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한국여성 융모상피질환에 관한 임상 및 병리조직학적 고찰

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[영문] Trophoblastic disease represents an inclusive term for hydatidiform mole, choriocatcinoma and chrioadenoma destruens, which is relatively uncommon disease in the Uniged States and Europe, but certain areas of the A냠 have greater incidence. Most of the patients are of the extremely poverty-stricken group where-in an inadequate diet in standard. Histircally ir was Sanger, in 1889m who suggested that there was a special tumor derived from the decidua of pregnancy which he felt was of a sarcomatous mature. In 1895, Marchand demostrated that these tumors were invariably the sequel to normal pregnancy, abortion, hydatidiform mole, or ectopic pregnancy, and that they were derived from chorionic epithelium. There is still a difference of opinion as to whether hydatidiform mole is to be considered a degenerative or neoplastic lesion. Hertig and Mansell (1956) believe that mole is a degenerative process, though capablitity if neoplastic change. The direct causation of the hydatid process is seemingly deficiency of the circulation to the placental tissue. Chorioadenoma destruens should always follow a molar pregnancy but exception rarely occur such as abortion and term deliverly. Most pathologists regard chorioadenoma destruens to be morphologically benign, but it causes uterine perforation with consequent intraperitoneal hemorrhage and more frequntly transition to the choriocacinoma than lydatidiform mole, so it can not always be regarede as a benign neoplasm. Scott (1962) suggests that the cause of choriocarcinoma be related to a lack of maternal antibody to retained pregnant tissue, but the causes is still unknown. It is well known that the most common preceding pregnancy type of choriocarcinoma is hydatidiform mole and the hydatidiform mole transformed to the choriocarcinoma more frequently than normal pregnancy and abortion. The relationship between hydatidiform mole and chorionic malignant chafge is still debated. The porspective study of histological observation the process from hydatidiform mole to choriocarcinoma by biopsy is impossibe and a few reported if retrospecitive study an choriecarcinoma are reported and which are very important. There are several reports on trophoblastic disease among Korea Women based on Clinical aspects but is very little reports on trophoblastic tumors based on pathological aspects, The present study is an attenpt to investigate progress mainly the relationship between histopathological classification, the clinical and prognosis namely hydatidiform mole is classified by Elston and Bagehawe (1972) and choriocarcinoma by Kawashima (1974), using retrospective study because the prospective study for histologic follos up is impossible. Materials and Methods The materials used in this study consist of 209 cases of trophoblastic disease for 13 years from January, 1960 to December, 1973. All specimens were fixed in 10% neutral formalin, paraffin embedded blocks were cut in 5 micron thickness, and sections were stained by hematixylin-eosin methods and the classification were done on all case of hydatidiform mole by Elston and Bagehawe (1972) and of the choriocarcinoma by Kawashima (1974). For all cases of trophoblastic disease whose clinical records were available, sex, age chief complaints, durations, gravidity, previous pregnancy history, metastatic site, H.C.G. titer and X-ray findings were investigated. Results and Summary By histopatholigical and clinical studies on 209 cases of trophoblastic disease which were submitted to the Department of Pathology, Yonsei University Collefe of Medicine, during the period of 14 years from January 1960 to December, 1973, following results were obtained. 1. The histological types and respective frequencies of the trophoblastic disease were hydatidiform mole 125 cases, cherioadenoma destruens 25 cases, and choriocarcinoma 59 cases. 2. The histological grading of hydatidiform mole showed Grade Ⅰ 46.2%, Grade Ⅱ 35.9%, Grade Ⅲ 17.9%, and that of choriocarcinoma were Group Ⅰ 29.5%, Group Ⅱ 41.0% and Group Ⅲ 29.5%. Cherioadenoma destruens was frequently associated with hydatidiform mole, particularly Grade Ⅱ and Ⅲ. 3. The average ages were 32.5 year-old in hydatidiform mole, 39.5 year-old in chorioadenoma destruens, 36.5 year-old in choriocarcinoma. 4. The relationship between histological types and age distribution was not signigicant in hydatidiform mole and choriocarcinoma except the frequency of Group Ⅲ choriocarcinoma is apparently low in age group of 20-29. 5. Metastases in choriocarcinoma in order of frequency were lung (79.2%), vagina (45.8%), intestine (20.8%), brain (16.7%), etc. Matastases in choriocarcinoma were frequency in Group Ⅱ and Ⅲ. In summary, these findings suggest that the higher grades of hydatidiform mole may closely be related to chorioadenoma destruens and the histological type of trophoblastic disease is correlated with clinical course, so the follow-up study based on the histological grading and grouping is very significant in trophoblastic disease.
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