Turner综合征女性在供卵试管婴儿后妊娠期发生HPV相关宫颈腺癌：病例报告

HPV-Related Cervical Adenocarcinoma during Pregnancy Following Donor Oocyte IVF in a Woman with Turner Syndrome: A Case Report

摘要: 目的：报告1例Turner综合征(TS)患者在供卵体外受精–胚胎移植技术(IVF)妊娠期间确诊人乳头瘤病毒(HPV)相关宫颈腺癌的病例，探讨高剂量外源性雌激素与妊娠期内源性激素增加对HPV相关病变进展的潜在影响，并强调辅助生殖前宫颈筛查的重要性。方法：回顾患者妊娠与围产期病历，包括既往HPV感染史、辅助生殖方案、孕期宫颈病理学检查、影像学、手术及术后随访资料；并结合相关文献进行分析。结果：患者为39岁TS女性，长期HPV16持续感染，采用供卵IVF妊娠。孕31周4天宫颈活检提示HPV相关腺癌，MRI示宫颈管内局灶性病变(16 × 13 mm)。孕36周行剖宫产联合广泛子宫切除及盆腔淋巴结清扫，病理示中分化HPV相关宫颈腺癌、Silva A型、FIGO IB1期。术后三个月复查未见残余或复发，CA-125降至正常。新生儿经治疗后顺利出院。结论：在持续高危HPV感染背景下，供卵IVF周期高剂量外源性雌激素与妊娠期内源性雌激素峰值可能共同促进宫颈腺上皮病变的快速进展。高危HPV阳性者在接受辅助生殖前应加强宫颈癌筛查，必要时进行宫颈管评估，以减少妊娠期延误诊断的风险。

Abstract: Objective: To report a case of human papillomavirus (HPV)-related cervical adenocarcinoma diagnosed during pregnancy in a woman with Turner syndrome (TS) following donor oocyte in vitro fertilization and embryo transfer (IVF-ET), to explore the potential impact of high-dose exogenous estrogen and pregnancy-related endogenous hormonal surges on the progression of HPV-associated lesions, and to emphasize the importance of cervical screening before assisted reproductive technology (ART). Methods: The clinical data of pregnancy and the perinatal period were retrospectively reviewed, including the history of persistent HPV infection, ART regimen, cervical pathological findings during pregnancy, imaging examinations, surgical treatment, and postoperative follow-up. Relevant literature was reviewed and analyzed. Results: A 39-year-old woman with Turner syndrome and long-term persistent HPV16 infection conceived through donor oocyte IVF. At 31 + 4 weeks of gestation, cervical biopsy revealed HPV-related adenocarcinoma. Pelvic magnetic resonance imaging demonstrated a focal lesion within the endocervical canal measuring 16 × 13 mm. At 36 weeks of gestation, cesarean section combined with radical hysterectomy and pelvic lymph node dissection was performed. Postoperative pathology confirmed moderately differentiated HPV-related cervical adenocarcinoma, Silva pattern A, FIGO stage IB1. No residual or recurrent disease was detected at the 3-month follow-up, and serum CA-125 levels returned to normal. The neonate recovered well and was discharged after treatment. Conclusion: In the background of persistent high-risk HPV infection, high-dose exogenous estrogen used during donor oocyte IVF cycles combined with peak endogenous estrogen levels during pregnancy may contribute to the rapid progression of cervical glandular lesions. Enhanced cervical cancer screening should be implemented before ART in women with high-risk HPV infection, with endocervical evaluation performed, when necessary, to reduce the risk of delayed diagnosis during pregnancy.