胞状奇胎分娩後の管理における子宮腔内細胞診の意義

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  • Significance of cytological survey of endometrial smear for trophoblastic cells among postmolar women.

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To investigate into the significance of cytodiagnosis of endometrial smears in the postpartum management of hydatidiform mole, the specimens obtained by sequential aspiration were examined for trophoblastic cells, referring to the urinary concentration of human chorionic gonadotropin (HCG). The subjects were 13 women with hydatidiform mole and 4 women with invasive mole.<BR>Among the 13 women with hydatidiform mole, the number of patients harboring trophoblastic cells decreased with time after delivery, as evidenced by the figures of 10 (77%) at 1 week, 5 (39%) at 2 weeks, 3 (23%) at 3 weeks, and nil at 4 weeks. The disappearance of trophoblastic cells and the substitute appearance of endometrial repair cells were followed by reduction of the urinary HCG concentrations falling below the luteinizing hormone (LH) concentration.<BR>For the 4 women with invasive mole, all were positive for trophoblastic cells and showed high HCG concentrations even 4 or more weeks after hydatidiform molar delivery. Chemotherapy enabled all the patients to turn negative for trophoblastic cells but positive for endometrial repair cells, and reduced their urinary HCG concentrations to the LH concentrations or less. These time-dependent cytological changes helped us in establishing the treatment of choice.<BR>These findings suggest the significance of examination of endometrial smears for trophoblastic cells in the management of postmolar women, particularly among those whose smears remain positive for these cells even 4 or more weeks after delivery, who are strong candidates for secondary pathological changes.

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