罕见的妊娠期胎盘内绒癌合并大量胎母输血1例

A rare case report of placental choriocarcinoma during pregnancy complicated with massive fetal maternal blood transfusion

妊娠期胎盘内绒毛膜癌(Intraplacental choriocarcinoma,IC)特别罕见,足月妊娠期发生的绒毛膜癌为1/170000,分娩时很少被发现,IC可能破坏胎盘正常的滋养细胞,导致大量的胎母输血(Fetomaternal hemorrhage,FMH)。而>150 mL的FMH可能会造成严重后果,如死产、缺氧缺血性脑病等。现报告1例妊娠期IC合并大量FMH的病例,近足月妊娠,虽胎母输血量大(胎儿失血量约550 mL),但母婴结局良好。产后胎盘组织学及免疫组化提示为IC,未采用联合化疗,随访7个月母婴结局良好。

Intraplacental choriocarcinoma(IC)during pregnancy is particularly rare,with 1 in 170,000 choriocarcinomas occurring during full-term pregnancy and rarely detected during labor.The IC may destroy the normal trophoblasts of the placenta and cause massive fetomaternal hemorrhage(FMH).However,FMH larger than>150 mL may cause serious consequences,such as stillbirth and hypoxic-ischemic encephalopathy.We present a case of IC during pregnancy complicated with FMH.It was a near-term pregnancy,and although the amount of maternal and fetal blood transfusions was large(the fetal blood loss was about 550 mL),the maternal and fetal outcomes were good.Postnatal placental histology and immunohistochemistry revealed intraplacental choriocarcinoma,and no combined chemotherapy was used.After a follow-up of seven months,the mother and child had a good outcome.