ABSTRACT
Background: Wide variation in the lipid profile in pregnancy is quite common. Exaggerated changes in insulin and lipid levels in women with GDM during pregnancy, lead to significant alterations in lipid levels in comparison to normal pregnancy. Lipid metabolism during pregnancy has a significant role to play in the aetiology and pathogenesis of GDM as is indicated by various studies previously.Methods: A hospital-based case control study was conducted at Hi-Tech Medical College and Hospital, Bhubaneswar, Odisha in the Department of Endocrinology. The sample size was 100 pregnant women. Study period was of one year from June 2018 to June 2019. In women of both the groups, i.e., with GDM and without GDM the mean age of presentation were 20-25 yrs. Out of the 100 cases, we took 50 patients of GDM in the cases group and 50 patients of non GDM pregnant women as control group. Fasting lipid profile was sent to the hospital laboratory analyzed by Tinder’s methods. The results thus obtained were analyzed using student ‘t’ test for statistical significance using SPSS version 20.Results: There was no statistical difference in age and parity between control and case group. Triglyceride (cases- 286.4±77.60 mg/dl) (controls-166±26mg/dl), total cholesterol (cases-256.5±41.7 mg/dl) (controls - 202.5±20.18mg/dl), VLDL (cases-53.4±13.2 mg/dl) (controls-46.6±13.1mg/dl) showed statistically significant values (p value<0.001). HDL and LDL values did not show any statistical significance (p value >0.5) among GDM and non GDM group. Lipid profile was performed predominately in women in II trimester.Conclusions: In comparison to non GDM women, it was observed that serum triglyceride, total cholesterol and VLDL level are significantly higher in woman with GDM. Whether lipid profile can be used as a predictor for gestational diabetes mellitus in future needs further research.
ABSTRACT
Extragonadal non-gestational choriocarcinoma (ENC) is an uncommon malignant tumor occasionally found in the gastrointestinal tract. ENC is characterized by a biphasic tumor growth with distinct areas of adenocarcinoma and choriocarcinoma differentiation. Primary choriocarcinoma of the colon is extremely rare, with only 21 cases reported in the literature. Most of the perforation of colorectal cancers occurs in the abdominal cavity, while abdominal wall abscess is rare; the psoas abscess associated with colon carcinoma is even less observed. Herein, we report the case of a 61-year-old female with poorly differentiated adenocarcinoma of the ascending colon and sigmoid, with choriocarcinomatous differentiation, masquerading a psoas abscess formation. Unfortunately, despite the aggressive therapy, the patient's disease rapidly progressed, and she died within 2 months after the diagnosis. The typical morphological pattern, immunohistochemistry, and its correlation with serum β-human chorionic gonadotropin enabled a correct diagnosis.
Subject(s)
Humans , Female , Middle Aged , Colorectal Neoplasms , Adenocarcinoma/diagnosis , Psoas Abscess/diagnosis , Colon , Choriocarcinoma, Non-gestational , Choriocarcinoma , Abdominal Wall , Abscess/diagnosisABSTRACT
Objective: To introduce the diagnosis and treatment of a case of male primary mediastinal choriocarcinoma, and to summarize the diagnosis and treatment of the disease by literature review. Methods: The diagnosis and treatment process of a male patient with primary mediastinal choriocarcinoma was reported. The clinical characteristics, diagnosis and treatment of 132 cases of primary mediastinal choriocarcinoma were retrospectively analyzed, in order to summarize the experience of diagnosis and treatment of this disease. Results: A 19-year-old male was admitted to hospital in September 2017 due to “chest pain and dyspnea for 1 week”. After 2 times of CT-guided mediastinal punctures, he was diagnosed with “choriocarcinoma”. After 8 times of chemotherapy and local radiotherapy for mediastinal and lung masses were completed in the hospital from October 2017 to March 2018, the response evaluation was partial remission. Following up to December 2018, the patient was generally in good condition, and no progression of tumor was observed; but he died in March 2019 due to suspected tumor recurrence. The literature review showed that the disease was rare in clinical practice, lacking of large-scale clinical studies and consensus on treatment options, so the median survival time of patients was generally short. Conclusion: Primary mediastinal choriocarcinoma in male is a rare disease that lacks specific clinical features. The treatment mainly relies on the comprehensive treatment including surgery, chemotherapy and radiotherapy, but the disease progresses rapidly with poor prognosis.
ABSTRACT
Resumen ANTECEDENTES: El coriocarcinoma es una neoplasia maligna del epitelio trofoblástico, agresiva pero susceptible de curación, incluso cuando hay metástasis. Puede ser de origen gestacional o no, el primero aparece después de un embarazo molar o aborto. CASO CLÍNICO: Paciente de 14 años, acudió a Urgencias debido a un cuadro de abdomen agudo, con prueba en orina positiva de embarazo; además, una tumoración en la región anexial derecha. En la laparotomía se encontró una tumoración dependiente del anexo derecho, con la cápsula rota, adherida al colon. Un día después de la intervención quirúrgica (por no contar con recursos en la unidad) se tomó la fracción beta de gonadotropina coriónica. El diagnóstico definitivo se estableció con base en el reporte del estudio histopatológico de la pieza quirúrgica. CONCLUSIÓN: El coriocarcinoma es una neoplasia maligna del epitelio trofoblástico, muy agresiva pero susceptible de curación, incluso cuando se detectan metástasis. La incidencia en México de coriocarcinoma gestacional es de 0.133 por cada 100,000 mujeres, mientras que la incidencia del cariocarcinoma no gestacional se desconoce. Se reporta como un tumor muy raro; por ello el diagnóstico preciso y oportuno es difícil en este tipo de tumores; la presentación más habitual es el abdomen agudo.
Abstract BACKGROUND: Choriocarcinoma is a malignant neoplasm of the trophoblastic epithelium, very aggressive but highly curable, even when there is metastasis. It can be of gestational and non-gestational origin, the first one can develop after a pregnancy, abortion or molar pregnancy; in Mexico it is calculated with an incidence of 0.133 per 100,000 women. While the incidence of non-gestational choriocarcinoma is unknown as it is reported as a very rare tumor. The objective is present the first case reported in our hospital, there are few cases reported in Mexico, it is important to know them in order to identify, diagnose and refer them on time. CLINICAL CASE: A 14-year-old patient who presented to the emergency department with a picture of acute abdomen with pregnancy test in positive urine and tumor in the right adnexal region, laparotomy was performed, finding a tumor dependent on the right annex with a broken capsule attached to the colon, one day after the surgical event (due to lack of resources in the unit) beta fraction of chorionic gonadotropin, the definitive diagnosis was made by the histopathological study of the surgical piece. CONCLUSION: Choriocarcinoma is a malignant neoplasm of the trophoblastic epithelium, very aggressive but highly curable, even when metastases are detected. In Mexico, the incidence of gestational choriocarcinoma is 0.133 per 100,000 women, while the incidence of non-gestational cariocarcinoma is unknown, it is reported as a very rare tumor, which is why accurate and early diagnosis is difficult in this type of tumors. , since the most common presentation is an acute abdomen.
ABSTRACT
Objective To investigate the clinical manifestations,pathological features,treatment and prognosis of nongesta-tional choriocarcinomas.Methods The clinicopathological data in 4 cases of nongestational choriocarcinoma were retrospectively analyzed and the relevant literatures were reviewed.Results All 4 patients had no confirmed diagnosis at first visit to hospital.All patients received the operative therapy and postoperative bleomycin,etoposide and cis-platinum (BEP)regimen chemotherapy.The followed up lasted for 3-32 months.One case died at postoperative 26 months due to pulmonary metastasis;one case was loss of follow up;two cases had relatively favorable condition.Conclusion Nongestational choriocarcinoma is a rare and highly invasive trophoblastic neoplasm,and is prone for early distant metastasis.The treatment is recommended to adopt operation combined with postoperative combined chemotherapy of multiple drugs.
ABSTRACT
A pure ovarian choriocarcinoma is a very rare disease which can be either pregnancy related (gestational), may not be related (non-gestational), or commonly correlated with different type of germ cell; teratocarcinoma, dysgerminoma or undifferentiated carcinoma. A pure non-gestational primary ovarian choriocarcinoma is astronomically uncommon and we recorded such condition in 14-year-old teenage girl’s ovary. An abdominal operative procedure with the help of a careful histopathology examination revealed choriocarcinoma in absence of other type of germ cell element. Multiple courses of Etoposide/Methotrexate/Actinomycin-D (EMA) regime of chemotherapy were shown to be effective in this case.
Subject(s)
ChoriocarcinomaABSTRACT
Pure primary ovarian choriocarcinoma is an extremely rare and aggressive tumor. It can be of gestational or nongestational in origin. The gestational type can arise from an ovarian pregnancy or can be of metastatic origin from uterine choriocarcinoma. The nongestational type is a very rare germ cell neoplasm. It is important to distinguish between two types of choriocarcinomas as nongestational origin is highly malignant and has worse prognosis than gestational type. But it is very difficult to differentiate by routine histological examination. Nongestational choriocarcinoma has been found to be resistant to single agent chemotherapy. It occurs usually around 13 years of age and is mainly confined to females under 20. Here we report a case of primary pure nongestational choriocarcinoma of the ovary in an unmarried girl of 14 years, diagnosed in 2001 and treated successfully with surgery and combination chemotherapy and remained disease-free till last reporting in September 2013.
ABSTRACT
<p><b>OBJECTIVE</b>To look into the glucose tolerance test characteristics and determine complications in non-gestational diabetes pregnant subjects.</p><p><b>METHODS</b>From 2006 to 2009 all non-gestational diabetes mellitus (non-GDM) pregnant women who delivered macrosomia at the North Australia's Townsville Hospital were retrospectively reviewed by extracting data from clinical record. Glucose tolerance tests results were analysed in the light of an earlier diagnosis of non-GDM.</p><p><b>RESULTS</b>Ninety-one non-GDM mothers with macrosomia were studied and compared with 41 normoglycemic subjects without macrosomia. Of the subjects with non-GDM macrosomia, 45 (49.4%) had normal 50 g glucose challenge test (GCT) without further testing, another 8 (8.8%) had abnormal GCT but normal 75 g oral glucose tolerance test (OGTT). A total of 4 (4.4%) subjects had normal GCT and OGTT. Interestingly, 14 out of 16 (87.5%) subjects who were tested with OGTT owing to past history of macrosomia had normal results but delivered macrosomic babies. Only 12 subjects had both GCT and OGTT, the rest of the cohort had either of the two tests. Subjects with non-GDM macrosomia had higher frequency of neonatal hypoglycaemia 34% as compared to 10% in non-macrosomic babies (P=0.003). Other feto-maternal complications were similar in both groups.</p><p><b>CONCLUSIONS</b>No significant pattern of glucose tolerance characteristics was identified in non-GDM mothers with macrosomic babies. In spite of being normoglycemic significant neonatal hypoglycaemia was recorded in non-GDM macrosomic babies. Further prospective studies on a larger population are needed to verify our findings.</p>
ABSTRACT
Choriocarcinoma is a highly invasive and metastatic neoplasm which arises in women of reproductive age. It can be either gestational or nongestational in origin, but the latter form is very rare. Choriocarcinoma is characterized by the production of human chorionic gonadotropin. It can metastasize to distant organs such as lung, brain, liver, kidney, and vagina in the early stages of disease, but retroperitoneal metastasis is extremely rare. Treatment options include surgical intervention and chemotherapy. We present the case of a 25-year-old nulliparous woman who presented to our department with a retroperitoneal mass and negative urine human chorionic gonadotropin test, who was immunohistopathologically diagnosed with nongestational choriocarcinoma. The patient responded well to surgery and multi-drug chemotherapy.
Subject(s)
Adult , Female , Humans , Pregnancy , Brain , Choriocarcinoma , Chorionic Gonadotropin , Drug Therapy , Kidney , Liver , Lung , Neoplasm Metastasis , VaginaABSTRACT
Nongestational ovarian choriocarcinoma is an exceedingly rare and highly aggressive tumor. Although early diagnosis and timely initiation of therapy is important, it is difficult in reproductive aged patients because of the frequent elevation of human chorionic gonadotropin. We report a primarily nongestational ovarian choriocarcinoma in a 12-year-old virgin female. Initial diagnosis based on abdominopelvic computed tomography and pelvis magnetic resonance imaging was ectopic pregnancy with hemoperitoneum. A diagnostic laparoscopy of the ovarian tumor revealed choriocarcinoma. Unilateral salpingo-oophorectomy and omental sampling revealed surgical stage of IA. Six courses of adjuvant combination chemotherapy (bleomycin, etoposide, and cisplatin) followed surgery.
Subject(s)
Child , Female , Humans , Pregnancy , Choriocarcinoma , Chorionic Gonadotropin , Diagnosis , Drug Therapy, Combination , Early Diagnosis , Etoposide , Hemoperitoneum , Laparoscopy , Magnetic Resonance Imaging , Ovary , Pelvis , Pregnancy, EctopicABSTRACT
Objective: To look into the glucose tolerance test characteristics and determine complications in non-gestational diabetes pregnant subjects. Methods: From 2006 to 2009 all non-gestational diabetes mellitus (non-GDM) pregnant women who delivered macrosomia at the North Australia's Townsville Hospital were retrospectively reviewed by extracting data from clinical record. Glucose tolerance tests results were analysed in the light of an earlier diagnosis of non-GDM. Results: Ninety-one non-GDM mothers with macrosomia were studied and compared with 41 normoglycemic subjects without macrosomia. Of the subjects with non-GDM macrosomia, 45 (49.4%) had normal 50 g glucose challenge test (GCT) without further testing, another 8 (8.8%) had abnormal GCT but normal 75 g oral glucose tolerance test (OGTT). A total of 4 (4.4%) subjects had normal GCT and OGTT. Interestingly, 14 out of 16 (87.5%) subjects who were tested with OGTT owing to past history of macrosomia had normal results but delivered macrosomic babies. Only 12 subjects had both GCT and OGTT, the rest of the cohort had either of the two tests. Subjects with non-GDM macrosomia had higher frequency of neonatal hypoglycaemia 34% as compared to 10% in non-macrosomic babies (P=0.003). Other feto-maternal complications were similar in both groups. Conclusions: No significant pattern of glucose tolerance characteristics was identified in non-GDM mothers with macrosomic babies. In spite of being normoglycemic significant neonatal hypoglycaemia was recorded in non-GDM macrosomic babies. Further prospective studies on a larger population are needed to verify our findings.
ABSTRACT
Pure ovarian choriocarcinomas are extremely rare and aggressive tumors which are gestational or non-gestational in origin. Due to the rarity of the tumor, there is a lack of information on the clinicopathologic features, diagnosis, and treatment. We report a case of a pure ovarian choriocarcinoma, likely of non-gestational origin, treated by cytoreductive surgery in combination with post-operative chemotherapy. The patient was free of disease after a 12-month follow-up.
Subject(s)
Female , Humans , Pregnancy , Choriocarcinoma , Follow-Up Studies , OvaryABSTRACT
Primary ovarian choriocarcinoma arising from a germ cell is an extremely rare occurrence, especially in postmenopausal women, and the prognosis is poor. Non-gestational choriocarcinoma of the ovary (NGCO) accounts for 0.6% or less of all ovarian neoplasms. It is important to distinguish gestational choriocarcinomas of the ovary (GCO) from other carcinomas because of the poor prognosis of NGCO. We describe a case of NGCO with lung metastasis in a 55 year old woman, which we present together with a brief review of the literature.
Subject(s)
Female , Humans , Pregnancy , Choriocarcinoma , Choriocarcinoma, Non-gestational , Germ Cells , Lung , Neoplasm Metastasis , Ovarian Neoplasms , Ovary , Postmenopause , PrognosisABSTRACT
Choriocarcinoma is a HCG-producing epithelial neoplasm derived from either trophoblastic or totipotential germ cells. It is a highly malignant tumor, which is rapidly invasive and widely metastatic, and in most cases develops within the uterus after a normal or abnormal gestation, including ectopic pregnancy. Non-gestational choriocarcinoma rarely occur as a primary neoplasm in the gonads or in the extragonadal midline locations such as mediastinum, retroperitoneum, and pineal gland. It also has been reported very rarely to arise in parenchymal organs such as the prostate, lung, breast, brain, liver, kidney, bladder, vagina, and gastrointestinal tract. A 58-year old man was admitted to our hospital with symptoms of tarry stool and epigastric discomfort. The endoscopic biopsy specimen initially revealed pooly differentiated carcinoma of stomach with regional lymph node metastasis. Patient underwent distal gastrectomy with Billroth II anastomosis. Choriocarcinoma of stomach with well differentiated tubular adenocarcinoma was diagnosed by the surgical biopsy specimen, and the serum level of beta-HCG was 2,775 mIU/mL.In three months after operation, the patient presented with pain on right upper quadrant abdomen, and the CT scan revealed multiple liver metastasis. Bleomycin, etoposide, and cisplatin (BEP) combination chemotherapy were administered, but he died three months after the initial diagnosis.
Subject(s)
Female , Humans , Middle Aged , Pregnancy , Abdomen , Adenocarcinoma , Biopsy , Bleomycin , Brain , Breast , Choriocarcinoma , Choriocarcinoma, Non-gestational , Cisplatin , Diagnosis , Drug Therapy, Combination , Etoposide , Gastrectomy , Gastroenterostomy , Gastrointestinal Tract , Germ Cells , Gonads , Kidney , Liver , Lung , Lymph Nodes , Mediastinum , Neoplasm Metastasis , Neoplasms, Glandular and Epithelial , Pineal Gland , Pregnancy, Ectopic , Prostate , Stomach , Tomography, X-Ray Computed , Trophoblasts , Urinary Bladder , Uterus , VaginaABSTRACT
Primay ovarian choriocarcinoma is very rare disease. Especially, non-gestational choriocarcinoma of ovary has worse prognosis than gestational tumor. Here, we report a non-gestational pure ovarian choriocarcinoma in 11 years old woman with the review of literature.
Subject(s)
Child , Female , Humans , Pregnancy , Choriocarcinoma , Choriocarcinoma, Non-gestational , Ovary , Prognosis , Rare DiseasesABSTRACT
Primary ovarian choriocarcinoma is an extremely rare germ cell neoplasm, and the prognosis is poor. Especially, the diagnosis of primary ovarian nongestational chori-ocarcinoma can be reliably established in a girl or innocent virgin. We report a case of primary ovarian, nongestational, pure choriocarcinoma in a 16-year-old woman. She died within 1 year after diagnosis in spite of the treatment with surgery and combin-ation chemotherapy.
Subject(s)
Adolescent , Female , Humans , Pregnancy , Choriocarcinoma , Choriocarcinoma, Non-gestational , Diagnosis , Drug Therapy , Germ Cells , PrognosisABSTRACT
Most instances of choriocarcinoma of the ovary are gestational in origin. In contrast, nongestational choriocarcinoma of the ovary is an exceedingly rare primary germ cell neoplasm that has worse prognosis than gestational neoplasm. We report a case of pure nongestational choriocarcinoma of the ovary in view of the rarity of its kind. The patient was a 35-year-old Korean unmarried woman who had suffered from vaginal bleeding and feeling of abdominal inflation for two months. The X-ray studies and CT scanning revealed a child head sized cystic mass on the right pelvic cavity and multiple nodular densities in both lung fields and the liver. The mass in pelvic cavity was excised and histologically confirmed to be a nongestational pure choriocarcinoma, arising from the right side ovary.