Struma ovarii-associated pseudo-Meigs−syndrome with concomitant abdominopelvic tuberculosis masquerading as ovarian malignancy / Philippine Journal of Obstetrics and Gynecology

@#Pseudo-Meigs' syndrome (PMS) is a rare disease characterized by the triad of (1) an ovarian neoplasm, other than a fibroma or thecoma, (2) ascites, and (3) pleural effusion. Tumors such as struma ovarii, mucinous and serous cystadenomas, and germ cell tumors have been linked with the condition. Due to its clinical features combined with the elevation of serum cancer antigen 125 (CA-125) levels, it is often mistaken and treated as a malignant ovarian tumor. Ascites or pleural effusion could be massive leading to various life-threatening complications. Despite its presentation, this entity has an excellent prognosis when surgical excision of the tumor is performed. This article presents an unusual case of a 41-year-old gravida 10 para 10 (10-0-0-9) who was diagnosed with a case of struma ovarii associated PMS with concomitant abdominopelvic tuberculosis and elevated CA-125 resembling an ovarian malignancy.

Metastatic choriocarcinoma presenting as intracranial hemorrhage and intussusception / Philippine Journal of Obstetrics and Gynecology

@#Extrauterine choriocarcinoma is a rare entity. The criteria used for its diagnosis are as follows: (1) Absence of disease in the uterine cavity, (2) pathologic confirmation of diagnosis, (3) exclusion of molar pregnancy, and (4) absence of a coexistent intrauterine pregnancy. Delay in the diagnosis can be attributed to its nongynecologic manifestations such as bleeding from any organ system, unexplained systemic symptoms, and metastatic foci from an unknown primary malignancy. This is an unusual case of 27-year-old G3P3 (3-0-0-3) who underwent emergency left parietal craniotomy excision due to increased intracranial pressure symptoms secondary to left parietal tumor. Histopathology revealed metastatic adenocarcinoma. About a month later, she underwent exploratory laparotomy for acute abdominal symptoms secondary to a jejunal mass. Jejuno-jejunal resection anastomosis was done and histopathology revealed choriocarcinoma.

Primary pulmonary Epithelioid Trophoblastic tumor co-existing with Choriocarcinoma / Philippine Journal of Obstetrics and Gynecology

@#A 28-year old, G5P4 (4014), noted neck lymph nodes associated with cough. A chest X-ray was done showing a left nodular opacity. Antibiotics were prescribed with a resolution of symptoms. Five months after, a routine chest X-ray revealed interval progression in size of the lung nodule. A chest computed tomography (CT) scan and positron-emission tomography scan were done subsequently showing the precise location and size of the nodule and with no other focus of tumor seen. Transvaginal ultrasound was normal. With an initial diagnosis of lung carcinoma, a percutaneous needle aspiration biopsy under CT scan guidance was done. Immunohistochemical staining panel showed that beta-human chorionic gonadotropin (hCG) was positive. Subsequently, a serum beta-hCG done showed low levels from 33.48 to 59.7 mIU/ml. The final diagnosis given was a poorly differentiated malignancy highly suggestive of malignant trophoblastic tumor. A video-assisted left upper lobectomy was performed with histopathology and immunohistochemistry consistent with epithelioid trophoblastic tumor with co-existing choriocarcinoma elements. Postoperative beta-hCG level dropped to normal and remained so for 2½ years.