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An Extremely Rare Case of Asymptomatic Choriocarcinoma, Originating from the Interstitial Part of the Fallopian Tube. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2017. [DOI: 10.1007/s40944-017-0163-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tempfer C, Horn LC, Ackermann S, Beckmann MW, Dittrich R, Einenkel J, Günthert A, Haase H, Kratzsch J, Kreissl MC, Polterauer S, Ebert AD, Schneider KTM, Strauss HG, Thiel F. Gestational and Non-gestational Trophoblastic Disease. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry No. 032/049, December 2015). Geburtshilfe Frauenheilkd 2016; 76:134-144. [PMID: 26941444 DOI: 10.1055/s-0041-111788] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Purpose: The aim was to establish an official interdisciplinary guideline, published and coordinated by the German Society of Gynecology and Obstetrics (DGGG). The guideline was developed for use in German-speaking countries. In addition to the Germany Society of Gynecology and Obstetrics, the guideline has also been approved by the Swiss Society of Gynecology and Obstetrics (SGGG) and the Austrian Society of Gynecology and Obstetrics (OEGGG). The aim was to standardize diagnostic procedures and the management of gestational and non-gestational trophoblastic disease in accordance with the principles of evidence-based medicine, drawing on the current literature and the experience of the colleagues involved in compiling the guideline. Methods: This s2k guideline represents the consensus of a representative panel of experts with a range of different professional backgrounds commissioned by the DGGG. Following a review of the international literature and international guidelines on trophoblastic tumors, a structural consensus was achieved in a formalized, multi-step procedure. This was done using uniform definitions, objective assessments, and standardized management protocols. Recommendations: The recommendations of the guideline cover the epidemiology, classification and staging of trophoblastic tumors; the measurement of human chorionic gonadotropin (hCG) levels in serum, and the diagnosis, management, and follow-up of villous trophoblastic tumors (e.g., partial mole, hydatidiform mole, invasive mole) and non-villous trophoblastic tumors (placental site nodule, exaggerated placental site, placental site tumor, epitheloid trophoblastic tumor, and choriocarcinoma).
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Affiliation(s)
- C Tempfer
- Universitätsfrauenklinik der Ruhr-Universität Bochum, Bochum
| | - L-C Horn
- Institut für Pathologie, Universitätsklinikum Leipzig, Leipzig
| | | | - M W Beckmann
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - R Dittrich
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
| | - J Einenkel
- Universitätsfrauenklinik, Universitätsklinikum Leipzig, Leipzig
| | - A Günthert
- Frauenklinik, Luzerner Kantonsspital, Lucerne, Switzerland
| | - H Haase
- Frauenselbsthilfe nach Krebs, e. V
| | - J Kratzsch
- Institut für Laboratoriumsmedizin, Klinische Chemie und Molekulare Diagnostik, Universitätsklinikum Leipzig, Leipzig
| | - M C Kreissl
- Klinik für Nuklearmedizin, Klinikum Augsburg, Augsburg
| | - S Polterauer
- Universitätsfrauenklinik, Medizinische Universität Wien, Vienna, Austria
| | - A D Ebert
- Praxis für Gynäkologie und Geburtshilfe, Berlin
| | - K T M Schneider
- Abteilung für Geburtshilfe und Perinatalmedizin, Klinium rechts der Isar, Technische Universität München, Munich
| | - H G Strauss
- Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Halle (Saale), Halle (Saale)
| | - F Thiel
- Frauenklinik, Alb Fils Kliniken, Göppingen
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Karaman E, Çetin O, Kolusari A, Bayram I. Primary Tubal Choriocarcinoma Presented as Ruptured Ectopic Pregnancy. J Clin Diagn Res 2015; 9:QD17-8. [PMID: 26500968 DOI: 10.7860/jcdr/2015/15828.6534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 08/05/2015] [Indexed: 11/24/2022]
Abstract
The primary tubal choriocarcinoma associated with ectopic pregnancy is very rare. A 31-year-old woman was admitted to the emergency room due to amenorrhea, left lower abdominal pain and fatigue. Her β-Hcg level was 29251.4 mIU/ml and transvaginal ultrasund revealed a 24x21 mm of left tubal ectopic pregancy mass with large amount of free fluid in pelvic cavity. The patient was diagnosed with ruptured tubal ectopic pregnancy and thus, she underwent laparotomy with left total salpingectomy. The pathological assessment was reported as primary tubal choriocarcinoma with the involvement of whole tubal layer. The patient was defined to have stage I choriocarcinoma with good prognostic factors and methotrexate monotherapy was administered. Serum β- Hcg levels of the patient gradually declined and eventually became negative at the first month of the treatment. With this case report we aimed to implicate that when diagnosing the ectopic pregnancy, even very rare, the tubal choriocarcinoma should be kept in mind.
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Affiliation(s)
- Erbil Karaman
- Assistant Professor, Department of Obstetric and Gynecology, School of Medicine, Yuzuncu Yil University , Van, Turkey
| | - Orkun Çetin
- Medical Doctor, Department of Obstetric and Gynecology, School of Medicine, Yuzuncu Yil University , Van, Turkey
| | - Ali Kolusari
- Professor, Department of Obstetric and Gynecology, School of Medicine, Yuzuncu Yil University , Van, Turkey
| | - Irfan Bayram
- Professor, Department of Pathology, School of Medicine, Yuzuncu Yil University , Van, Turkey
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Rettenmaier MA, Khan HJ, Epstein HD, Nguyen D, Abaid LN, Goldstein BH. Gestational choriocarcinoma in the fallopian tube. J OBSTET GYNAECOL 2014; 33:912-4. [PMID: 24219747 DOI: 10.3109/01443615.2013.834879] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wan X, Li J, Xie X. Extrauterine choriocarcinoma of the greater omentum after tubal pregnancy: case report. Int J Gynecol Cancer 2007; 16:1476-8. [PMID: 16803554 DOI: 10.1111/j.1525-1438.2006.00610.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
Extrauterine choriocarcinoma is a rare form of gestational trophoblastic tumor. Extrauterine choriocarcinoma of the greater omentum is extremely rare in the literature. A 24-year-old female with irregular vaginal bleeding, mimicking as ectopic pregnancy, underwent emergency exploratory laparotomy and local excision of the greater omentum mass. The serum beta-human chorionic gonadotropin level decreased rapidly after operation; however, it rose up again before long. Pathology showed choriocarcinoma in the greater omentum. No evidence showed lesions on uterus. No other metastasis was found. Multiple courses of combined chemotherapy were effective for this case. Surgical excision and combined chemotherapy were effective for extrauterine choriocarcinoma of the greater omentum.
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Affiliation(s)
- X Wan
- Gynecology/Oncology Department, Women's Hospital, Zhejiang University, 2nd Xueshi Road, Hangzhou 310006, China.
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Horn LC, Vogel M. [Gestational trophoblastic disease. Non-villous forms of gestational trophoblastic disease]. DER PATHOLOGE 2004; 25:281-91. [PMID: 15184992 DOI: 10.1007/s00292-004-0702-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The non-villous forms of gestational trophoblastic disease (GTD) include a wide range of morphologic different lesions and cover a wide range of differential diagnosis. Choriocarcinomas (CCA) represent the most malignant form displaying a dimorphic pattern with proliferation of syncytio- and zytotrophoblast. An early start of chemotherapy is of great prognostic impact. Placental site nodule (PSN) and exaggerated placental site (EPS) are non-neoplastic lesions of the intermediate trophoblast without tumorous appearance, whereas placental site trophoblastic tumor (PSTT) and epitheloid trophoblastic tumor (ETT) represent tumorous neoplasms with a potential for local invasion and metastases. PSNs are incidental findings of highly polymorphic cells. In EPS chorionic villi are almost present, endometrial glands and spiral arteries are completely engulfed by intermediate trophoblastic cells without necroses. In PSTT the monomorphic, occasional multinucleated giant cells separating individual muscle fibers and charactersitically blood vessel walls are extensively replaced by trophoblastic cells and fibrinoid material. The ETT consists large necrotic areas with hyalinisation. Typically small blood vessels with preserved walls are located within the center of glycogen-rich monomorphous proliferation of trophoblastic cells.
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Affiliation(s)
- L-C Horn
- Institut für Pathologie, Abteilung für Gynäkopathologie, Universität Leipzig.
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Gálvez CR, Fernández VC, de Los Reyes JMR, Jaén MMM, Teruel RG. Primary tubal choriocarcinoma. Int J Gynecol Cancer 2004; 14:1040-4. [PMID: 15361223 DOI: 10.1111/j.1048-891x.2004.014550.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Choriocarcinoma is one of the most serious forms of gestational trophoblastic tumor. It is a malignant tumor from the epithelium of the chorionic villi. The most frequent location site is the uterus. Associated with ectopic pregnancy, it is extremely rare and in general, very aggressive. In 75% of the cases, it items from distant metastasis; therefore, a histological examination of the tubes must be performed in all ectopic pregnancies. Our patient was a 33-year-old woman who was admitted to emergency room (ER) with an intense pain in the right, iliac cavity, and limited genital bleeding. During the exploration, there was abdominal pain, with doubtful signs of peritoneal irritation. The vaginal ultrasound offered an image that was compatible with an extra uterine pregnancy in the left appendages. At emergency, right salpingectomy was performed via laparotomy. The patient was treated with polychemotherapy and contraceptives for a year, with no recurrence of the disease. Control follow-up was performed using beta-human chorionic gonadotropin (HCG) testing on a weekly basis during the first month and then bi-monthly during the first year of follow-up.
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Affiliation(s)
- C R Gálvez
- Gynecology and Obstetrics Department, H.U de Valme (Hospital), Sevilla, Spain.
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Zanetta G, Maggi R, Colombo M, Bratina G, Mangioni C. Choriocarcinoma coexistent with intrauterine pregnancy: two additional cases and a review of the literature. Int J Gynecol Cancer 1997; 7:66-77. [PMID: 12795807 DOI: 10.1046/j.1525-1438.1997.00406.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Choriocarcinoma coexistent with normal intrauterine pregnancy is rare and poses questions about its origin. Although the development from trophoblastic remnants of previous pregnancies can not be excluded in some cases, the findings of incidental macro- and microscopic foci of choriocarcinoma in apparently normal placentas show the possible transformation of normal trophoblast into choriocarcinoma during an otherwise normal pregnancy. The diagnosis and management of choriocarcinoma coexistent with intrauterine pregnancy have changed dramatically over the decades but the survival rates are still unsatisfactory. In this review, we summarize some of the most common features of this disease.
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Affiliation(s)
- G Zanetta
- Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza, III Branch of the University of Milan, Italy
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