以阴道大出血为首发症状的宫颈上皮样滋养细胞肿瘤成功治疗一例

doi:10.12280/gjfckx.20250680

摘要/Abstract

摘要：

上皮样滋养细胞肿瘤（epithelioid trophoblastic tumor，ETT）是一种极罕见的妊娠滋养细胞肿瘤（gestational trophoblastic neoplasia，GTN），常伴有停经史和血清人绒毛膜促性腺激素（human chorionic gonadotropin，hCG）水平升高，好发于子宫下段或宫颈。由于临床表现缺乏特异性，且血清hCG水平往往仅轻度升高，诊断具有较大难度，通常需要结合临床病史进行病理学及免疫组织化学综合评估。报告1例有停经史的女性，突发大量阴道出血，伴宫颈肿块及低水平血清hCG。由于其形态学和免疫表型与宫颈癌部分重叠，诊断极具挑战。患者在行子宫动脉栓塞后，接受腹腔镜子宫及双附件切除术，获得了良好疗效。通过探讨该疾病的临床特征、组织病理学表现、免疫学特点及治疗方法，本病例强调在非典型宫颈肿瘤中应将ETT纳入鉴别诊断，以避免误诊并确保及时有效的治疗。

关键词: 滋养层肿瘤, 子宫出血, 子宫动脉栓塞术, 生育力保存, 上皮样滋养细胞肿瘤

Abstract:

Epithelioid trophoblastic tumor (ETT) is an exceedingly rare subset of gestational trophoblastic neoplasia (GTN) that typically arises in the lower uterine segment or cervix and is classically associated with a history of amenorrhea and only modestly elevated serum human chorionic gonadotropin (hCG). Because of its non-specific clinical presentation and the frequently low hCG levels, diagnosis is challenging and requires integrated evaluation of clinical history, morphology, and immunohistochemistry. We report a woman with prior amenorrhea who presented with acute life-threatening vaginal bleeding, a cervical mass, and low serum hCG. Owing to overlapping morphologic and immunophenotypic features with cervical carcinoma, the differential diagnosis was complex. After emergent uterine artery embolization, the patient underwent laparoscopic hysterectomy with bilateral salpingo-oophorectomy and achieved an excellent outcome. This case underscores the necessity of including ETT in the differential diagnosis of atypical cervical neoplasms to avoid misdiagnosis and ensure timely, effective therapy.

Key words: Trophoblastic neoplasms, Uterine hemorrhage, Uterine artery embolization, Fertility preservation, Epithelioid trophoblastic tumor

香惠华, 吴珮君, 何欣怡, 叶飞, 罗新, 林伟钊, 舒珊荣. 以阴道大出血为首发症状的宫颈上皮样滋养细胞肿瘤成功治疗一例[J]. 国际妇产科学杂志, 2026, 53(1): 27-32.

XIANG Hui-hua, WU Pei-jun, HE Xin-yi, YE Fei, LUO Xin, LIN Wei-zhao, SHU Shan-rong. Cervical Epithelioid Trophoblastic Tumor Presenting with Vaginal Massive Hemorrhage as the Initial Symptom: A Successfully Managed Case Report[J]. Journal of International Obstetrics and Gynecology, 2026, 53(1): 27-32.

图/表 6

图1 ETT子宫动脉栓塞术前、术后盆腔超声对比注：A 宫颈处见低回声、界限欠清的不均质回声团，呈管道样或蜂窝状结构；B 宫颈占位周围及内部见丰富血流信号，呈“彩色马赛克样”分布；C 宫颈占位周围见粗大条状血流信号。

图2 子宫动脉栓塞术中见增粗迂回的子宫动脉

图3 宫颈ETT的全腹CT 注：A 矢状面，B 水平面；宫颈右后壁见团片状高低混杂密度影，边界欠清，大小约8.5 cm×7.0 cm×5.7 cm（如箭头所示），增强扫描病灶四周及其内可见多发增粗迂曲血管影。

图4 腹腔镜术中及术后标本照片注：A 腹腔镜下见宫颈明显增粗，向直肠子宫陷凹突出，包块周围见丰富迂曲、增粗的异生血管（如箭头所示）；B 宫颈管切开，宫颈可见一个大小约5.5 cm×5.0 cm×3.0 cm的实性、边界不清的灰黄色肿物，见出血灶。

图5 宫颈ETT的病理图注：A 肿瘤细胞（HE×100）；B p63（部分，+）（免疫组织化学染色×100）；C p40（部分，+）（免疫组织化学染色×100）；D GATA3（弥漫，+）（免疫组织化学染色×100）；E Ki-67增殖指数15%（免疫组织化学染色×100）；F α-inhibin（+）（免疫组织化学染色×100）。标尺=100 μm。

表1 153例ETT临床特征

指标	例数	占比（%）	指标	例数	占比（%）
年龄			与上一次妊娠间隔时间
<40岁	89	58.2	<48个月	76	49.7
≥40岁	64	41.8	≥48个月	65	42.5
症状			N/A	12	7.8
阴道出血	95	62.1	血清hCG水平
腹痛	24	15.7	<100 IU/L	53	34.6
无症状	26	17.0	100~1 000 IU/L	38	24.9
N/A	8	5.2	>1 000 IU/L	37	24.2
既往妊娠史			N/A	25	16.3
足月妊娠	93	60.8	FIGO分期
流产	40	26.1	Ⅰ	66	43.1
葡萄胎	9	5.9	Ⅱ	17	11.1
异位妊娠	1	0.7	Ⅲ	38	24.9
N/A	10	6.5	Ⅳ	32	20.9

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