Etoposide is commonly used in the treatment of a variety of neoplasms. Hypersensitivity reactions to etoposide are infrequently reported and include hypotension, hypertension, flushing, diaphoresis, chest discomfort, dyspnea, bronchospasm and loss of consciousness. We report the case of a 39-year-old woman who experienced acute bronchospasm, tachycardia, hypoxia and hypotension. The symptoms resolved within an hour after administration of intravenous fluids, methylprednisolone, diphenhydramine and oxygen. Subsequently, the patient was given etoposide phosphate without incident.

It is crucial for each obstetrician to cautiously distinguish and reach an appropriate decision about the exact indications for cesarean delivery having in mind growing incidence of cesarean sections, which is the main risk factor for puerperal morbidity and mortality.

Choriocarcinoma is the most malignant tumor of gestational trophoblastic disease arising from any gestation. It has a tendency toward relapse as well as metastasis. Here, a case of relapsed high-risk choriocarcinoma (FIGO stage IV, WHO score 12) in a 37-year-old female presenting with vaginal bleedings is described. Relapse developed at the site of the surgical scar from hysterectomy that had been performed 2 years earlier. Although the patient was treated with aggressive chemotherapy, she was in a bad general condition and died from infection and liver insufficiency.

Gestational trophoblastic disease is characterized by abnormal proliferation of pregnancy-associated trophoblastic tissue with malignant potential. Gestational trophoblastic disease covers a spectrum of conditions including hydatidiform mole, invasive mole, choriocarcinoma and placental site trophoblastic tumour. It is very important to understand the pathophysiology and natural history of the disease in order to achieve faster recognition and effective treatment. The presence and course of the disease can be monitored with quantitative levels of human chorionic gonadotrophin in all cases. Clinical signs and symptoms are usually insufficient to diagnose and predict the extent of disease. Nowadays, gestational trophoblastic diseases are the best treated gynaecological malignancy thanks to modern technology. This review covers various aspects of gestational trophoblastic disease: its development, epidemiology, aetiology and pathogenesis, as well as its classification, clinical manifestations and diagnostic methods.

the treatment of gestational trophoblastic disease (GTD) were reviewed. The diagnosis of metastasis was based on clinical and radiologic evidence (chest X-ray and computed tomography) and on whether the women had elevated levels of serum human chorionic gonadotropin. Particular attention was paid to previous abortions, the interval between previous abortions and the diagnosis of metastasis, the mortality rate, and the need for hysterectomy. Ethics approval was not required for the present study.Of the 82 women, 9 (10.9%) had metastasis: 6 (7.3%) had pulmonary metastasis and 3 (3.6%) had vaginal metastasis. The present study focused on the 6 patients with pulmonary metastasis, 5 of whom were multiparous and had experienced a molar pregnancy within 1 year of the abortion of a preceding pregnancy. The ages of the women ranged from 25 to 51 years (mean, 36 years). A 39-year-old woman had primary GTD with pulmonary metastasis. The diagnosis of pulmonary metastasis was made using chest X-ray and, when the radiologic findings were deemed inconclusive, confirmed using computed tomography.

The most frequent obstetrical cause of coagulation disorders as disseminated intravascular coagulation is placental abruption, which can be found in women without any apparent clinical disturbances or in the state of established preeclampsia. Hypertension occurs in 5-8% of all pregnancies and may be complicated by preeclampsia. Preeclampsia is a complex clinical syndrome with insufficiently clear pathophysiology based on the damage of the vascular endothelium. As a result of this, generalized endothelial disruption in preeclampsia, a multiorgan dysfunction, can develop, most frequently reflected in the clinical presentation with haematological and renal disturbances and with a disordered function of the liver and central nervous system. We are presenting a case of a gravid woman with poorly regulated hypertension that resulted from development of preeclampsia, later complicated by placental abruption and disseminated intravascular coagulation (DIC) with multi-organ dysfunction. The importance of rapid recognition of coagulation disorder and the attempt at surgical treatment aiming at removal of the triggering mechanisms of DIC was shown, suggesting all the symptomatic therapeutic measures would be ineffective. Although our patient was surgically treated in the phase of generalised disorder characterised by development of coma, acute respiratory distress syndrome and renal insufficiency when mortality was 70%, the recovery of functions of all involved organs was achieved, except for the renal function that required chronic haemodialysis treatment.

Gestational trophoblastic neoplasia refers to a subset of gestational trophoblastic conditions characterized with persistently elevated serum β-human chorionic gonadotropin, absence of a normal pregnancy, and a history of normal or abnormal pregnancies. We described a case of suspected ectopic molar pregnancy in a primiparous woman who had elevated β-human chorionic gonadotropin and required chemotherapy to achieve remission. Final histopathological finding was ectopic pregnancy; no gestational trophoblastic neoplasia was found. This case stresses the importance of histopathological analysis in diagnosis of gestational trophoblastic neoplasia when ectopic pregnancy is present, considering that histopathological analysis is less sensitive for gestational trophoblastic neoplasia than for ectopic pregnancy

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