Diagnóstico y tratamiento quirúrgico de una paciente con una neoplasia trofoblástica gestacional / Diagnosis and surgical treatment of a patient with gestational trophoblastic neoplasia

Resumen ANTECEDENTE: La neoplasia trofoblástica gestacional forma parte del grupo de afecciones derivadas de la proliferación anómala del trofoblasto con capacidad para invasión y metástasis. CASO CLÍNICO: Paciente de 42 años, asintomática, con sospecha ecográfica de mola hidatiforme. El legrado uterino y el estudio anatomopatológico confirmaron el diagnóstico de mola hidatiforme completa. Con la cuantificación consecutiva de tres elevaciones de la β-HCG se diagnosticó: neoplasia trofoblástica gestacional. Se estadificó en estadio I, bajo riesgo y ante el deseo genésico satisfecho la paciente aceptó la histerectomía más salpingectomía bilateral. En el seguimiento posterior la paciente se encontró asintomática, con determinaciones seriadas de b-HCG negativa y ecografías vaginales sin hallazgos. CONCLUSIÓN: La histerectomía con salpingectomía bilateral puede ser el tratamiento definitivo en casos seleccionados de neoplasia trofoblástica. La evidencia disponible es escasa, por lo que es necesario seguir investigando en este campo.

Abstract BACKGROUND: Gestational trophoblastic neoplasia is one of a group of conditions resulting from abnormal trophoblast proliferation with capacity for invasion and metastasis. CLINICAL CASE: 42-year-old asymptomatic patient with ultrasound suspicion of hydatidiform mole. Uterine curettage and anatomopathological study confirmed the diagnosis of complete hydatidiform mole. With the consecutive quantification of three elevations of β-HCG a diagnosis of gestational trophoblastic neoplasia was made. It was staged as stage I, low-risk, and the patient agreed to hysterectomy plus bilateral salpingectomy. At subsequent follow-up the patient was found to be asymptomatic, with negative serial determinations of β-HCG and vaginal ultrasound scans without findings. CONCLUSION: Hysterectomy with bilateral salpingectomy may be the definitive treatment in selected cases of trophoblastic neoplasia. The available evidence is scarce and further research is needed in this field.

Recurrent Ectopic pregnancy after bilateral Salpingectomy: A case report / Philippine Journal of Obstetrics and Gynecology

@#Recurrent ectopic pregnancy after bilateral salpingectomy is a very rare condition, with only one previous case reported. This is a case of a 29 year old G4P0(0030) who presented with abdominal pain at the background of missed menses and positive pregnancy test, two years after bilateral salpingectomy. Intraoperatively, a 5x4cm bleeding mass was visualized at the right distal tubal remnant, containing an embryo and decidualized tissues. Excision of the adnexal mass and bilateral tubal remnants were completed. In such cases, total salpingectomy is the gold standard in preventing recurrence of another extrauterine gestation. In the presence of tubal remnants, a hysterosalpingography is recommended to assess tubal patency. Ultimately, the rarity of this case demands prompt recognition of risk factors, clinical presentation and appropriate management. It underscores the importance of maintaining vigilance, with high index of clinical suspicion in all women in the reproductive age group, especially those with risk factors.

Influence of prophylactic bilateral salpingectomy in ovarian function and its preventive effect on pelvic disease / 吉林大学学报(医学版)

Objective:To study the influence of prophylactic bilateral salpingectomy during hysterectomy in ovarian function of the premenopausal women with benign uterine disease and its preventive effect on the pelvic diseases(malignant /benign pelvic lesions or pelvic inflammatory disease).Methods:A total of 100 patients with benign uterine disease underwent hysterectomy were collected and divided into two groups,including 50 patients underwent simultaneous hysterectomy and prophylactic bilateral salpingectomy (prevention group) and 50 patients underwent only hysterectomy (control group).The operative time,blood loss,evacuation time,and hospitalization time of the patients in two groups were detected;the antral follicle count,levels of serum estradiol(E2),follicle stimulating hormone(FSH) and luteinizing hormone(LH)) and the incidence of perimenopausal symptoms of the patients in two groups before operation and six months,1 year after operation were compared;the incidence of pelvic disease of the patients after operation were compared.Results:The operative time,blood loss,evacuation time,and hospitalization time of the patients between two groups were not significantly different(P>0.05).Compared with before operation,the antral follicle count and the E2 levels of the patients 6 months and 1 year after operation in two groups were decreased,and the FSH and LH levels of the patients were inc reased (P0.05).The incidence of perimenopausal symptoms of the patients in two groups 6 months and 1 year after operation showed no significant difference(P>0.05).The incidence of ovarian malignant tumor and ovarian benign tumor of the patients in two groups 6 months and 1 year after operation had no significantly differences (P>0.05).The incidence of pelvic inflammatory disease of the patients in control group was higher than that in prevention group(P<0.05).There were 2 patients diagnosed as tubal carcinoma in control group 1 year after operation,and the pathological findings showed the atypical cells in 2 patients in prevention group.Conclusion:Prophylactic bilateral salpingectomy during hysterectomy does not damage the ovarian function and can reduce the incidence of pelvic malignant/ benign tumor and pelvic inflammatory disease.

Short-term influence on ovarian reserve in premenopausal women with hysterectomy plus salpingectomy / 医学研究生学报

Objective The risk of ovarian/pelvic serous cancer can be reduced by prophylactic bilateral salpingectomy ( PBS) at the time of hysterectomy .This study was to evaluate the short-term influence of PBS plus hysterectomy on ovarian reserve in premenopausal women . Methods We retrospectively analyzed the clinical data about 60 premenopausal women treated by total lapa-roscopic hysterectomy ( TLH) for benign indications , 30 undergoing PBS at the same time ( the experimental group ) while the other 30 with the ovary preserved ( the control group ) .We compared the levels of FSH, LH, E2, and anti-Müllerian hormone ( AMH) and the inci-dence of peri-menopausal symptoms between the two groups of patients before and at 1 and 3 months after operation . Results Statistically significant differences were not observed between the two groups in the such baseline clinical characteristics as age , gravidity, parity, men-strual cycle, comorbidity, diagnosis, comorbidities, and history of abdominal surgery (P>0.05), nor in the AMH level at the baseline ([1.08±0.08] vs [1.04±0.10] ng/mL) or at 1 month ([0.86± 0.44] vs [0.81±0.48] ng/mL) or 3 months postoperatively ([0.84±0.94] vs [0.68±0.42] ng/mL) (F=0.247, P=0.746).Howev-er, the mean level of AMH was markedly reduced at 1 and 3 months after operation as compared with the baseline ( P0.05) .There were not any statistically significant differences in the levels FSH, LH, and E2 between the two groups before or at 1 and 3 months after surgery (P>0.05), nor in the incidence rates of peri-menopausal symptoms at 1 month (6.7%vs 3.3%, P>0.05) or 3 months postoperatively (10.0%vs 6.7%, P>0.05). Conclusion PBS at the time of total hysterectomy in premenopausal women does not affect ovarian reserve in the short term .The level of AMH has a higher sensitivity than those of FSH , LH and E2 in the assessment of postoperative ovarian function .

Advances in prophylactic bilateral salpingectomy / 医学研究生学报

Ovarian cancer accounts for more deaths than any other cancers of the female reproductive tract .There are no ef-fective screening tests .Prophylactic bilateral salpingectomy ( PBS) in standard hysterectomy in premenopausal women with benign con-dition may be a strategy for preventing pelvic serous cancer .To evaluate this procedure , we review the advances of the effectiveness of PBS in reducing the risk of malignant or benign pelvic pathologies , surgical or perioperative complications as well as the effects of sal-pingectomy on ovarian function .

Interstitial heterotopic pregnancy by in vitro fertilization and embryo transfer after bilateral salpingectomy / 대한산부인과학회지

Although assisted reproductive technology is associated with higher rates of interstitial pregnancy and heterotopic pregnancy, heterotopic pregnancy after bilateral salpingectomy is still extremely rare. We report a case of heterotopic pregnancy after bilateral salpingectomy in an in vitro fertilization/embryo transfer patient, who underwent cornual resection by laparotomy due to ruptured cornual pregnancy. However, 3 days after surgery, the remaining intrauterine pregnancy miscarried, and a dilatation and curettage was performed.