We present the case of a year-old Caucasian patient, para 2, presenting a cervical well vascularised tumor in 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 endometrial cancer biopsy results 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 extrem 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.
Coriocarcinom gestaţional al colului uterin – prezentare de caz
Endometrial cancer biopsy results 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 stabilit 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.
Coriocarcinom gestaţional al colului uterin – prezentare de caz
Coriocarcinomul are un prognostic foarte bun, chiar şi în stadii avansate, deoarece este o tumoare foarte chimiosensibilă. 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.
Revista Romana de Anatomie
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, the 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.
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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 endometrial cancer biopsy results 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 dispensing 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. Discussion Gestational trophoblastic neoplasia includes invasive endometrial cancer biopsy results, choriocarcinoma, trophoblastic placental tumor, and epithelioid trophoblastic tumor.
Half endometrial cancer biopsy results 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 three weeks or longer — days 1, 7, 14, and The serum level of β-hCG remains detectable for six months or longer.
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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. Several hypotheses have been postulated to explain the pathogenesis of endometrial cancer biopsy results choriocarcinoma.
HISTOPATHOLOGICAL DIAGNOSIS CRITERIA IN ENDOMETRIAL HYPERPLASIA
It may develop from cervical metastases from a primary tumor in the corpus that later spontaneously regresses, it is 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. 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 cervical cancer, endometrial cancer biopsy results to a endometrial cancer biopsy results 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 disease characterized by abnormal trophoblastic hyperplasia and anaplasia, absence of chorionic villi, hemorrhage and necrosis Figure 3with direct invasion into the myometrium endometrial cancer biopsy results vascular invasion resulting in spread to distant sites, most commonly to the lungs, brain, liver, pelvis, vagina, kidney, intestines, and spleen.
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Choriocarcinoma has been reported to occur in association with any pregnancy event. Figure 3.
- Aim: To highlight the value of histopathological examinations with assessment of the ways to obtain endometrial biopsies and the appreciation of the contribution of different histopathological techniques that can be used to establish a correct and complete diagnosis.
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- Parazitii intestinali copii
These placental tumors are 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.