肿瘤预防与治疗2025，Vol.38Issue(4)：322-328,7.DOI:10.3969/j.issn.1674-0904.2025.04.010
胎盘部位滋养细胞肿瘤继发肾病综合征1例暨文献复习
Nephrotic Syndrome Secondary to Placental Site Trophoblastic Tumor:A Case Report and Literature Review
摘要
Abstract
Objective:To explore the clinical characteristics,diagnosis,and treatment strategies of nephrotic syndrome(NS)secondary to placental site trophoblastic tumor(PSTT),and to provide evidence for clinical practice.Methods:We collected the clinical data of a patient with NS secondary to PSTT treated at the Affiliated Hospital of Southwest Medical University on December 2,2023.Relevant literature was re-viewed,and the clinical manifestations,treatment,and prog-nosis were summarized and analyzed.Results:The patient is a 32-year-old woman(G4P1).One year ago,she underwent uterine curettage due to a"missed abortion."Postoperative pathological examination revealed"decidual tissue with tropho-blastic hyperplasia,"but no follow-up treatment was performed.She has since experienced amenorrhea.Ten days prior to ad-mission,the patient developed generalized pitting edema without obvious precipitating factors.Serum beta-human chorionic gonadotropin(β-hCG)level was 2,881.96 mIU/ml.Laboratory findings revealed serum albumin(23.5 g/L),proteinuria(4 g/L),total cholesterol(5.85 mmol/L),and β-hCG(1,880.15 mIU/ml).Transvaginal sonogram demonstrated find-ings suspicious for gestational trophoblastic neoplasia.Pelvic MRI demonstrated diffuse myometrial thickening with prominent vascularity and significant pelvic fluid.CT showed no distant metastasis.Histopathological examination of the abortion speci-men and hysteroscopic curettage confirmed PSTT.The multidisciplinary team diagnosed NS secondary to PSTT.Due to dif-fuse uterine involvement of the tumor,total abdominal hysterectomy with bilateral salpingectomy was performed.Postopera-tive pathology confirmed PSTT with necrosis,full-thickness myometrial invasion,lymphovascular space involvement,and a mitotic count of 6 per 10 high-power fields.The final diagnosis was stage Ⅰ PSTT secondary to NS.The patient was discharged on postoperative day 8 and declined adjuvant chemotherapy.The edema resolved,urinary protein normalized,and β-hCG levels returned to baseline within two weeks.No recurrence was observed during the 1-year follow-up period.This study in-cluded eight patients(age range:20～42 years).Obstetric history revealed six term deliveries and two miscarriages.Clinical presentations consisted of amenorrhea(n=6)and severe bleeding(n=2),with all cases demonstrating uterine enlarge-ment.Preoperative β-hCG levels were elevated in all patients(mean:2,153.81 mIU/mL).Renal biopsy in four cases dem-onstrated glomerular immune complex deposition.Medical therapy alone exhibited suboptimal efficacy.Among 7 stage Ⅰ pa-tients,hysterectomy resulted in rapid resolution of NS symptoms and normalization of serum β-hCG levels.Among the stage Ⅰ cases,one patient was lost to follow-up.The remaining six patients all exhibited high-risk factors for recurrence,but only one received adjuvant chemotherapy.No recurrences were observed during follow-up in any case.Conclusion:PSTT-associ-ated NS is clinically rare and may represent a paraneoplastic syndrome.Hysterectomy is an effective treatment for stage Ⅰ pa-tients,while the potential benefit of chemotherapy requires further investigation.关键词
胎盘部位滋养细胞肿瘤/肾病综合征/闭经/子宫切除术Key words
Placental site trophoblastic tumor/Nnephrotic syndrome/Amenorrhea/Hysterectomy分类
医药卫生引用本文复制引用
谢成艾,李武志,任中连..胎盘部位滋养细胞肿瘤继发肾病综合征1例暨文献复习[J].肿瘤预防与治疗,2025,38(4):322-328,7.基金项目
This study was supported by grants from Science and Technology Department of Sichuan Province(No.2023ZHYZ0009). 四川省科学技术厅科技计划项目(编号:2023ZHYZ0009) （No.2023ZHYZ0009）
