난관의 완전 포상기태에서 발생한 폐의 전이형 임신성 영양모 세포증
Metastatic Gestational Trophoblastic Disease in the Lung Occuring with Hydatidiform-mole in Tubal Pregnancy
안희정, 김규래, 정창조,
소속 상세정보
안희정 ( )
경희분당차병원 해부병리과
김규래 ( )
삼성의료원 진단병리과
정창조 ( )
차병원 산부인과
KMID : 0357919960300090851
Abstract
자궁외 임신은 전체임신의 약 1∼2%를 차지하고 포상기태는 전체임신의 약 0.8%로 그리
적지 않으나 자궁외 임신에 동반된 포상기태는 전체 자궁외 임신의 1/5000 정도로 드물게
보고되어 있다. 저자는 자궁외 임신 의심하에 적출된 난관에서 고도의 영양모 세포의 증식
을 보이는 포상 기태가 폐에 전이형 임신성 영양모 세포증(Gestational trophoblastic
disease; GTD)으로 발전된 매우 드문 예를 경험하여 보고하는 바이다.
#초록#
Gestational trophoblastic disease associated with the tubal pregnancy is uncommon,
and the incidence has been described as 1/5000 tubal pregnancy. We have experienced a
case of metastatic gestational trophoblastic disease(GTD) in the lung occuring with
complete hydatidiform mole arising in tubal pregnancy The patient was a 39-year-old,
G4P2A2L2 woman with amenorrhea for 5 weeks. Ectopic pregnancy in the right
fallopian tube was suspected on transvaginal ultrasonogram. A right adnexectomy was
performed. The fallopian tube was markedly dilated and ruptured. The right ovary and a
round hematoma had adhered to the external surface of the fallopian tube. On gross
examination, no molar tissue was identified. On microscopic examination, the lulnen of
the dilated fallopian tube was filled with blood clots admixed with several chorionic villi
showing hydropic swelling and marked proliferation of atypical trophoblasts. Proliferating
syncytio-and cytotrophoblasts invaded the wall of the blood vessels of the fallopian tube
and sheets of trophoblasts and some villi were identified in the lumen of blood vessels.
Multiple pulmonary nodules thought to be metastatic nodules were identified in the chest
X-ray and serum B-HCG had increased 2 weeks later. This case indicates that a
careful pathological examination in the ectopic pregnancy is mandatory, because tubal
GTD is not clinically distinguishable from ordinary tubal pregnancy.
키워드
metastatic GTD; complete H-Mole; tubal pregnancy;
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