1
|
Rafiq S, Posh S, Jeelani B, Wani S. Spectrum of neurological complications of pregnancy on magnetic resonance imaging. MATRIX SCIENCE MEDICA 2022. [DOI: 10.4103/mtsm.mtsm_9_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
2
|
Wang X, Yang J, Wan X, Feng F, Zhao J, Ren T, Xiang Y. Identification and treatment of primary cervical gestational trophoblastic neoplasia: a retrospective study of 13 patients and literature review. Orphanet J Rare Dis 2021; 16:480. [PMID: 34794477 PMCID: PMC8600730 DOI: 10.1186/s13023-021-02111-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/06/2021] [Indexed: 12/04/2022] Open
Abstract
Background Primary cervical gestational trophoblastic neoplasias (GTNs) are extremely rare ectopic GTNs. Such lesions are difficult to diagnose clinically because of their rarity, with abnormal vaginal bleeding of a non-specific cause being the most common symptom. To that end, this retrospective study aimed to identify the clinical characteristics of cervical GTN and to explore diagnostic and therapeutic strategies. Results Thirteen patients diagnosed with primary cervical GTN at the Department of Gynecology, Peking Union Medical College Hospital, Beijing, China, between June 1, 1988 and May 31, 2020 were included in the study. All patients had irregular vaginal bleeding, including six who presented with massive bleeding. Seven patients (53.8%) were initially misdiagnosed with a cervical pregnancy. All patients received chemotherapy; 11 (84.6%) also underwent hysterectomy because of chemoresistant lesions or uncontrolled bleeding. All patients achieved complete remission; however, two women (15.4%) experienced a relapse during the median follow-up period of 35 months. A comprehensive review of English-language literature published between 1980 and 2020 identified 22 case reports encompassing 27 patients. The definitive diagnosis was achieved via pathology in 26 of them (96.3%), and hysterectomy was performed in 21 (77.8%). Conclusions Owing to its rarity and nonspecific symptoms, the diagnosis of primary cervical GTN is challenging and often relies on pathology. The combination of chemotherapy and hysterectomy is the main therapeutic strategy for this disease.
Collapse
Affiliation(s)
- Xiaoyu Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, National Clinical Research Center for Obstetric and Gynecologic Diseases, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Junjun Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, National Clinical Research Center for Obstetric and Gynecologic Diseases, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Xirun Wan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, National Clinical Research Center for Obstetric and Gynecologic Diseases, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Fengzhi Feng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, National Clinical Research Center for Obstetric and Gynecologic Diseases, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Jun Zhao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, National Clinical Research Center for Obstetric and Gynecologic Diseases, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Tong Ren
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, National Clinical Research Center for Obstetric and Gynecologic Diseases, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China
| | - Yang Xiang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Science, National Clinical Research Center for Obstetric and Gynecologic Diseases, Shuaifuyuan No. 1, Dongcheng District, Beijing, 100730, China.
| |
Collapse
|
3
|
Laifer-Narin SL, Kwak E, Kim H, Hecht EM, Newhouse JH. Multimodality imaging of the postpartum or posttermination uterus: evaluation using ultrasound, computed tomography, and magnetic resonance imaging. Curr Probl Diagn Radiol 2014; 43:374-85. [PMID: 25041975 DOI: 10.1067/j.cpradiol.2014.06.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 06/10/2014] [Indexed: 11/22/2022]
Abstract
Postpartum and posttermination complications are common causes of morbidity and mortality in women of reproductive age. These complications can be broadly categorized into vascular, infectious, surgical, and neoplastic etiologies, or are due to ectopic implantation of placental or endometrial tissue. Causes of postpartum vascular complications include retained products of conception, arteriovenous malformation, and pseudoaneurysm. Infectious entities include endometritis, abscess, wound cellulitis, and pelvic septic thrombophlebitis. Postsurgical complications include uterine scar dehiscence, bladder flap hematoma, and subfascial hematoma. Neoplastic complications include the spectrum of gestational trophoblastic neoplasms. Ectopic tissue implantation complications include abnormal placentation and uterine scar endometriosis. Imaging is essential for diagnosis, and radiologists must be familiar with and aware of these entities so that accurate treatment and management can be obtained. In this review, we illustrate the imaging findings of common postpartum and posttermination complications on ultrasound, computed tomography, and magnetic resonance imaging.
Collapse
Affiliation(s)
- Sherelle L Laifer-Narin
- Department of Radiology, New York Presbyterian Columbia University Medical Center, New York, NY.
| | - Ellie Kwak
- Department of Radiology, New York Presbyterian Columbia University Medical Center, New York, NY
| | - Hyonah Kim
- Department of Radiology, New York Presbyterian Columbia University Medical Center, New York, NY
| | - Elizabeth M Hecht
- Department of Radiology, New York Presbyterian Columbia University Medical Center, New York, NY
| | - Jeffrey H Newhouse
- Department of Radiology, New York Presbyterian Columbia University Medical Center, New York, NY
| |
Collapse
|
4
|
Qian ZD, Zhu XM. Caesarean scar choriocarcinoma: a case report and review of the literature. Eur J Med Res 2014; 19:25. [PMID: 24887563 PMCID: PMC4026121 DOI: 10.1186/2047-783x-19-25] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Accepted: 05/02/2014] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To report the clinical characteristics, pathologic findings and treatments of a patient with a Caesarean scar choriocarcinoma. PATIENT HISTORY A 22-year-old woman had a diagnosis of primary gestational choriocarcinoma in a uterine Caesarean scar misdiagnosed as a normal Caesarean scar pregnancy. The patient underwent selective uterine artery embolization coupled with methotrexate arterial injection, along with dilatation and curettage of the uterine Caesarean scar. Finally, she received eight courses of multiagent chemotherapy. The reproductive function of the patient was preserved. CONCLUSIONS Primary gestational choriocarcinoma out of the uterine corpus is a rare disease. A Caesarean scar choriocarcinoma is an extremely unusual example of this entity because of its unique position. To the best of our knowledge, this is the first report of this phenomenon. Our experience and a literature review suggest that a clinical diagnosis of a primary gestational choriocarcinoma of the uterine Caesarean scar is difficult to make, and uterine artery embolization is beneficial to prevent massive bleeding before curettage.
Collapse
Affiliation(s)
| | - Xiao-Ming Zhu
- Department of Obstetrics and Gynecology, Women's Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Hangzhou, Zhejiang Province 310006, People's Republic of China.
| |
Collapse
|
5
|
Longo R, Battaglia F, Gattuso D, De Sio L, Sarmiento R, Amici S, Gasparini G. Primary Nongestational Choriocarcinoma of the Uterine Cervix. J Clin Oncol 2011; 29:e301-2. [DOI: 10.1200/jco.2010.33.2361] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
6
|
Uterine artery embolization as treatment for life-threatening haemorrhage from a cervical choriocarcinoma: a case report. Eur J Obstet Gynecol Reprod Biol 2008; 141:87-8. [PMID: 18649986 DOI: 10.1016/j.ejogrb.2008.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Revised: 04/08/2008] [Accepted: 05/10/2008] [Indexed: 12/28/2022]
|
7
|
Kairi-Vassilatou E, Papakonstantinou K, Grapsa D, Kondi-Paphiti A, Hasiakos D. Primary gestational choriocarcinoma of the uterine cervix. Report of a case and review of the literature. Int J Gynecol Cancer 2007; 17:921-5. [PMID: 17309671 DOI: 10.1111/j.1525-1438.2006.00852.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Gestational choriocarcinoma usually arises in the uterine cavity and is associated with coincident or antecedent pregnancy. Extrauterine choriocarcinomas are very rare entities, and most of these are located in the uterine cervix. In our case, a 43-year-old woman was admitted in our hospital because she had amenorrhea for 2 months and elevated serum beta-human chorionic gonadotropin levels. The patient was considered to have an ectopic pregnancy. Initially, she was treated with methotrexate, but since there was a continuous rise in human chorionic gonadotropin levels, the patient underwent a laparoscopy, along with dilatation and curettage (D&C) of the uterine cavity. Histopathologic findings, including immunohistochemical study, led to the diagnosis of choriocarcinoma of the cervix. Finally, the patient underwent a transabdominal hysterectomy and received single agent chemotherapy with methotrexate. Our case represents a primary choriocarcinoma of the cervix, which was initially misdiagnosed as an ectopic pregnancy. The difficulties in differential diagnosis are discussed. Immunohistochemical evaluation remains the mainstay of the diagnosis in most cases. Choriocarcinoma has a very good prognosis even in advanced stages, since it is a very chemosensitive tumor.
Collapse
Affiliation(s)
- E Kairi-Vassilatou
- Department of Pathology, University of Athens, School of Medicine, Aretaieion Hospital, Athens, Greece
| | | | | | | | | |
Collapse
|
8
|
Fu Y, Lu W, Zhou C, Xie X. Primary cervical choriocarcinoma: report of four cases and literature review. Int J Gynecol Cancer 2007; 17:715-9. [PMID: 17504385 DOI: 10.1111/j.1525-1438.2007.00819.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Primary cervical choriocarcinoma is very rare. So far, approximately 82 authenticated cases have been reported in the literature. We present additional four cases of primary cervical choriocarcinoma; the clinical features, differential diagnosis, and appropriate management are reported. Up to January 2005, all the four patients survived.
Collapse
Affiliation(s)
- Y Fu
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | | | | | | |
Collapse
|
9
|
Magnon C, Galaup A, Rouffiac V, Opolon P, Connault E, Rosé M, Perricaudet M, Roche A, Germain S, Griscelli F, Lassau N. Dynamic assessment of antiangiogenic therapy by monitoring both tumoral vascularization and tissue degeneration. Gene Ther 2006; 14:108-17. [PMID: 16943854 DOI: 10.1038/sj.gt.3302849] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Tumor growth is dependent both on endothelial and tumor cells. The aim of this study was to investigate dynamically whether changes in tumor vasculature implicate tumor tissue degeneration during antiangiogenic therapies. In order to quantify intra-tumor vascularization and necrosis, we have used ultrasound technology. This study has identified essential parameters needed to quantify specifically and sensitively the number of microvessels and the extent of necrosis in xenografted human carcinomas during natural tumor evolution, using contrast-enhanced high-frequency ultrasonography with (HFCDUS) or without (HFUS) color Doppler. We showed that quantification of intra-tumor microvessels between HFCDUS and immunohistochemistry is correlated using an anti-CD31 antibody. Furthermore, quantification of tumor necrosis with HFUS was confirmed by histological examination of hematoxylin-eosin-saffranin-stained sections over the observation period. Subsequently, for the assessment of novel angiogenic inhibitors, HFCDUS and HFUS were used to elucidate the underlying dynamics linking vessel inhibition and tumor eradication. We describe a novel application for HFCDUS/HFUS that constitutes an effective, convenient, and non-invasive method for clinical assessment of angiogenic inhibitors. In conclusion, we showed that tumor cells abruptly became necrotic following an antivascular therapy, whereas untreated tumors were protected from degeneration by a significant blood supply.
Collapse
MESH Headings
- Adenoviridae/genetics
- Angiogenesis Inhibitors/genetics
- Angiogenesis Inhibitors/therapeutic use
- Animals
- Antibodies, Monoclonal/genetics
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Bevacizumab
- Breast Neoplasms/blood supply
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/drug therapy
- Cell Line, Tumor
- Genetic Therapy/methods
- Genetic Vectors/administration & dosage
- Genetic Vectors/genetics
- Humans
- Mice
- Mice, Nude
- Necrosis
- Neovascularization, Pathologic
- Random Allocation
- Transduction, Genetic/methods
- Ultrasonography, Doppler, Color
- Ultrasonography, Interventional
- Xenograft Model Antitumor Assays
Collapse
Affiliation(s)
- C Magnon
- UMR 8121 Vectorologie et transfert de gènes, Institut Gustave Roussy, Villejuif cedex, France.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Maestá I, Michelin OC, Traiman P, Hokama P, Rudge MVC. Primary non-gestational choriocarcinoma of the uterine cervix: a case report. Gynecol Oncol 2005; 98:146-50. [PMID: 15925400 DOI: 10.1016/j.ygyno.2005.03.045] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2004] [Revised: 03/17/2005] [Accepted: 03/31/2005] [Indexed: 12/26/2022]
Abstract
BACKGROUND Primary non-gestational choriocarcinoma of the female genital tract has been described in the ovaries and is very unusual in other genital sites. CASE Primary non-gestational uterine cervical choriocarcinoma was diagnosed in a patient, 32, single, without previous sexual contact nor antecedent pregnancy, admitted to the hospital with irregular vaginal hemorrhaging. Pelvic examination realized under anesthetic revealed a tumor mass occupying the uterine cervix. Metastases investigation was realized and the patient was accepted as FIGO IV: risk factor of 13. She was submitted to intensive chemotherapy and hysterectomy, showing general recovery, but died from drug-resistant disease 12 months later. Histological, immunohistochemical, and molecular genetics studies confirmed non-gestational choriocarcinoma. CONCLUSION Primary non-gestational uterine cervical choriocarcinoma may arise from germ cell tumor or epithelial tissue.
Collapse
Affiliation(s)
- Izildinha Maestá
- Department of Gynecology and Obstetrics, UNESP-São Paulo State University, Botucatu/SP, Brazil.
| | | | | | | | | |
Collapse
|
11
|
Baykal C, Tulunay G, Bülbül D, Boran N, Köse MF. Primary choriocarcinoma of the uterine cervix in a postmenopausal patient: a case report. Gynecol Oncol 2003; 90:667-9. [PMID: 13678743 DOI: 10.1016/s0090-8258(03)00369-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Primary cervical choriocarcinoma seen in a postmenopausal patient is a very rare entity. CASE Primary choriocarcinoma of the uterine cervix was diagnosed in a 54-year-old woman. She had admitted to our clinic with vaginal bleeding and had been postmenopausal for 1 year at the time of diagnosis. A cervical tumoral mass was seen in her pelvic examination and cervical biopsy revealed squamous cell carcinoma of the cervix. Pelvic examination under anesthesia was done and patient was accepted as FIGO Stage IIA. Type III hysterectomy with bilateral salphingoopherectomy and bilateral pelvic-paraaortic lymph node dissection was carried out. Postoperative pathological evaluation of the surgical specimen showed that case was a primary choriocarcinoma of the cervix. CONCLUSION This is one of the few reported cases of cervical choriocarcinoma in a postmenopausal patient. The most appropriate theory for the development of this tumor is metaplastic differentiation of the tumor from another histologic type.
Collapse
Affiliation(s)
- C Baykal
- Department of Gynecologic Oncology, SSK Ankara Women's Hospital, Etlik, Ankara, Turkey.
| | | | | | | | | |
Collapse
|
12
|
Sironi S, Picchio M, Mangili G, Garavaglia E, Zangheri B, Messa C, Voci C, Taccagni GL, del Maschio A, Fazio F. [18f]fluorodeoxyglucose positron emission tomography as a useful indicator of metastatic gestational trophoblastic tumor: preliminary results in three patients. Gynecol Oncol 2003; 91:226-30. [PMID: 14529686 DOI: 10.1016/s0090-8258(03)00437-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The goal of this study was to evaluate the usefulness of positron emission tomography with [(18)F]fluorodeoxyglucose ([(18)F]FDG-PET) in detecting metastases in patients with gestational trophoblastic tumor (GTTs). METHODS A retrospective study was conducted on three patients with GTTs who had been studied with [(18)F]FDG-PET and computed tomography (CT) after an increase in human chorionic beta-gonadotropin (betahCG) serum levels. PET scans were performed with a multiring whole-body positron emission tomograph 45 min after an intravenous bolus injection of [(18)F]FDG ( approximately 5.2 MBq/kg). CT studies were obtained on a spiral scanner prior and after administration of intravenous iodinated contrast material. Within a week of CT and [(18)F]FDG-PET studies, the patients underwent surgical procedures for histological diagnosis. RESULTS In one patient, a lung lesion positive for neoplastic tissue with [(18)F]FDG-PET and negative with CT was confirmed to be a GTT metastasis at histology. In another patient, [(18)F]FDG-PET was negative, while CT was positive for the presence of lung metastasis; no viable tumor tissue was found at histological analysis. The remaining patient had a positive [(18)F]FDG-PET and CT study for lung metastasis; this was confirmed at histological analysis. In the same patient, both [(18)F]FDG-PET and CT depicted the presence of a liver lesion. Necrotic lesion regression after treatment was clearly documented with [(18)F]FDG-PET only. CONCLUSIONS Our preliminary results suggest that [(18)F]FDG-PET may be useful for the assessment of metastatic disease in patients with GTTs.
Collapse
Affiliation(s)
- S Sironi
- University of Milano-Bicocca, Milan, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|