Coriocarcinoma gástrico primario: reporte de caso / Primary gastric choriocarcinoma: case report

El coriocarcinoma gástrico primario (CGP) es un tumor extremadamente raro, altamente invasivo y de rápida diseminación hematógena. Presentamos el caso de una paciente de 57 años que inicia con cuadro de hematemesis y, progresivamente, se le suman episodios de melena, baja de peso y epigastralgia. Es derivada al Instituto Nacional de Enfermedades Neoplásicas en donde se le realizan gastroscopía y biopsia. Así, el análisis histológico reportó patrón sugestivo para CGP; el cual se confirmó al realizarle a la paciente los estudios por imágenes necesarios y llevar a cabo el análisis inmunohistoquímico para gonadotrofina coriónica humana y alfa feto proteína. Posteriormente, a la paciente se le realiza una gastrectomía radical D2 con preservación esplénica y de cola de páncreas. Lamentablemente, su evolución no fue favorable y fallece por la progresión de la enfermedad.

Primary gastric choriocarcinoma (PGC) is an extremely rare and highly invasive tumor with rapid hematogenous spread. We present the case of a 57-year-old female patient who started with hematemesis and progressive episodes of melena, weight loss and epigastralgia. It is derived from the National Institute of Neoplastic Diseases where gastroscopy and biopsy are performed. Histological analysis reported pattern suggestive of PGC; that was confirmed by immunohistochemical analysis for human chorionic gonadotrophin and fetal alpha protein. Subsequently, the patient underwent a radical D2 gastrectomy with splenic preservation and tail of the pancreas preservation. Unfortunately, her evolution was not favorable and died due to the progression of the disease.

Cutaneous metastasis of testicular choriocarcinoma, diagnosed by fine-needle aspiration cytology: A rare case report and review of the literature.

Skin metastasis of testicular choriocarcinoma is very rare. Until now about nine cases have been reported in the English literature; however, only one of them has been diagnosed by fine-needle aspiration (FNA) cytology. Herein, we report our experience with FNA cytology diagnosis of a metastatic testicular choriocarcinoma to the skin of chin. The combination of highly atypical mononuclear cells (cytotrophoblasts) and multinucleated malignant cells (syncytiotrophoblasts) are characteristic of metastatic tumor in a known case of choriocarcinoma of testis.

Gestational choriocarcinoma presenting as hemothorax.

Choriocarcinoma include a spectrum of chorionic neoplasms that may be gestational or non-gestational. By virtue of their high vascularity and affinity of trophoblast for blood vessels, metastases often occur early, and the most common site of such metastases is the lung. Metastatic pleural effusions from choriocarcinoma are infrequent. Pleural seeding usually results from extension of a sub-pleural peripheral nodule. We describe a case of gestational choriocarcinoma whose clinical presentation was medical like hemothorax as in our case rather than gynecologic.

Epithelioid trophoblastic tumor of uterus presenting as an ovarian mass: a diagnostic and therapeutic dilemma.

Epithelioid trophoblastic tumor (ETT) is a rare gestational trophoblastic tumor and often poses a diagnostic and therapeutic challenge to the involved clinicians. We report a case of epithelioid trophoblastic tumor in a young woman which involved the uterus, parametrium and the right ovary. Misdiagnosis as a choriocarcinoma led to improper treatment and progressive disease. Microscopically it revealed a relatively monotonous population of epithelioid cells arranged in nests with hyaline-like matrix surrounding the tumor cells. Differential diagnosis between placental site trophoblastic tumor and carcinoma was ruled out based on histology and immunohistochemistry. The patient developed lung and brain metastasis after 10 months and is alive with disease 1(1/2) years thereafter and is taking palliative chemotherapy. The patient had beta-HCG level of 85.1 mIU/mL at the time of diagnosis; but just before metastasis, the levels rose. Awareness of the histological features of ETT is essential to avoid misdiagnosis, as it represents a tumor which is primarily treated by surgery rather than with chemotherapy.

Molar pregnancy - experience at a tertiary care hospital of South Punjab

To determine the frequency, clinical presentation and management outcomes of molar pregnancy. Descriptive cases series. Department of Obstetrics and Gynaecology Unit-II. Bahawal Victoria Hospital, Bahawalpur, from January 2005 to December 2007. The case records of all the gestational trophoblastic cases during the study period were analyzed regarding their history, clinical examination, investigations, treatment and follow up. The main outcomes were measured in terms of duration, antecedent pregnancy, investigations, treatment and follow up. There were a total of 21499 admissions during study period which included 54 cases of molar pregnancy. Hence frequency of Molar pregnancy was 2.5/1000 pregnancies. Most of the patients belonged to the extremes of ages. Most common presenting complaint was bleeding per vagina in 39[72.2%]. Out of 54 patients, suction evacuation was done in 51[94.4%] patients and in only 3[5.5%] patients, ended up in hysterectomy. Forty one [75.9%] patients received no adjuvant therapy, 13[24.1%] received chemotherapy. Among all 54 cases, 51[94.4%] patients fully recovered and 3[5.6%] died because of extensive disease and reported late. In this series, frequency of molar pregnancy was as equal as in different parts of the world. Proper management in the early stages influences the outcome of the disease. Hence the key point of whole discussion is to detect the disease in early stage to decrease the mortality and morbidity of patients

Post-mortem diagnosis of gestation choriocarcinoma: A case report.

The present case demonstrates how a clinico-pathological approach of a forensic pathologist played a key role in deciding a sudden suspicious death and also highlights the characteristics of gestational choriocarcinoma and its importance’s in post mortem diagnosis among the forensic experts and clinicians. Investigating authorities were curious in knowing whether the death was due to criminal abortion or suicidal consumption of poisoning. The case was unraveled so that the rested soul is given justice and free from all defames.

Lungs: victim of synchronous double malignancies.

A 20 year young man was referred to our institution with superior vena cava (SVC) syndrome, multiple lung opacities and a mass lesion in the right upper zone (RUZ). CT-guided FNAC from the mass lesion was consistent with the diagnosis of non-small cell lung carcinoma (NSCLC). A lump in his left testis was detected during clinical examination. Both FNAC and excisional biopsy of the testicular mass confirmed the diagnosis of immature teratoma with choriocarcinoma, a form of non-seminomatous germ cell tumour (NSGCT). With chemotherapy all metastatic lesions of lung and SVC syndrome disappeared, and the tumour-marker levels decreased. However, the opacity in RUZ progessed to involve right recurrent laryngeal nerve at thoracic inlet, metastasized to the brain, and the patient expired after 4th cycle of chemotherapy. This case of synchronous double primary malignancies (SDPM) is being reported for its rarity.

Primary Duodenal Choriocarcinoma Presenting as Massive Intestinal Bleeding and Metastasis to Brain / 대한소화기학회지

Duodenal choriocarcinoma, either primary or metastatic, is very rare. Early diagnosis and prompt initiation of chemotherapy improve the prognosis of this neoplasm. We herein present, together with the referred literatures, a case of a 47-year-old female patient who visited to our hospital with upper intestinal bleeding. She was diagnosed as duodenal choriocarcinoma by operation. Brain metastasis was found soon after the operation and combination chemotherapy was done.

Choriocarcinoma with negative urinary and serum beta human chorionic gonadotropin (betaHCG)--a case report.

This was a rare case where a patient presented clinically as a case of post abortal sepsis and ultrasound showing the picture of an intramural degenerating fibroid. Her serum and urine both were negative for beta human chorionic gonadotropin (betaHCG). Patient succumbed to choriocarcinoma 1 month later. Failure to detect urinary and serum betaHCG lead to maternal mortality due to the choriocarcinoma. The failure to detect, certain degradation products of HCG which may predominate in gestational trophoblastic neoplasia, by many common HCG testing kits lead to the error of diagnosis. Only 3 of the 7 common commercial serum HCG tests appropriately detects nicked HCG and its free betaHCG, DPC immulite assay, being the most sensitive method. Though of rare occurrence, this awareness is important for diagnosis and follow-up of gestational trophoblastic neoplasia and could have been life saving in our case.

[ case report of metastatic choriocarcinoma to jejunum with severe lower GI bleeding]

A 33-year-old female presented with intermittent abdominal pain and severe attacks of lower gastrointestinal [GI] bleeding since 2 weeks. She has had history of irregular menses in last 3 months. In the labeled RBC-Scan study, the bleeding site was detected in left upper quadrant [LUQ]. In surgery, a tumor with the diameter of 2x1cm in a 65 cm distance of ligament of Trietz was detected. In pathological assessment jejunal metstatic choriocarcinoma was reported. Generally, choriocarcinoma is very rare among the intestinal metastatic tumors, including less than 5% of these tumors. Its presentation is acute lower GI bleeding and organ rupture, especially splenic rupture. These tumors will respond appropriately to the treatment in initial stages. Chemotherapy is the treatment of choice in these tumors

Neoplasia trofoblastica gestacional: Hospital Félix Bulnes Cerda, 1992 - 2002 / Gestational trophoblastic neoplasia: Hospital Félix Bulnes Cerda, 1992 - 2002

Objetivo: Analizar los hallazgos clínicos y el seguimiento de los casos de neoplasia trofoblástica gestacional. Material y Métodos: Se revisaron todos los casos de mola hidatidiforme en el Hospital Félix Bulnes Cerda, entre los años 1992 y 2002. Resultados: Se diagnosticaron 79 casos. La edad promedio de las pacientes fue 26,4 años. El diagnóstico de mola hidatidiforme fue sospechado clínicamente en 75,6 por ciento y en 24,4 por ciento fue hallazgo anatomopatológico. Los principales síntomas al ingreso fueron: dolor hipogástrico (75,6 por ciento), náuseas y/o vómitos (32,1 por ciento) y disuria (19,2 por ciento). Entre los signos clínicos destacan sangrado vaginal (83,3 por ciento), altura uterina discordante (25,3 por ciento) y expulsión de vesículas (12,8 por ciento). La ecografía concluyó mola hidatidiforme en 74,4 por ciento y quistes tecaluteínicos en 23,1 por ciento. Los hallazgos de anatomía patológica fueron mola completa (61,5 por ciento), mola parcial (31,2 por ciento) y coriocarcinoma (1,3 por ciento). En el seguimiento, 30,8 por ciento no volvieron a control y 23,1 por ciento tuvieron entre 7 y 12 controles. Conclusión: Los hallazgos de este estudio son similares a los descritos en la literatura.

Choriocarcinome tubulaire primitif

A partir d'un cas de Choriocarcinome tubulaire primitif diagnostique au CHU de Brazzaville. Les auteurs analysent la frequence; le diagnostic; le traitement et le pronostic de cette pathologie dans le contexte des pays en developpement

Primary choriocarcinoma of the ovary. Report of two cases.

Primary choriocarcinoma of the ovary (PCO) is rare. This can be gestational (GCO) or nongestational (NGCO) in origin. It is difficult to differentiate between CGO and NGCO. NGCO carries a worse prognosis than GCO. We present two cases of metastatic GCO who were treated successfully with combination chemotherapy and are alive and disease free at the time of reporting.

Coriocarcinoma metastático para a pleura: relato de um caso / Pleural metatastic choriocarcinoma: a case report

Os autores relatam um caso de coriocarcinoma metastático para a pleura, com invasäo pulmonar. Tratava-se de uma mulher de 27 anos de idade, cujos primeiros sintomas foram dispnéia leve e dor tipo pleurítica, apresentando PPD forte reator. A radiografia de tórax mostrava velamento do hemitórax direito, com desvio contralateral do mediastino. A tomografia computadorizada do tórax demonstrava volumosa massa pleural hipodensa, ocupando todo o hemitórax direito, determinando colapso do pulmäo direito e confirmando o desvio do mediastino, sem plano de clivagem definido com o fígado. A paciente foi submetida a uma toracotomia, sendo feita a exérese da massa tumoral, que se apresentava difusamente aderida à pleura parietal em toda a sua extensäo e que invadia o lobo inferior do pulmäo direito. Após o diagnóstico histopatológico e confirmaçäo laboratorial, a paciente foi encaminhada ao Instituto Nacional de Câncer para iniciar tratamento com quimioterapia combinada

Cariocarcinoma en la Maternidad "Concepción Palacios" 1985-1994 / Choriocarcinoma in the \"Concepcion Palacios\" Maternity 1985-1994

Analizar los múltiples factores de interés clínico en mujeres embarazadas con coriocarcinoma en la Maternidad "Concepción Palacios", Caracas. Se revisaron 18 historias de 724 pacientes con enfermedad trofoblástica de la gestación atendidas por coriocarcinoma diagnosticado histológicamente. El origen fue posmola hidatiforme en 12 casos (66,66 por ciento), postparto en 3 pacientes (16,66 por ciento) y postaborto en 3 casos (16,66 por ciento). El estadio del tumor: IA 6 casos (33,33 por ciento), IB 1 caso (5,55 por ciento), IIB 1 caso (5,55 por ciento), IIIA 1 caso (5,55 por ciento), IIIB 5 casos (27,77 por ciento), IIIC 2 casos (11,11 por ciento), IVB 2 casos (11,11 por ciento). El tratamiento sólo quimioterapia, 3 casos (16,66 por ciento), histerectomía 15 (83,33 por ciento), extirpación de metástasis en vagina y pulmón 2 (11,11 por ciento), 16 pacientes (88,88 por ciento) sobrevivieron, todas tenían menos de 6 meses de evolución y 14 (77,77 por ciento) menos de 100 000 mU/ml de hCG. Hubo dos muertes (11,11 por ciento). El coriocarcinoma es un tumor curable cuando el diagnóstico se hace antes de los 6 meses de desarrollo