The aim of this paper was to correlate the circumstances that could lead to an abnormal invasion of placenta with the updated requirements to perform screening by ultrasound for all pregnant women prone to develop this pathology. To screen in the middle trimester of gestation for placenta accreta spectrum (PAS) disorders sets up an in-time referral opportunity for pregnant women prenatally detected with this pathology to a medical center with elevated level of expertise in the management of PAS disorders, able to act permanently by a multidisciplinary team (MDT) and to have access at medical resources including blood bank available. The literature review reveals especially useful data for clinical practice as regards novel explanations related to the etiology and physiopathology of PAS disorders, the composition of the MDT and the relevance of an indispensable pathologist physician at the time of Cesarean hysterectomy involved in the selection of best samples with the purpose of avoiding the possibility of losing undiagnosed cases with litigation implications. Conclusions show that the prenatal diagnosis of PAS disorders is possible so decreasing the risk of mortality and morbidity of pregnant women. Screening in the second trimester of pregnancy for PAS disorders becomes mandatory as the number of births by Cesarean section is expected to rise past three-fold until 2030. The professional expertise of the pathologist physician could be enriched by immunohistochemical staining in all suspected cases of placental invasion in myometrium wall.
RezumatAvortul tubar se caracterizează prin eliminarea unui produs de concepţie implantat ectopic la nivelul trompei uterine, prin ostiumul abdominal, în cavitatea peritoneală. Poate fi complet sau incomplet putând provoca hemoragie severă. Recunoaşterea avortului tubar complet poate reprezenta o provocare, însa este esenţială, deoarece permite abordarea unei atitudini conservatoare, ce asigură păstratrea funcţionalităţii tubare şi a fertilităţii, în absenţa tratamentului citostatic. Este prezentat cazul unei paciente în vârstă de 30 de ani ce se internează pentru durere în etajul abdominal inferior. Valoarea serică a β-hCG-ului a fost de 659.2 mU/mL, iar examenul ecografic transvaginal a evidenţiat prezenţa unei colecţii lichidiene în spaţiul Douglas. S-a intervenit laparoscopic pentru suspiciune de sarcină ectopică cu hemoperitoneu. Coroborarea nivelurilor serice ale β-hCG-ului în dinamică cu aspectele laparoscopice au condus la stabilirea diagnosticului de avort tubar complet. Examenul histopatologic al ţesutului recoltat laparoscopic a confirmat prezenţa de trofoblast intermediar. Examinarea ecografică facilitează diagnosticarea hemoperitoneului, dar nu oferă informaţii specifice pentru diagnosticul de avort tubar. Aspectul laparoscopic poate fi sugestiv pentru avortul tubar complet, însă diagnosticul se stabileşte coroborat cu dinamica β-hCG-ului. În aceste cazuri, atitudinea conservatoare poate fi suficientă, asigurând păstrarea funcţiei tubare şi a fertilităţii, fără a necesita terapie citostatică suplimentară.Cuvinte cheie: avort tubar, sarcină ectopică, β-hCG, hemoperitoneu, conservarea fertilităţii AbstractTubal abortion is characterized by the extrusion of an ectopic product of conception implanted in the fallopian tube through the abdominal ostium into the peritoneal cavity. It can be either complete or incomplete and may lead to
Ovarian germ cell tumors of the ovary represent a histologically heterogenous group of tumors with a high incidence at reproductive age. Patients with this pathology are very often young women with amenorrhea. The aim of this article is to present a pictorial essay of this rare pathology and to promote a national tumor registry and protocol. The treatment is individualized according to age, and fertility-sparing surgery is the actual standard of surgical treatment for young patients in early stage of the disease.
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