35 一位19歲大學女生，因骨盆腔巨大腫瘤接受手術治療，發現是左側卵巢不成熟型畸胎瘤（immature teratoma），有關她的治療預後因子為：

amount of undifferentiated neural tissue

degree of glandular differentiation

presence of solid parts more than cystic parts

presence of sexual pseudoprecocity

A

37 對於一位年紀為32歲女性罹患侷限於子宮之絨毛膜癌（choriocarcinoma），下列敘述何者最合理？

如屬低危險群，可選用單一化學藥物治療

hCG是cytotrophoblast分泌，因細胞週期之故有時會呈陰性

病理切片組織均為hydropic change villi，手術應全子宮切除不需卵巢摘除

如屬高危險群應放射治療後再手術摘除全子宮

A

Choriocarcinoma is a malignant, trophoblastic^[1] and aggressive cancer, usually of the placenta. It is characterized by early hematogenous spread to the lungs. It belongs to the far end of the spectrum ofgestational trophoblastic disease (GTD), a subset of germ cell tumors.

Treatment

Choriocarcinoma is one of the tumors that is most sensitive to chemotherapy. The cure rate, even for metastatic choriocarcinoma, is around 90-95%. Virtually everyone without metastases can be cured; however, metastatic disease to the liver and/or brain is usually fatal. At present, treatment with single-agentmethotrexate or actinomycin D is recommended for low-risk disease, while intense combination regimens including EMACO (etoposide, methotrexate, actinomycin D, cyclosphosphamide and vincristine (Oncovin)) are recommended for intermediate or high-risk disease.^[6][7]

Hysterectomy (surgical removal of the uterus) can also be offered^[8] to patients > 40 years of age or those for whom sterilisation is not an obstacle. It may be required for those with severe infection and uncontrolled bleeding.