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.
Exaggerated placenta site in placenta previa: an imaging differential diagnosis of placenta accreta, placental site trophoblastic tumor and molar pregnancy