Ung thư nguyên bào nuôi sau đẻ đủ tháng: báo cáo ca bệnh

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Tác giả: Thái Giang Nguyễn, Văn Khanh Nguyễn, Thị Thanh Ngọc Vũ

Ngôn ngữ: Vie

Ký hiệu phân loại: 616.994 +Cancers

Thông tin xuất bản: Tạp chí Phụ sản 2023

Mô tả vật lý: 112-115

Bộ sưu tập: Metadata

ID: 394801

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Chủ đề

Ung thư nguyên bào nuôi (Choriocarcinoma) là bệnh lý liên quan tới sự tăng sinh không kiểm soát, biến đổi ác tính của tế bào gai rau, là bệnh lý ác tính cuối cùng của bệnh lý nguyên bào nuôi. Những khối u này thường phát triển sau khi mang thai trứng và rất hiếm khi sảy ra khi mang thai đủ tháng. Chúng tôi báo cáo 01 trường hợp bệnh nhân nữ 35 tuổi, vào viện sau đẻ 2 tháng với tình trạng ra máu âm đạo sau đẻ mổ đủ tháng bình thường. Xét nghiệm Beta HCG: 408,000 mUI/ml. Siêu âm đầu dò âm đạo trong buồng tử cung khối hỗn âm, tăng sinh mạch kích thước 45 x 51 mm. Tiến hành chụp X-quang ngực, xuất hiện 1 số nốt tổn thương thứ phát tại trường phổi 2 bên, siêu âm ổ bụng và CT - sọ não chưa có bất thường. Bệnh nhân được chẩn đoán là ung thư nguyên bào nuôi sau sinh đủ tháng (chấm điểm theo hiệp hội sản phụ khoa thế giới( FIGO) là 8 điểm). Bệnh nhân được chuyển Bệnh viện Phụ sản Trung ương được hội chẩn mổ mở cắt tử cung hoàn toàn và 2 phần phụ có vét hạch chậu ngày thứ 02 nhập viện, 7 ngày mổ được điều trị đa hóa trị EMA - CO. Hiện tại đang truyền hoá chất đợt 4 tại Bệnh viện Phụ sản Trung ương. Ung thư nguyên bào nuôi sau sinh đủ tháng là bệnh lý rất hiếm gặp. Bệnh thường liên quan tới biến chứng thai kỳ trong thời kỳ trước sinh. Tiên lượng thường rất tốt với điều kiện được phát hiện sớm và điều trị kịp thời tại các bệnh viện chuyên khoa. Với các trường hợp nhẹ có thể điều trị bằng Methotrexate, nếu nặng hơn càn điều trị đa hóa trị liệu. Việc chẩn đoán u thư nguyên bào nuôi có thể là một thách thức đối với bác sĩ lâm sàng kể cả những bác sĩ có kinh nghiệm. Về phía người bệnh, chúng ta tư vấn bệnh tiên lượng tốt chỉ cần điều trị đúng phác đồ., Tóm tắt tiếng anh, Choriocarcinoma is a disease associated to uncontrolled proliferation, malignant transformation of placental cells and is the malignant end of trophoblastic disease. These tumors usually develop after a hydatidiform mole and very rarely occur during a full-term pregnancy. We report 01 case of a 35-year-old female patient, admitted to the hospital 2-months after giving birth with vaginal bleeding after a full-term caesarean section. Beta HCG test: 408,000 mUI/ml. Transvaginal ultrasound result showed a mixed echoic mass in the uterine cavity with angiogenesis and 45 x 51 mm in size. We performed a chest X-ray and the result showed a number of secondary lesions in the lung on both sides. Abdominal ultrasound and CT-cranial scan had no abnormalities. The patient was diagnosed as choriocarcinoma after term pregnancy (the score according to the International Federation of Gynecology and Obstetrics - FIGO is 8 points). The patient transferred to the National Hospital of Obstetrics and Gynecology for a complete hysterectomy and 2 adnexa with pelvic lymphadenectomy on the 2nd day of admission. After 7 days of surgery, patient was treated with multiagent-chemotherapy EMA-CO and currently receiving chemotherapy for the 4th phase at the Central Institute of Obstetrics and Gynecology. Trophoblastic cancer in postpartum period of fullterm pregnancy is a very rare disease. The disease is often associated with pregnancy complications in the antenatal period. Prognosis is usually good if it is detected early and treated in specialized hospitals. Mild cases can be treated with Methotrexate, but more severe cases need to treat with multiagent chemotherapy. The diagnosis of choriocarcinoma can be challenging for clinicians, including those with experience. We should advise patients that the disease has a good prognosis as long as it is treated with the right regimen.

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