Primary tubal choriocarcinoma

Gálvez, Castillo; Fernández, Virgínia; Reyes, Jared; Jaén, M. M. M.; Teruel, Rogelio Garrido

doi:10.1111/j.1048-891x.2004.014550.x

Cited by 20 publications

(7 citation statements)

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“…Consequently, the risk for persistent GTD is probably no greater than after uterine molar gestations, approximately 00.5% for PHM and 15% for CHM (27). The diagnosis of apparently primary tubal choriocarcinoma with no confirmed previous ectopic hydatidiform mole is now well-reported but poses no specific histopathologic diagnostic problems; the features are identical to choriocarcinoma at other sites (28)(29)(30)(31)(32). In many such cases, metastatic disease may be present at diagnosis, but it remains unclear in what proportion of cases the choriocarcinoma may have developed from a previous unrecognized tubal molar conceptus or whether some cases may represent seeding from a uterine primary conception.…”

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confidence: 99%

Overdiagnosis of Complete and Partial Hydatidiform Mole in Tubal Ectopic Pregnancies

Sebire

Lindsay

Fisher

et al. 2005

International Journal of Gynecological Pathology

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Partial or complete hydatidiform mole (HM) affects approximately 1 in 500 to 1,000 pregnancies. Previous small series suggest that histopathologic diagnosis of HM may be difficult in tubal ectopic pregnancies. The histopathology database of a regional Trophoblastic Disease Unit was searched to identify cases with a referral diagnosis of tubal HM, and the histopathologic findings were reviewed. During the study period (1986-2004 inclusive), there were 132 cases. After central review by specialist histopathologists, the final diagnosis was ectopic partial mole in two, ectopic complete mole in five, and ectopic hydatidiform mole (not otherwise specified) in one. The final diagnosis of definite hydatidiform mole was made in eight (6%) cases, significantly less than in referred uterine curettage specimens, in which approximately 90% have a confirmatory diagnosis of HM (Z = 12.9; p < 0.0001). No cases in this series developed persistent gestational trophoblastic disease, the human chorionic gonadotropin concentration spontaneously returning to normal. Ectopic pregnancies, where managed surgically, should be submitted for histopathologic examination; however, the pathologist should be aware that the degree of extravillus trophoblastic proliferation may appear more florid compared with evacuated uterine products of conception. Molar pregnancy should only be diagnosed when strict criteria regarding morphologic abnormalities previously described in uterine evacuation material are applied.

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confidence: 99%

Overdiagnosis of Complete and Partial Hydatidiform Mole in Tubal Ectopic Pregnancies

Sebire

Lindsay

Fisher

et al. 2005

International Journal of Gynecological Pathology

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“…These patients need close follow-up with regarding to serum levels of b-hCG per trophoblastic regional centre protocol and need effective contraception for 1 year. 11 The presentation of ectopic GTD is similar to normal ectopic pregnancy. Abdominal pain and vaginal bleeding are the most common symptoms.…”

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confidence: 87%

Ectopic Gestational Trophoblastic Disease

ElhossamyHashem¹,

Morsi²

2014

Journal of Gynecologic Surgery

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Background: Gestational choriocarcinoma associated with ectopic pregnancy is an extremely rare event with a reported incidence of 1.5/1,000,000 births. This article reports a rare case of gestational choriocarcinoma associated with an ectopic pregnancy. Case: An 18-year-old woman, gravida 3, para 0 + 2, was admitted to the emergency gynecology assessment unit complaining of abdominal pain. Her presentation was the same as for a conventional ectopic pregnancy. Her transvaginal ultrasound images were compatible with a tubal ectopic pregnancy. A left salpingectomy was performed. The histopathologic evaluation reported the lesion as a primary tubal choriocarcinoma. The patient was referred to a tertiary-care center for treatment and follow-up. Results: This patient had a good recovery and follow-up has been ongoing for the last 9 months, as of this writing. Her b-human chorionic gonadotropin level dropped to normal at 7 weeks postsurgery, and she has no indications for chemotherapy. This patient's general physical and neurologic assessment results have remained normal. Her prognosis is excellent. Conclusions: Ectopic gestational trophoblastic disease is rare and is still overdiagnosed. The presentation is the same as that of a normal ectopic pregnancy. Expert review of the patient's histopathology should be performed. Conventional chemotherapy for gestational choriocarcinoma is effective. The prognosis for these cases is excellent. ( J GYNECOL SURG 30:1)

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“…The risk of persistent trophoblastic disease is no greater than after uterine molar gestations, approximately 0.5% for partial mole and 15% for complete [14]. The diagnosis of apparently primary tubal choriocarcinoma with no confirmed previous ectopic hydatidiform mole is now well reported but poses no specific histopathologic diagnostic problem because the features are identical to choriocarcinoma at other sites [15,16]. In many such cases, metastatic disease may be present at diagnosis, but it remains unclear in what proportion of cases the choriocarcinoma may have developed from a previous unrecognised tubal mole or whether some cases may represent seeding from a uterine primary conception.…”

Section: Resultsmentioning

confidence: 99%

Partial mole in ectopic pregnancy

Ghazi

Donovan

2006

Gynecol Surg

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Objective: To evaluate the incidence of molar pregnancy in the fallopian tube pregnancy. Setting: Outpatient clinic. Patient: 32-year-old Asian woman. Intervention: Left salpingectomy. Outcome: Molar ectopic pregnancy. Result: Ectopic partial mole pregnancy. Conclusion: Molar pregnancy can occur in ectopic pregnancy. Clinically, molar pregnancy mimics normal tubal ectopic pregnancy.Keywords Tubal ectopic pregnancy . Molar pregnancy Case reportA 32-year-old Asian woman with four children was referred to the early pregnancy unit in January 2005. She was 11 weeks pregnant and was having vaginal bleeding that had started 7 days before admission and had included the passing of clots, which had settled. She had no associated pelvic or shoulder pain. Her past medical and surgical history was not significant. She was not a smoker and had no allergies.On examination her pulse was 88, blood pressure 120/68, and temperature 36.9ºC. High vaginal and chlamydia swabs were taken. The chest examination was clear, and the heart examination showed S1, S2. Abdominal examination showed tenderness over the left iliac fossa with no guarding or rigidity. The vulva was smeared with blood, and there was brown blood in the vagina. Internal examination revealed a bulky anteverted uterus with no adnexal masses. No tenderness over the pelvic area or cervical excitation could be identified.The pregnancy test in the hospital was positive. An ultrasound scan was arranged, which showed a bulky anteverted uterus with thin (4 mm) endometrium. No evidence of intrauterine pregnancy was seen, and both ovaries appeared normal. In the left adnexa there was a 44×25×38-mm complex mass. It appeared to be in the fallopian tube, and there was also a hydrosalpinx at the medial section. No free fluid was identified. The findings were consistent with ectopic pregnancy. The patient's beta human chorionic gonadotropin (BHCG) level on the day of admission was 12,894 U/l, and her haemoglobin level was 13 g/dl. She was RH-positive.A diagnosis of left tubal pregnancy was made, and the patient was prepared for surgery on the same day of admission. She was grouped and saved, and a diagnostic laparoscopy was done. Both ovaries and the right tube were normal, but a left tubal pregnancy could be seen actively bleeding in the tube. Laparotomy was performed, and the laparoscopic findings were confirmed. The left tube was found to be ruptured. A left salpingectomy was done and the specimen sent to histopathology. The patient recovered uneventfully and was discharged home on the 3rd day after admission. Her haemoglobin level on discharge was 10.3 g/dl. The swab results came back positive only for Candida, and the patient's general practitioner was informed.The histopathology report suggested partial hydatidiform mole of ectopic pregnancy (Fig. 1). Therefore, the patient was notified to be seen in the gynaecology clinic 6 weeks from the procedure for follow-up of the partial molar pregnancy. She was advised to refrain from getting pregnant until her HCG levels had been normal...

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Primary tubal choriocarcinoma

Cited by 20 publications

References 5 publications

Overdiagnosis of Complete and Partial Hydatidiform Mole in Tubal Ectopic Pregnancies

Overdiagnosis of Complete and Partial Hydatidiform Mole in Tubal Ectopic Pregnancies

Ectopic Gestational Trophoblastic Disease

Partial mole in ectopic pregnancy

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