임신 첫 석달에 생긴 임신융육모막암종 -1예 보고-

초록

Chorionic villi associated with trophoblastic proliferation typically represent hydatidiform mole or a nonmolar abortion specimen, except for the rare cases of gestational choriocarcinoma arising within an otherwise normally developing placenta, as rapidly growing tropohblast in any of these conditions results in a somewhat similary histologic features. Choriocarcinoma concurrent with normal intrauterine pregnancy is uncommon and an incidence of one case per 160,00 pregnancies has been reported. We report here a case of early gestational choriocarcinoma at the first trimester. A 23-year-old female, gravida 0, para 0, presented with vaginal spotting after 11-week-history of amenorrhea. At physical examination the uterus was slightly larger for the gestational age. Ultrasonographic evalulation showed snow storm appearance without fetal heart tone and serum β-hCG level was greater than 500,000 IU/ml. Chest radiographs did not show any significant abnormality. With clinical impression of partial hydatidiform mole, evacuation by dilatation and curettage was performed. The curettage specimen of 100 ml contained consisted of large amount of blood clot and non-hydropic villi, decidual tissue and no fetal elements. There were no macroscopic abnormlaity. Histologically, there were biphasic trophoblastic proliferation with significant nuclear atypia of the non-villous trophoblasts. The chorionic vili did not show feature of comlete hydatidiform mole. Immunohistochemically, the villous cytotrophoblasts were diffusely positive for p57, by which possiblity of complete hydatidiform mole could be ruled bout. The serum β-hCG level decreased dramatically and normalized after 3 months of curettage.