Background and Objectives: Cervical ectopic pregnancy is one of the rarest forms of ectopic pregnancy. We present a single center case series of 10 cases of cervical ectopic pregnancy, where 3 patients underwent small-caliber hysteroscopy as a single treatment method.Methods: This was a retrospective study of women treated at our medical center with the diagnosis of cervical ectopic pregnancy from January 1, 2018 to December 31, 2020. Patient characteristics, medical history, obstetric history, diagnostic methods were collected. Small-caliber hysteroscopy treatment was performed in 3 patients and 7 patients underwent dilation and curettage (D&C).Results: We identified 10 patients diagnosed with cervical ectopic pregnancy who were treated at our center. Ultrasonography was used to diagnose all cervical ectopic pregnancies Three patients underwent small-caliber hysteroscopy as a single treatment option, while D&C was performed in 7 patients. Patients who underwent small-caliber hysteroscopy had a median gestational age at diagnosis of 7 weeks and initial b HCG < 10,000 mIU/ mL. These patients had shorter hospital stay and a lower estimated blood loss than patients who underwent D&C. Conclusions:In our experience, small-caliber hysteroscopy is a safe and effective single treatment option for cervical ectopic pregnancy, but requires a skilled and experienced gynecologist.
Introducton. Frequency of malignant gestational trophoblastic neoplasms (GTN) is estimated at 1.03 cases in 1,000 deliveries with 5 fold greater risk in patients younger than 20 and older than 40 years. Serum value of human chorionic gonadotropin is the most relevant parameter in diagnosis of GTN. In placental site trophoblastic tumor (PSTT), serum levels of chorionic gonadotropin do not have the same significance as they do in other malignant GTN. Definite diagnosis of PSTT is almost always confirmed by immunohistochemistry. Case report. In the course of just a few months (August 2016 to January 2017) in the Clinic for Obstetrics and Gynecology ?Narodni front? in Belgrade, two GTN patients were admitted and treated, with almost equal ultrasonography (pictures), operative findings and postoperative outcome. Due to histopathological and immunohistochemical examinations two different types of malignant GTN were confirmed. The first patient (admitted in August 2016), 26 years old, was admitted for uterine bleeding 11 months after vaginal delivery and histopathological examination confirmed PSTT. The second patient (admitted in January 2017), 27 years old, was admitted 4 months after vaginal delivery because of uterine bleeding. Histopathological examination confirmed choriocarcinoma. Conclusion. Considering the fact that malignant GTN can appear in different types, with different ultrasonography pictures, this report is significant because two distinctly different malignant GTN entities could appear with equal clinical manifestations and equal ultrasound pictures even when they may have very different course of the disease treatment and outcome. Such cases need correct diagnosis which may be reached only after immunohistochemical analysis. The ultrasound patterns, both in gray scale, color flow, and Doppler values, were almost equal in both cases and guided the diagnostic procedures to the final treatment, even regardless of their very different histopathology.
Introduction. Interstitial pregnancy (IP) is the rarest type of tubal pregnancy which has a high rupture rate and often remains asymptomatic in the first 10-12 gestational weeks. Therefore, the timing of the diagnosis is crucial for successful management. Case reports. Two patients, aged 24 and 22, were diagnosed with IP using transvaginal ultrasound. Both patients were asymptomatic, with initial serum bhCG of 6 664 and 4641 mIU/mL, respectively. Since they refused treatment with methotrexate and wanted to preserve their fertility, we have performed operative hysteroscopy with resection and evacuation of the gestational tissue. The procedures were uneventful. bhCG levels dropped significantly, and the patients were discharged after three and four hospital days, respectively. Conclusion. We have successfully treated two asymptomatic patients with IP of gestational age < 10 weeks by ultrasonography and levels of serum bhCG < 7000 mIU/mL. With the occurrence of IP but also numerous advantages of hysteroscopy, we aim for larger, multicenter studies to further investigate the place of this approach as a single treatment method for IP. Consequences and trends observed during the COVID 19 pandemics correlate with the importance of timely diagnosis of ectopic pregnancies, benefits of a minimally invasive approach in their treatment, and epidemiologically justified shorter hospital stay.
Introduction. Measurement of the serum levels of human chorionic gonadotropin?s beta isoform (bhCG) remains a crucial marker for diagnosing the GTN. Choriocarcinoma is commonly diagnosed due to extremely high levels of bhCG, but the presence of distant metastasis is not uncommon. Placental site trophoblastic tumor and epithelioid trophoblastic tumor remain some sort of an enigma because the levels of bhCG are usually low. Case report. A 44-year old patient, P2G3,was admitted to the Clinic under the suspicion of molar pregnancy, vaginal bleeding with variable intensity, and levels of bhCG of 1 837 787 mIU/mL. After two explorative curettages, bhCG saw a decline and a partial hydatidiform mole was diagnosed histopathologically. The patient was admitted to the Clinic on two occasions due to the increasing values of bhCG. Since bhCG failed to drop after two explorative curettages, hysteroscopic biopsy, one chemotherapy cycle, along with the suspicious ultrasonographic feature of metastatic GTN and the fact that the patient has refused further chemotherapy, a total laparoscopic hysterectomy was performed. Histopathological exam made the diagnosis of choriocarcinoma. A 50-year old patient, P2G4, was admitted to the Clinic under the ultrasonographic suspicion of molar pregnancy. She was complaining of pelvic discomfort and frequent urination. Initial levels of bhCG were 128 351 mIU/mL. Instrumental revision of the uterine cavity was performed and partial hydatidiform mole was diagnosed histopathologically. Because of the increasing levels of bhCG, ultrasonographical suspicion of the development of GTN in the uterine corpus, in accordance with patient?s age and the fact that she has regular menstrual cycles, total laparoscopic hysterectomy was performed, and a histopathological exam made the diagnosis of the placental site trophoblastic tumor. Conclusion. Laparoscopic hysterectomy could be a treatment of choice for the chemotherapy resistant GTNs but also for the choricarcinoma in patitent?s who have finished their reproductive activity and refuse to be treated with chemotherapeutics.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.