Cervical cancer mri. Современные аспекты лучевой диагностики рака шейки матки


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Case report. In this paper we cervical cancer mri the case of a year-old woman, gesta 2, para 2, presenting with a cervical well vascularized mass causing vaginal bleeding two years after the delivery of her second baby at term by caesarean section.

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The cervical CCA suspicion diagnosis was established based on imaging aspect - transvaginal ultrasound showing a parenchymatous area that protrudes into the cervical canal with intense peripheral vascular network and contrast-enhanced MRI describing an cervical cancer mri bulky, round-oval, well defined mass with a long necrotic pedicle and extensive central area of ne­crosis.

The histopathological results correlated with the increased levels of βHCG suggested choriocarcinoma with large necrotic and hemorrhagic areas.

Usually, the diagnosis of a cervical cancer mri extrauterine CCA is difficult because of the non-specific clinical presentation that can mimic other conditions. Primary cervical choriocarcinoma is an extremely rare condition that should be considered in the differential diagnosis of a cervical mass with profuse bleeding particularly due to intense vascularity, especially in young women.

Trachelectomy represents a therapeutic measure able to stop the bleeding in patients who wish to maintain future fertility. Keywords primary cervical choriocarcinoma, gestational trophoblastic neoplasia, cervical mass, vaginal bleeding Rezumat Introducere.

Primary choriocarcinoma of the cervix mimicking a cervical pregnancy

Prezentare de caz. În această lucrare am raportat cazul unei paciente, în vârstă de 40 cervical cancer mri ani, secundigestă, secundipară, care prezintă o formaţiune tumorală bine vascularizată la nivelul colui uterin, cauzatoare de sângerari vaginale debutate la doi ani de la naşterea celui de-al doilea copil, prin operaţie cezariană.

Diagnosticul de suspiciune de CCA cervicală a fost cervical cancer mri pe baza aspectului imagistic - ecografia transvaginală arată o masă parenchimatoasă care protruzionează în canalul cervical cu reţea vasculară periferică intensă, cervical cancer mri IRM cu cancerul mucoasei bucale de contrast descrie un proces expansiv voluminos, rotund-ovalar, bine definit, cu pedicul lung necrotic şi zonă centrală extinsă de necroză.

Rezultatele histopatologice corelate cu nivelurile crescute de βHCG au sugerat diagnosticul de coriocarcinom cu zone necrotice şi hemoragice extinse.

Coriocarcinom primar al colului uterin mimând o sarcină cervicală

A fost efectuată trachelectomie urmată de cerclaj uterin abdominal, în scopul de a păstra capacitatea ulterioară a pacientei de a obţine şi păstra o viitoare sarcină până la termen.

De obicei, diagnosticul unui CCA extrauterin primar este dificil, din cauza tabloului clinic nespecific care poate imita alte patologii. 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.

Trachelectomia reprezintă o atitudine terapeutică în măsură să oprească sângerarea la pacientele care doresc să îşi menţină fertilitatea ulterioară. Cuvinte cheie coriocarcinom primar al colului uterin neoplazie trofoblastică gestaţională tumoră col uterin sângerări vaginale Introduction Gestational trophoblastic neoplasia GTN represents a generic term that includes a variety of malignant pathologies, the common link between them being the uniqueness of their physiopathology, as the cervical cancer mri characteristic lesions arise hpv y cancer de garganta from fetal tissues 1.

On the other hand, the term gestational trophoblastic disease GTD describes a set of benign proliferation of the trophoblast of the placenta, including placental site nodule, exaggerated placental site, and hydatidiform mole 2.

Gestational trophoblastic disease GTN has an incidence of 0. Half of the GTN appear after molar pregnancies, a quarter after ectopic pregnancies or abortions and another quarter after normal term pregnancies 4. The period of time between the last pregnancy of any type and the appearance of CCA is described in very wide range, from a few months up to 15 years cervical cancer mri.

Choriocarcinoma is the most aggressive, malignant form of gestational trophoblastic disease and has varying incidence, increasing in patients older than 40 years 6.

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cancer testicular non seminomatous They are associated with high levels of the beta subunit of the human chorionic gonadotropin bHCGand frequently need monochemotherapy, usually using methotrexate or actinomycin D. On the other hand, the more rare cases of PSTT and ETT express low levels of bHCG and are relatively resistant to chemotherapy, multiagent treatment which combines etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine being necessary, but in these cases the first line of treatment is surgery, especially in non-metastatic cases 8.

In this paper we cervical cancer mri the case of a year-old woman, gesta 2, para 2, presenting with a cervical well vascularized mass causing vaginal bleeding two years after the delivery of her second baby at term by cesarean section. Case report The year-old Caucasian patient had an obstetrical history of two term deliveries by caesarean section inrespectively She presented in June at the gynecologist accusing irregular vaginal bleeding with reduced to moderate flow, after her last normal cervical cancer mri in 20 May.

The local exam showed normal external genital organs and reduced metrorhagia with a normal cervical cervical cancer mri at the speculum exam. The vaginal tact revealed though an enlarged cervix, with a diameter of 6 centimeters, regulated surface and reduced consistency with a normal uterine dimension and mobility and normal adnexal areas.

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A transvaginal ultrasound was then performed, which described normal ovaries and at the level of the uterine isthmus in the posterior uterine wall a parenchymatous area with a diameter of 5 centimeters, which protrudes into the inferior third of the uterine cavity and the superior cervical cavity with peripheral vascular network in direct contact with the urinary bladder.

According to the clinical examination findings and the ultrasound aspect, the diagnostic suspicion of uterine leiomyoma is raised. Magnetic resonance imaging with contrast substance is recommended in order to establish the extent and particularities of the cervical cervical cancer mri.

The expansive mass pedicle shows peripheral gadolinophily, with extensive central area of necrosis and necrotic pedicle. It does not invade the cervical wall or the vagina, which show normal appearance.

Uterine junctional zone appears continuous with normal thickness and normal hyposignal. The ovaries and the rest of abdominal pelvic organs appeared normal, with no lymph nodes involvement, cervical cancer mri, abdominopelvic collections or bone lesions with secondary character in the examined segments.

The conclusion of the contrast MRI exam was the presence of a bulky pediculate mass developed within the uterine cavity, locally noninvasive papillary thyroid cancer recurrence treatment zone, cervixwhich obstructs and protrudes in the cervical cavity - MRI appearance suggests a cervical cervical cancer mri, an endometrial polyp or a submucosal pediculate leiomyoma Figures 1, 2, 3.

Figure 1.

MRI aspect of cervical expansive mass - transversal section Figure 2. MRI aspect of cervical expansive mass - axial section Figure 3. This paraclinical finding brings into attention the diagnosis of primary cervical choriocarcinoma, according to its location. The surgical excision of the tumor is decided, given the fact that no secondary lesions have been found.

Distance dissemination, which occurs on hematogeous way most frequently in cases of choriocarcinoma as it is a highly vascularized tumor, has been investigated in our case with chest X-ray and contrast enhanced abdomen and pelvis MRI. Pulmonary X-ray cervical cancer mri no sign of metastasis, while abdomen MRI described normal ovaries, urinary bladder, rectum, sigmoid, liver, spleen, pancreas and kidneys with no abdominal lymph node involvement and no sign of ascites, collections or secondary bone lesions.

Given the fact that no sign of metastasis was found, on 16 June an exploratory laparotomy is performed, with the finding of a slightly enlarged uterus with a much increased cervix, with a diameter of centimeters and macroscopically normal adnexa. The histopathological extemporaneous exam had an uncertain result, showing cervical cancer mri of wide necrotic hemorrhagic area with chronic inflammation and the presence of pleomorphic cells, hyperchrome atypical cervical wall with fibro-conjunctive structure showing tumor infiltrates with high malignancy suspicion and haemorrhagic areas.

Preliminary report. BolboacaClaudia OrdeanuViorica M. NagyZsolt FeketeLiliana ChioreanSorin M Dudea Abstract Aims: The aim of this study was to evaluate the use of pre and post-therapy transrectal and transvaginal ultrasonography TRUS, TVUS with contrast enhancement and strain elastography compared with clinical examination and magnetic reso- nance imaging MRI in the assessment of advanced stage cervical cancer.

cervical cancer mri Thus, the high suspicion of malignancy called cervical cancer mri the certainty paraffin exam. After that, an abdominal uterine cerclage was performed and the bHCG repeated. The paraffin exam described malignant proliferation of trophoblastic cell made up of pleomorphic confounding cyto and syncytiotrophoblast cells and intermediate trophoblast cells, with hyperchromic nuclei that separate vascular spaces and have trabecular disposition infiltrating the cervical wall until near the endocervical lining.

Bizarre intermediate trophoblast cells, some multinucleated, were present, as well as large areas of intratumoral and peritumoral hemorrhage and necrosis and chronic inflammation and bleeding at the level of the endocervical mucosa.

The cervix presented acanthosis, parakeratosis and subepithelial chronic inflammation, the tumor proliferation interesting the smooth muscle, while chorionic villi were absent. The histopathological results correlated with the increased levels of bHCG cervical cancer mri choriocarcinoma with large necrotic and hemorrhagic areas that interested the endocervical wall until near the endocervical mucosa and adjacent smooth muscle fibers Figure 4.

Figure 4. Trophoblast proliferation of malignant cells, including cytosyncytiotrophoblast type with wide areas of intra- and peritumoral hemorrhage and necrosis - HE staining x40 Immunohistochemistry testing was recommended for certainty diagnosis. The positive was established as trophoblastic tumor proliferation in the type of choriocarcinoma.

Local experience in cervical cancer imaging: Comparison in tumour assessment between TRUS and MRI

It was recommended the interpretation of the result in anatomical, clinical and imaging context, correlated with the dynamic bHCG dosing Figure 5. Figure 5. Diffusely positive in the syncytiotrophoblast - immunohistochemistry x40 βHCG Postoperative evolution of the patient was good, being discharged from the hospital three days later.

The last 3 rounds were recommended for stabilization. The follow-up of the patient revealed normal clinical and ultrasound exams, until 3 months cervical cancer mri.

Discussions Choriocarcinoma is a highly aggressive tumor, which depending on the association with pregnancy has two different forms.

Cervical Cancer Staging

It usually appears after a malignant alteration in a molar gestation, only rarely after an abortion or normal or ectopic pregnancy 9.

If associated with gestation, it is the most aggressive, malignant form of GTN and bears the name of gestational choriocarcinoma.

If it appears in the absence or preceding pregnancy, the term used is cervical cancer mri gestational choriocarcinoma, appearing most frequently in the ovary in women or testes in men. CCA cervical cancer mri arises in cervical cancer mri with genital organs such as: the uterus, which is the most common site, the cervix, the fallopian tubes, the ovary, the vagina, the vulva or the vulvar region.

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It can also occur extremely rare outside the reproductive system, the sites of appearance where it has been described including: the brain, the lungs, the pulmonary arteries, the stomach, the small cervical cancer mri or the pancreas.

Even more rare cases of intrauterine pregnancy associated with placental CCA have been reported Trophoblastic tumor cells have great affinity for blood vessels, which is why the tumors frequently metastasize by hematogenous route Saito et al. Although an extremely rare pathology with only 87 cases reported in literature until present Table 1from all types of extrauterine CCA, the cervical one is the most common, and several hypotheses have been developed in order to explain its physiopathology Some authors say it could be a metastasis of a vanishing uterine choriocarcinoma, cervical cancer mri a malignant transformation of a cervical pregnancy, others describe it as the result of the implantation of trophoblasts in the cervix after an abortion with malignant change after a dormant period 14, Tabelul 1.

Primary cervical choriocarcinoma - cases published in the specialty literature The risk of fetal teratogenicity from chemotherapy is present only if conception occurs during or cervical cancer mri following the treatment cycles. Fertility is not impaired following chemotherapy.

Successful cervical cancer mri have occurred in women who have had widespread GTN, including cerebral metastases The prevalence of CCA has decreased in the recent years according to the improvement of the social and economic conditions, remaining higher matar verme oxiurus Africa, Asia and South America compared to the United States and Europe 17, The diagnosis of cervical CCA is a difficult one considering its rare incidence, the differential diagnosis including isthmus or cervical leiomyomas, cervical cancer, endocervical polyp, abortion and cervical pregnancy In our case, the cervical CCA was first suspicioned to be a uterine cervical cancer mri protruding into the cervical cavity.

Cervical cancer mri suggestive ultrasound aspect showing intense vascularization was the diagnosis element that determined us to measure the bHCG serum level, knowing that trophoblastic malignant cells produce up to times more hormone than normal cells That is why its measurement has a great diagnostic value and is a useful tool in the follow-up of the patient, as it is the most important recurrence predictor factor of the disease Although in very rare cases its value is not very elevated, in our patient the extreme level of serum bHCG correlated with the rich vascularization was the decisive factor that inclined the balance towards considering cervical CCA as the positive diagnosis.

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Usually the diagnosis of a primary extrauterine CCA is difficult because of the non-specific clinical presentation that can mimic other conditions Persistent vaginal bleeding of small to moderate intensity present in our patient, correlated with antihelminticos definicion clinical exam, suggested the suspicion diagnosis of a posterior uterine leiomyoma, cervical cancer mri is a frequent confusion cervical cancer mri confronting with extrauterine CCA.

The cervical CCA suspicion diagnosis was established based on imaging aspect - transvaginal ultrasound showing a parenchymatous area that protrudes into the cervical canal with intense peripheral vascular network and contrast-enhanced MRI describing an expansive bulky, round-oval, well defined mass with a long necrotic pedicle and extensive cervical cancer mri area of necrosis. Given the clinical status of the patient, uterus conservative surgical excision was decided with histopathological extemporaneous exam.

Trophoblast cells surrounded by extensive necrosis are typical aspects of the CCA on microscopic evaluation. This type of approach, with conservative management of primary cervical choriocarcinoma, was also reported by Ben-Chetrit and metastatic cancer bowel co-workers and by Roopnarinesingh et al. In literature, most of the cases of cervical CCA were treated by total hysterectomy due to massive bleeding.

Nowadays, selective uterine arterial embolization may represent a useful tool in order to control important bleeding from cervical CCA, and surgical excision tends to be more conservative, as in our case, in women that want to procreate in the future Cervical cancer mri the fact that CCA is a highly dysbiosis how to say tumor, having generally a good prognosis even in advanced stages, the conservation of reproductive function should be considered if possible The therapeutic response to Methotrexate in our case was very good, serum bHCG level becoming zero after three cycles, which is a common aspect in this type of tumor.

IHC is the only diagnostic tool that can separate the origin on CCA whether gestational or non-gestational Conclusions Primary cervical choriocarcinoma is an extremely rare condition that should cervical cancer mri considered in the differential diagnosis of a cervical mass with profuse bleeding particularly due to intense vascularity, especially in young women.

Bibliografie 1. Baergen RN. Gestational trophoblastic disease pahology, www. Diagnosis, classification and treatment of gestational trophoblastic neoplasia. Rev Bras Ginecol Obstet. Current management cervical cancer mri gestational trophoblastic neoplasia.

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Hematol Oncol Clin North Am. Osborne R, Dodge J. Gestational trophoblastic neoplasia. Obstet Gynecol Clin North Am. Mitrovic S, et al. Gestational choriocarcinoma of the cervix. Arch Iran Med,17 11 Lurain JR. Gestational trophoblastic disease II: classification and management of gestational trophoblastic neoplasia.

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Am J Obstet Gynecol, ; 1 Gestational trophoblastic disease: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. Dehner LP. Gestational and nongestational trophoblastic neoplasia: a historic and pathobiologic survey. Am Cervical cancer mri Surg Pathol, ; Fox H. Gestational trophoblastic disease: neoplasia or pregnancy failure? BMJ, ; Pathology of the female reproductive tract. Philadelphia; Cervical cancer mri Livingstone, On ectopic choriocarcinoma.

World Obstet Gynecol. Primary gestational choriocarcinoma of the uterine cervix: Report of a case and review of the literature. Int J Gynecol Cancer. Primary non-gestational choriocarcinoma of the uterine cervix: A case report. Gynecol Oncol, ; Placental site trophoblastic tumor with unusual presentation  in the uterine cervix.

Am J Obstet Gynecol, 85; Int J Gynecol Cancer, ; 17 3 Primary non-gestational choriocarci-noma of the uterine cervix: a case report.