자궁외 난관임신에 동반된 난관의 병리조직학적 소견 및 혈청 β-HCG 수치와 난관 근층 침범과의 상관관계
Accompanied Histopathologic Findings and Association of Serum β-HCG Levels with Myosalpingeal Invasion in Ectopic Tubal Pregnancy
박혜진, 김호정, 구혜수, 성순희, 한운섭,
소속 상세정보
박혜진 ( Park Hye-Jin )
이화여자대학교 의과대학 병리학교실
김호정 ( Kim Ho-Jung )
이화여자대학교 의과대학 병리학교실
구혜수 ( Koo Hea-Soo )
이화여자대학교 의과대학 병리학교실
성순희 ( Sung Sun-Hee )
이화여자대학교 의과대학 병리학교실
한운섭 ( Han Woon-Sup )
이화여자대학교 의과대학 병리학교실
KMID : 0357919990330070497
Abstract
Most ectopic pregnancies occur in the fallopian tubes. There have been numerous theories to explain the occurrence of ectopic pregnancy in fallopian tubes. The most commonly held view is that the passage of the fertilized ovum through the fallopian tube is delayed or hindered by chronic inflammation and its sequelae. We designed a study to evaluate the details of histopathologic changes and the location of implantation and how they relate to the clinical history. 182 fallopian tube specimens from patients who had undergone total or partial salpingectomy were examined. A high incidence of non-specific inflammation of plicae and wall of tube (31.9%) and salpingitis isthmica nodosa (12.6%) were observed. Other associated findings included acute salpingitis, complex plicae or complex hyperplasia of tubal epithelium, fibrous adhesion with ovary, endometriosis, and calcification. History of previous ectopic tubal pregnancy was found in 8 cases. The cases with serum β-HCG value above 2,500 I.U./L (group I, n=97) were more frequently noted in those exhibiting myosalpingeal invasion of trophoblast (67 cases) than in those without invasion (30 cases). Of the 182 tubal pregnancies, 117 (64.3%) cases were found in the ampulla and 47 (25.8%) cases in isthmic location. In 117 ampullary pregnancies, the products of conception were found intraluminally in 71 cases (60.7%), and extraluminally in 34 (29.1%) cases, of which the products of conception were found entirely extraluminal. The products of conception, found both within and outside the tubal lumen, were found in 12 cases (10.2%). Of 47 tubes with isthmic pregnancies, 33 cases were intraluminal (70.2%), 12 cases were extraluminal (25.5%), and two cases were mixed (4.3%). In conclusion, significant histopathologic abnormalities accompany a majority of ectopic tubal pregnancy, and myosalpingeal invasion of trophoblast is correlated with high serum β-HCG. Thus, it is necessary to confirm not only the ectopic placental tissue but also the accompanying details of the other histopathologic findings or the pathologic evaluation of ectopic tubal pregnancy.
키워드
Ectopic pregnancy;Salpingitis isthmica nodosa;Fallopian tube
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