持續性妊娠滋養細胞疾病：病例報告與文獻回顧

Persistent gestational trophoblastic disease: a case report and literature review

妊娠滋養細胞疾病（gestational trophoblastic disease, GTD）為一種與妊娠相關的疾病，由異常受精所致。GTD可分為良性與惡性，其中以葡萄胎最為常見，年發生率約為每千次妊娠1-2例。葡萄胎的主要治療方式為子宮擴張及搔刮術（dilation and curettage, D&C），而對於已完成生育計畫的婦女，子宮切除術亦可作為替代方案。研究顯示，40歲以上女性發生葡萄胎後滋養細胞腫瘤（gestational trophoblastic neoplasia, GTN）的風險較高，而全子宮切除術有助於偵測侵入性葡萄胎。確診後需進行風險分層，以決定後續化學治療策略，並於治療過程中規則監測血清β-hCG濃度。本文報告一例葡萄胎後GTN病例，其特徵為在接受兩次D&C與甲氨蝶呤（methotrexate, MTX）化學治療後，雖未出現臨床症狀，但血清β-hCG濃度持續異常上升。本文將進一步探討可能之診斷與後續治療選擇。

Gestational trophoblastic disease (GTD) is a pregnancy-related condition caused by abnormal fertilization. GTD can be classified into benign and malignant forms, with molar pregnancy being the most common, occurring in approximately 1-2 per 1,000 pregnancies annually. The primary treatment for molar pregnancy is dilation and curettage (D&C), while hysterectomy is an alternative for women who have completed childbearing. Studies have shown that women over 40 years of age have a higher risk of developing post-molar gestational trophoblastic neoplasia (GTN), and total hysterectomy facilitates the detection of invasive molar pregnancy. Following diagnosis, risk stratification is required to guide chemotherapy strategies, andβ-hCG levels should be monitored regularly during treatment. Here, we report a case of post-molar GTN characterized by persistently elevatedβ-hCG levels after two D&Cs and methotrexate (MTX) chemotherapy, despite the absence of clinical symptoms. The possible differential diagnoses and subsequent treatment options are discussed.