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The Korean Journal of Pathology 1975;9(1): 39-52.
한국여성 융모상피 질환에 관한 임상 및 병리조직학적 고찰
Clinical and Histopathological Studies on Trophoblastic Tumors among Korean Women
ABSTRACT
Trophoblastic disease represents an inclusive term for hydatidiform mole, choriocarcinoma and chorioadenoma destruens, which is relatively uncommon disease in the United States and Europe, but certain areas of the Asia have greater incidence. Most of the patients are of the extremely poverty-stricken group where-in an inadequate diet is standard. Historically it was Sanger, in 1889, who suggested that there was a special tumor derived from the decidua of pregnancy which he felt was of a sarcomatous nature. In 1895, Marchand demonstrated 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 of 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 occurs such as abortion and term delivery. Most pathologists regard chorioadenoma destruens to be morphologically benign, but it causes uterine perforation with consequent intraperitoneal hemorrhage and more frequently transition to the choriocarcinoma than hydatidiform mole, so it can not always be regarded 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 cause is still unknown. It is well known that the most common preceding pregnancy type of choriocarcinoma is hydatidiform mole and the hydatidiform mole is transformed of the choriocarcinoma mole and chorionic malignant change is still debated. The prospective study on histological observation of the process from hydatidiform mole to choriocarcinoma by biopsy is impossible and a few reports of retrospecitive study on choriocarcinoma are reported and which are very important. There are several reports on trophoblastic disease among Korean Women based on clinical aspects but there is very little reports on trophoblastic tumors based on pathological aspects. The present study is an attempt to investigate mainly the relationship between histopathological classification, the clinical course and prognosis of hydatidiform mole classified by Eoston and Eagshawe(1972) and choriocarcinoma by Kawashima(1974), using retrospective study because the prospective study for hisological follow up is impossible. Materials and Methods The materials used in this study consist of 209 cases of trophoblastic disease for 14 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 hematoxylin-eosin methods and the classification was done on all cases of hydatidiform mole by Elston and Bagshawe(1972) and of 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 histopathological and clinical studies on 209 cases of trophoblastic disease which were submitted to the Department of Pathology, Yonsei University, College 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, chorioadenoma destruens 25 cases, and choriocarcinoma 59 cases. 2. The histological gradings of hydatidiform mole showes 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%. Chorioadenoma 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 significant 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. Metastases in chofiocarcinoma were frequent 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. Therefore it can be said that the follow-up study based on the histological grading and grouping is considered to be significant.