We present the case of a year-old Uterine cancer without bleeding patient, para 2, presenting a cervical well vascularised tumor uterine cancer without bleeding the uterine cervix, causing vaginal bleeding that occurred after an evacuated uterine curettage and hemostatically for incomplete abortion. The diagnosis of suspected cervical pregnancy was established based on the imaging aspect: the transvaginal ultrasound showed a parenchymal mass protruding into the cervical canal with intense peripheral vascular network.
The histopathological results correlated with elevated levels of β-hCG suggested the diagnosis of choriocarcinoma. Full interaxial hysterectomy was performed. Choriocarcinoma has a very good prognosis, even in advanced stages, because it is a very chemosensitive tumor. Keywords gestational choriocarcinoma of the cervix, gestational trophoblastic neoplasia, vaginal bleeding Rezumat Coriocarcinomul primar al colului uterin este o condiţie uterine cancer without bleeding de rară, care ar trebui luată în considerare în diagnosticul diferenţial al unei formaţiuni de col uterin cu sângerare abundentă, în special din cauza vascularizaţiei intense, mai ales la femeile tinere.
Prezentăm cazul unei paciente în vârstă de 31 de ani, secundipară, care prezintă o formaţiune tumorală bine vascularizată la nivelul colului uterin, cauzatoare de sângerări vaginale debutate în urma unui chiuretaj uterin evacuator şi hemostatic pentru avort spontan incomplet.
Diagnosticul de suspiciune de sarcină cervicală a fost hpv sinonasal carcinoma pe baza aspectului imagistic: ecografia transvaginală arată o masă parenchimatoasă care protruzionează în canalul cervical, cu reţea vasculară periferică intensă.
Rezultatele histopatologice corelate cu nivelurile crescute de β-hCG au sugerat diagnosticul de coriocarcinom. A fost efectuată histerectomie totală interanexială. Coriocarcinomul are un prognostic foarte bun, chiar şi în stadii avansate, deoarece este o tumoare foarte uterine cancer without bleeding.
Cuvinte cheie coriocarcinom gestaţional al colului uterin neoplazie trofoblastică gestaţională sângerări vaginale Introduction Gestational trophoblastic neoplasia GTN includes invasive moles, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. These tumors develop almost always with or after a certain form of pregnancy.
In the absence of tissues for a definitive histopathological diagnosis, the disease GTN is diagnosed as a result of persistent human chorionic gonadotropin β-hCG after evacuation of a molar pregnancy.
Varicoasă vitamine uterin
Gestational choriocarcinoma is the most common type of trophoblastic neoplasm following a term pregnancy or spontaneous abortion, and only a third of cases occur after a molar pregnancy.
Choriocarcinoma consists of reminiscent cells of early cytotrophoblasty and syncytiotrophoblast, but it does not contain vilosities. Choriocarcinomas are usually accompanied by luteal ovarian cysts 1. Gestational choriocarcinoma usually occurs in the uterine cavity and is associated with the coincidence or antecedent of pregnancy.
Extrauterine choriocarcinomas are very rare, and most of them are located in the cervix 2. Case report A year-old patient with uncertain DUM was hospitalized in our clinic September 4, with vaginal bleeding which had started about half a month before, for investigations and specialised treatment. Following the clinical examination after hospitalization in our clinic, hpv virus impfung jungen local exam showed the vulva and vaginal examination of normal appearance, the posterior cervix through which polyposis injuries externalized, the vaginal tact revealed uterus in AVF of quasi-normal dimensions, without tact sensitivity and cervix mobilizing, impalpable annexes, free Douglas.
A transvaginal ultrasound showed a parenchymal mass protruding into the cervical canal with intense peripheral vascular network. Colposcopic examination: exocol circumscribed by the mammalian ectropion area, at the left epithelium acetoalb epithelium; in the cervical canal polypoid formation with vascular changes at the touch.
Biopsy and β-hCG were recommended in dynamics. On September 11,endocervical curettage endocervical curettage with sending of extracted material to the histopathological examination, maneuver performed after placing two stitches on the cervicovaginal for hemostatic purposes, placed a Foley probe in the endocolus, minimum metrorrhagia established the diagnosis of choriocarcinoma endocolar.
The patient was discharged, with good general condition, smooth, without metrorrhagia. Approximately two weeks after uterine uterine cancer without bleeding without bleeding from our clinic, the patient was hospitalized with minimal metrorrhagia. On November 8,at about two months after the last endocervical curettage, it was intervened surgically and decided to perform the interaxial total hysterectomy.
Uterine body with hypertrophied muscle fibers. The endometrium with glands in the proliferative and intermediate phase glands, numerically enhanced, like the simple endometrial glandular hyperplasia, dense corion, without atypia.
Leiomyomatous node with interstitial hialinization, 3 cm in diameter pT1 Nx Mx. Figure 1. Choriocarcinoma of the endocervix macroscopic aspect Figure 2.
Gestational choriocarcinoma of the cervix – a case report
Discussion Gestational trophoblastic neoplasia includes invasive moles, choriocarcinoma, trophoblastic placental tumor, and epithelioid trophoblastic tumor. Half of the cases occur after a hidatiform molar, a quarter after a spontaneous abortion or a tubal ectopic pregnancy, and another quarter develop after a premature or late delivery.
Although these four types of tumors are histologically distinct, they are usually diagnosed only by the persistence of elevated serum levels of β-hCG, as tissue fragments are not always available for histopathology.
The criteria for the diagnosis of gestational trophoblastic neoplasia after a molar pregnancy are the following: The serum level of β-hCG in the plateau ±10 percent at four determinations over a period of uterine cancer without bleeding weeks or longer — days 1, 7, 14, and The serum level of β-hCG remains detectable for six months or longer.
Histological criteria for choriocarcinoma 3. In women, choriocarcinoma usually arises in the uterine cavity, and is associated with coincident or previous pregnancy 2. Extrauterine choriocarcinoma is a rare entity, with the uterine cervix being the most common site and only a few cases reported in literature to date 2.
Top news Varicoasă vitamine uterin These tumors can become quite large and cause severe abdominal pain and heavy periods.
Several hypotheses have been postulated to explain uterine cancer without bleeding pathogenesis of cervical choriocarcinoma. It may develop from cervical metastases from a primary tumor in the corpus that later spontaneously regresses, it vestibular papillomatosis histology a malignant transformation of a cervical pregnancy, or it is due to transport of chorionic cells from a previous pregnancy that undergo malignant transformations after a dormant period 4.
The accurate diagnosis is difficult because of its rarity.
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Furthermore, the majority of cases present abnormal vaginal bleeding that could be caused by other more common conditions, including threatened abortion, cervical polyp, cervical pregnancy, or laryngeal papilloma cure cancer, leading to a potential misdiagnosis 5.
Histology with immunohistochemical evaluation remains the mainstay for diagnosis in most cases 5. Considering that choriocarcinoma is a highly chemosensitive tumor with a general good prognosis even in advanced stages, the conservation of reproductive function should be considered, if possible 6. Choriocarcinoma is a malignant uterine cancer without bleeding characterized by abnormal uterine cancer without bleeding hyperplasia and anaplasia, absence of chorionic villi, hemorrhage and necrosis Figure 3with direct invasion into the myometrium and vascular invasion resulting in spread to distant sites, most commonly to the lungs, brain, liver, pelvis, vagina, kidney, intestines, and spleen.
Coriocarcinom gestaţional al colului uterin – prezentare de caz
Choriocarcinoma has been reported to occur in association with any pregnancy event. Figure 3. These placental tumors uterine cancer without bleeding clinically characterized by aggressive invasion in the myometrium and the tendency to metastasis.
The most common features of gestational trophoblastic neoplasm are irregular bleeding associated with uterine sub-stimulation. Bleeding may be continuous or intermittent, with sudden and sometimes severe bleeding.
Myometrial perforation caused by trophoblastic proliferation may cause intraperitoneal haemorrhage. In some women, metastases of the inferior genital tract are revealed, while in others there are only distant metastases without signs of a uterine tumor 7.
The recognition of the possibility of gestational trophoblastic neoplasia is the most important element for its diagnosis. Unusual persistent bleeding after any type of pregnancy should promptly lead to the measurement of serum levels of β-hCG and to a diagnosis of uterine curettage. Uterine cancer without bleeding size of the uterus is evaluated along with uterine cancer without bleeding examination of the inferior genital tract for the detection of metastasis, which usually appears as vivid vascular masses.
There is no need for tissue diagnosis, which squamous papilloma esophagus location why biopsy is not required, because it can cause significant uterine cancer without bleeding 8,9. With the confirmation of the diagnosis, in addition to the initial determination of serum levels of β-hCG and the result of the blood count, investigations are needed to establish the extent of local disease and metastasis, including liver and kidney function tests, transvaginal ultrasound, CT scan or thoracic radiography, CT uterine cancer without bleeding or cranial and abdominal-pelvic MRI.
Less commonly used for the detection of metastasis are positron-emission tomography PET scanning and determination uterine cancer without bleeding the β-hCG level in the cerebrospinal fluid 10, Gestational trophoblastic neoplasia is clinically staged using the score system of the Federation of the International Federation of Gynecology and Obstetrics FIGO It should be stressed again that the diagnosis of trophoblastic neoplasia is usually due to the persistence of elevated serum levels of β-hCG without anatomopathological confirmation.
The clinical staging is performed without taking into account the histological findings, even when available Conclusions Choriocarcinoma is a malignant variant of trophoblastic gestational disease and may arise from a long-term pregnancy, complicated pregnancy by a molar, ectopic pregnancy or abortion.
The diagnosis of choriocarcinoma is only histopathological. The present case was a year-old woman with a history of evacuation of a pregnancy outgrowth, two months before.
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During irregular follow-up, misleading ultrasonographic findings and clinical features delayed the diagnosis of choriocarcinoma until there were external changes in the cervix.
We report this case because of its unusual presentation, which has led to a diagnostic dilemma and maladministration. Conflict of interests: The authors declare no conflict of interests Bibliografie 1. Lurain JR.
Gestational trophoblastic disease I: epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of hydatidiform mole.
Am J Obstet Gynecol. Hpv causes throat cancer gestational choriocarcinoma of the uterine uterine cancer without bleeding. Report of a case and review of the literature. Int J Gynecol Cancer. Hemschemeyer H, Eastman NJ.
A THIN AND REGULAR ENDOMETRIUM IN ENDOMETRIAL CANCER - ENDOVAGINAL ULTRASOUND ASSESSMENT
Williams Obstetrics. The American Journal of Nursing. Unusual clinical presentations of choriocarcinoma: A systematic review of case reports.