中间型滋养细胞肿瘤的临床和超声特征分析

Clinical features and sonographic characteristics of intermediate trophoblastic tumor

目的:探讨中间型滋养细胞肿瘤患者的临床特点及超声声像特征。方法:对经病理证实的11例中间型滋养细胞肿瘤患者的临床资料及超声图像进行回顾性分析,总结临床及超声声像特征。结果:最常见的临床症状为不规则阴道流血(10/11)和停经(7/11)。前次妊娠以足月妊娠(5/11)、流产(4/11)为多。诊断距离前次妊娠的平均时间为16.3个月(2~34个月)。血清β人绒毛膜促性腺激素(β-human chorionic gonadotrophin,β-HCG)水平中位数为277 IU/L(2.9~29 608 IU/L)。出现远处转移的患者β-HCG水平中位数为2 486.5 IU/L(1 414~29 608 IU/L)。伴有远处转移与不伴转移患者之间β-HCG水平差异有统计学意义(P=0.023)。所有患者均显示子宫内单一病灶。超声声像:Ⅰ型(病灶位于宫腔)2例(实性、囊实性各1例);Ⅱ型(病灶部分位于宫腔、部分位于肌层)4例(实性3例、囊实性1例);Ⅲ型(病灶位于子宫肌层)5例(实性2例、囊实性1例、囊性2例)。实性病变血供可稀少、中等或丰富;囊性及囊实性病变均血供丰富。结论:中间型滋养细胞肿瘤的超声声像有一定特征,结合临床表现及血清低β-HCG水平,有助于初步判断。

Objective： To investigate the clinical features and sonographic characteristics of intermediate trophoblastic tumor （ITT）. Methods： Eleven cases of ITT were identified at The First Affiliated Hospital of Sun Yet-sen University between January 2003 and December 2016, and the clinical features and findings on ultrasound were investigated. Results： The most frequent symptoms associated with ITT were abnormal vaginal bleeding, which was present in 10 cases, and amenorrhea, which was present in 7 cases. The interval from antecedent pregnancy to diagnosis was 2-34 months （median, 16.3 months）. The serum level of β-human chorionic gonadotropin （[3-HCG） was generally low, with a median of 277 IU/L （range, 2.9-29 608 IU/L）. The findings on ultrasound were classified according to the location of the lesions. Type Ⅰ, lesions located in the uterine cavity （1 case with solid mass, 1 case with alveolate mass）; Type Ⅱ, lesions located both within the uterine cavity and myometrium （3 cases with solid masses, 1 case with alveolate mass）; Type Ⅲ, lesions located in the myometrittm （2 cases with solid masses, 1 case with alveolate mass, 2 cases with cystic lesions）. The solid masses presented with minimal to a high degree of vascularization. Both the alveolate and cystic lesions were highly vascularized. Conclusion： Combined with clinical features, the findings on ultrasound could lead to the suspicion of ITT and contribute to clinical diagnosis.