妊娠的完全性水泡状胎块容易合并侵袭性葡萄胎且发生肺等远隔器官转移;完全性水泡状胎块与胎儿共存妊娠与患者孕前服用激素类药物有关。

Purpose To study the clinical pathological characteristics of 4 pregnancy cases with hydatidiform mole and coexisting fetus. Methods Four pregnancy cases with hydatidiform mole and coexisting fetus were analyzed with review of clinical and pathological data, immunohistochemical detection of p57, FISH and genotyping. Results In 4 cases, 3 were twin pregnancies with complete hyda- tidiform moles and coexisting fetus. Among them, 1 was discovered in the fourteenth week with a live fetus being taken odinopoeia, and the other 2 in the twenty-ninth week and survival fetuses were taken out successfully. All of them were p57-negative expression while 2 cases were proved 46XX through FISH and genotype analysis. The case of partial hydatidiform mole was p57-positive. Conclusions Complete hydatidiform moles can coexist with a feta-survival normal pregnancy, and incomplete hydatidiform moles are often associated with abnormal or dead fetuses. The clinical development is different in each case of complete hydatidiform mole with coexisting fetuses. The symptoms such as hypertension and vaginal bleeding can happen in early weeks of pregnancy, or in the later period often with fetal being given survival childbirth. Complete hydatidiform mole with coexisting fetus is easier to develop into invasive mole and remote organ metastases such as lung. Pregnancy cases with complete hydatidiform mole and coexisting fetus are often induced by hormone before pregnancy.