破壊奇胎の病態と治療成績--15年間の症例の総括
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In the 15 years from 1967 through 1981, a total of 225 patients with gestational trophoblastic disease were treated at the Kobe University Hospital. Based upon histopathological diagnosis, there were 115 cases of invasive mole and 29 cases of choriocarcinoma, while 81 cases were histopathologically undetermined due to the achievement of sustained remission with chemotherapy alone. These 3 groups of gestational trophoblastic disease were further categorized based upon the extent of spread of lesions into 3 subgroups as having nonmetastatic intrauterine, metastatic and direct extrauterine invasive type. In this paper, antecedent pregnancy, interval from the antecedent pregnancy to diagnosis, regression patterns of hCG concentrations after molar evacuation, preoperative findings with pelvic angiography, effects of treatment and prognoses were respectively analized in order to elucidate a characteristic of each of the categories of gestational trophoblastic disease. Significant differences between invasive mole, undetermined cases and choriocarcinoma were recognized as follows.(1) 94.8% (109/115) of patients with invasive mole and 95.1% (77/81) with undetermined cases had had a hydatidiform mole as the antecedent pregnancy, whereas only 51.7% (15/29) with choriocarcinoma were found to have hydatidiform mole.(2) 93.0% (107/115) of patients with invasive mole and 90.1% (63/81) with undetermined case were diagnosed within 3 months after the antecedent pregnancy, whereas only 10.3% (3/29) with choriocarcinoma were diagnosed within 3 months and 58.6% (17/29) were diagnosed over one year after the antecedent pregnancy.(3) 37.4% (43/115) of patients with invasive mole and 37.0% (30/81) with undetermined case were found to have metastatic lesion, while 82.8% (24/29) of patients with choriocarcinoma demonstrated to have metastasis. The most frequent site of distant metastasis was to the lung, and the brain metastasis was next. There were, however, no patients with brain metastasis of invasive mole. Metastasis in more than one organ were found in 41.4% (12/29) of patients with choriocarcinoma, whereas those were in 3.5% (4/115) of patients with invasive mole.(4) In 115 patients with invasive mole, only one died of disseminated intravascular coagulation syndrome (DIG) caused by massive hemorrhage due to extensive extra-uterine invasion, and the remission rate was 99.1%. In the patients with histopathologically undetermined type, the remission rate was 100% (81/81). In choriocarcinoma, remission rate for the subgroup with nonmetastatic intrauterine disease was 100%, while the overall remission rate of choriocarcinoma was 55.2% (16/29).(5) Four (3.5%) of the 114 patients with invasive mole later had recurrence of trophoblastic malignancy following initial diagnosis of remission and all were successfully retreated. None of the 81 patients with undetermined type had recurrence. Five (31.3%) of the 16 patients with choriocarcinoma who achieved remission later had recurrence and two out of the four patients were successfully retreated, while one died of brain metastasis and two showed recurrence again after the remission retreated.
- 近畿産科婦人科学会の論文
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