Choriocarcinoma with uterine rupture presenting as acute haemoperitoneum and shock

Choriocarcinoma is a rare neoplasm and a malignant form of gestational trophoblastic disease. Invasive mole may perforate uterus through the myometrium resulting in uterine perforation and intraperitoneal bleeding. But uterine perforation due to choriocarcinoma is rare. We present a case of a young woman who presented 1 year after uterine evacuation of a molar pregnancy with invasive choriocarcinoma complicated by a uterine rupture and haemoperitoneum.

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Gestational trophoblastic disease in Nepalese women managed in B. P. Koirala Memorial Cancer Hospital

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e16570 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e16570-e16570

Author(s):

J. Pariyar

Keyword(s):

Brain Metastasis ◽

Ethnic Group ◽

Gestational Trophoblastic Disease ◽

Uterine Perforation ◽

Molar Pregnancy ◽

Trophoblastic Disease ◽

Cancer Hospital ◽

Invasive Mole ◽

Disseminated Disease

e16570 Background: Gestational trophoblastic disease (GTD) is potentially curable disease. Its incidence varies in different countries with high incidence reported in Japan (2/1000 pregnancies) and Mexico (2.5/1000 pregnancies). No studies have been reported regarding epidemiology, management and outcome of GTD in Nepal. Methods: The study was a descriptive case series. Case records of GTD patients attending B.P. Koirala Memorial Cancer Hospital, Nepal from 2001 to 2007 were analyzed. The main outcomes were measured in terms of duration, antecedent pregnancy, investigations, treatment and follow-up. Results: A total of 45 cases of gestational trophoblastic disease (GTD) were received from 26 districts of Nepal. The age of the patients ranged from 16 to 50 years with a mean age of 29.1 years (SD 9.4 years). Out of 45 cases 19 (43%) were of Tibeto-Burmese ethnic group and 15 (33%) belonged to Indo-Aryan ethnic group. There were 17 cases (37.8%) of hydatidiform mole, 6 were invasive mole (13.35%), 4 of persistent gestational trophoblastic tumour (8.8%) and 22 patients (48.8%) of choriocarcinoma. In 7 cases (15.5%) molar pregnancy had occurred in the first conception, another 7 cases (15.5%) had previous molar pregnancy and in 16 (35.5%) cases GTD had occurred following abortion. The most common presenting symptom was vaginal bleeding and 26 (57.8%) patients had anaemia. Theca Leuteal cyst was present in 11 (24.5%), 17 (37.8%) cases had lung metastasis, 4 (8.9%) had brain metastasis and another 4 (8.9%) had disseminated disease detecteted radiologically. Among the 45 cases 6 (13.3%) were treated with suction evacuation only; 9 (20%) underwent hysterectomy for uterine perforation, excessive hemorrhage and invasive mole. 28 (62.2%) cases underwent adjuvant chemotherapy among which 12 (26.6%) received single agent chemotherapy and 15 (33.3%) received EMA-CO regimen. Brain irradiation was required in a case with brain metastasis. Five (11.1%) cases with disseminated disease and high WHO risk score left the hospital against medical advice. There were 3 (6.7%) mortalities. 37 (82.1%) cases are in remission and follow-up. Conclusions: Early diagnosis of disease and proper management strongly influences the outcome of GTD. Even in disseminated state GTD can be cured. No significant financial relationships to disclose.

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Gestational Trophoblastic Disease: Review of Cases Managed at B P Koirala Memorial Cancer Hospital

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v8i1.8855 ◽

2013 ◽

Vol 8 (1) ◽

pp. 18-21

Author(s):

Jitendra Pariyar ◽

B Shrestha ◽

J Shrestha ◽

BP Rauniyar ◽

...

Keyword(s):

Brain Metastasis ◽

Hydatidiform Mole ◽

Single Agent ◽

Gestational Trophoblastic Disease ◽

Molar Pregnancy ◽

Brain Irradiation ◽

Trophoblastic Disease ◽

Cancer Hospital ◽

Invasive Mole ◽

Multiagent Chemotherapy

Aims: This study was done to analyze the clinical presentation and management outcomes of gestational trophoblastic disease managed at B.P. Koirala Memorial Cancer Hospital, Chitwan, Nepal. Methods: Descriptive study was conducted at B.P. Koirala Memorial Cancer Hospital. Case records of all gestational trophoblastic cases from January 2001 to December 2007 were analyzed regarding clinical details, investigations and treatment outcomes. Results: Forty-five cases of 16 to 50 years (mean 29.1 years) had gestational trophoblastic disease, among which 19 (43%) were of Tibeto- Burmese and 15 (33%) Indo-Aryan ethnic group. Hydatidiform mole, invasive mole and choriocarcinoma were observed in 17 (37.8%), six (13.3%) and 22 (48.8%) cases respectively. In seven cases (15.5%) molar pregnancy had occurred in primigravida, seven cases (15.5%) had previous molar pregnancy and in 16 (35.5%) cases GTD had occurred following abortion. Vaginal bleeding was the commonest presentation and 26 (57.8%) cases had anaemia. Eleven (24.5%) cases had theca luteal cyst, 17 (37.8%) had lung metastasis and 4 (8.9%) had brain metastasis. Chemotherapy was administered in 34 (75.5%) cases, among which 15 (33.3%) received single agent and 18 (40%) received multiagent chemotherapy. Hysterectomy was done in nine (20%) cases. Brain irradiation was done in a case with brain metastasis. Five (11.2%) cases with high WHO risk score left the hospital against medical advice. There were three (6.6%) mortalities. Thirty-seven (72.1%) cases were in remission and follow-up. Conclusions: Early diagnosis of disease and proper management strongly influences the outcome of GTD. Even in disseminated state GTD can be cured. Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 1 / Issue 15 / Jan- June, 2013 / 18-21 DOI: http://dx.doi.org/10.3126/njog.v8i1.8855

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Case Report: Acute abdomen presentation revealing a metastatic invasive mole with uterine rupture

F1000Research ◽

10.12688/f1000research.74051.1 ◽

2021 ◽

Vol 10 ◽

pp. 1115

Author(s):

Fatma Dhieb ◽

Miriam Boumediene ◽

Armi Saoussem ◽

Garci Mariem ◽

Mathlouthi Nabil ◽

...

Keyword(s):

Acute Abdomen ◽

Uterine Rupture ◽

Pulmonary Nodules ◽

Gestational Trophoblastic Disease ◽

Molar Pregnancy ◽

Gestational Trophoblastic Neoplasia ◽

Trophoblastic Tumor ◽

Clinical Presentations ◽

History Of ◽

Invasive Mole

Gestational trophoblastic neoplasia refers to the aggressive subset of gestational trophoblastic disease, including invasive mole, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. These tumors may have atypical clinical presentations that can mislead the diagnosis. The reported case is a 48-year-old woman in perimenopause, without any history of vaginal bleedings nor molar pregnancy, who presented to the Emergency Department with acute abdominal pain. Serum beta human chorionic gonadotropin (β-HCG) was highly elevated at 261 675.23 mIU/ml. A complicated invasive mole was suspected, and an abdominal computed tomography was performed, showing a moderate hemoperitoneum associated to complex cystic and solid uterine mass, with a common left iliac adenomegaly and multiple pulmonary nodules. MRI showed a multiloculated cystic uterine mass with zones of hemorrhage recalling an invasive mole with perforation of the posterior uterus wall, associated to a high abundance hemoperitoneum. The diagnosis of a metastatic invasive mole complicated of uterine rupture and hemoperitoneum was retained. A surgical intervention was decided immediately and a subtotal hysterectomy with bilateral annexectomy was done. Pathologic examination of the specimen was positive for an invasive mole. The patient was proposed for chemotherapy. This case study will increase awareness of unusual clinical presentations of gestational trophoblastic neoplasia We believe that our case will contribute to the literature not only because of the rarity of this entity in perimenopausal period, but also due the atypical clinical presentation as acute abdomen without vaginal bleeding nor history of molar pregnancy evacuation

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Gestational Trophoblastic Disease

10.2310/obg.19167 ◽

2018 ◽

Author(s):

Dario R Roque ◽

Anze Urh ◽

Elizabeth T Kalife

Keyword(s):

High Risk ◽

Chorionic Gonadotropin ◽

Actinomycin D ◽

Gestational Trophoblastic Disease ◽

Molar Pregnancy ◽

Gestational Trophoblastic Neoplasia ◽

Trophoblastic Disease ◽

High Risk Disease ◽

Β Hcg ◽

Invasive Mole

Gestational trophoblastic disease (GTD) represents a group of disorders that derive from placental trophoblastic tissue, including hydatidiform moles, postmolar gestational trophoblastic neoplasia (GTN), and gestational choriocarcinoma. GTN is the most curable gynecologic malignancy and tends to be more common after a complete molar pregnancy than a partial mole. Human chorionic gonadotropin (β-hCG) represents a marker for GTD and should be followed for 6 months after molar pregnancy evacuation to rule out the development of postmolar GTN. GTN is defined by a plateaued, rising, or prolonged elevated β-hCG value after molar evacuation; histologic diagnosis of choriocarcinoma, invasive mole, placental site trophoblastic tumor, or epithelioid trophoblastic tumor; or identification of metastasis after molar pregnancy evacuation. Classification for GTN as low (score ≤ 6) or high risk (score > 7) is based on the World Health Organization prognostic score. This scoring system helps select treatment, which usually entails actinomycin D or methotrexate for low-risk disease and EMA/CO (etoposide, methotrexate, actinomycin D/cyclophosphamide, vincristine) for high-risk disease. These regimens can achieve cure rates approaching 100% and over 90% for low- and high-risk disease, respectively. This review contains 5 figures, 8 tables and 49 references Key words: choriocarcinoma, gestational trophoblastic disease, gestational trophoblastic neoplasia, human chorionic gonadotropin, hydatidiform mole, invasive mole

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Patient profile of gestational trophoblastic disease at Patan Hospital, Nepal

Journal of Patan Academy of Health Sciences ◽

10.3126/jpahs.v2i1.20332 ◽

2015 ◽

Vol 2 (1) ◽

pp. 3-6

Author(s):

Alka Singh ◽

Reena Shrestha

Keyword(s):

Gestational Age ◽

Vaginal Bleeding ◽

Gestational Trophoblastic Disease ◽

Cross Sectional Study ◽

Molar Pregnancy ◽

Cross Sectional ◽

Gonadotropin Level ◽

Patient Profile ◽

Trophoblastic Disease ◽

Invasive Mole

Introductions: This study was designed to determine the demographic pattern, incidence, clinical features and management outcome of gestational trophoblastic disease (GTD) in Patan Hospital.Methods: This was a cross sectional study conducted at Patan Hospital from April 13, 2008 to April 12, 2013. Medical record of cases diagnosed as GTD were retrieved from the record section for review. The age, parity, estimated gestational age at the time of evacuation, presence or absence of vaginal bleeding, uterine size in relation to gestational age, ultrasonogram report and urinary beta human chorionic gonadotropin level, histopathology findings, modalities of treatment and outcomes were analyzed.Results: There was total of 41,543 deliveries during five years study period and 54 GTD on histopathology. Among the 54 GTDs, 40 (74%) were molar pregnancy, 8 (14.4%) invasive mole and 6 (11%) choriocarcinoma. The frequency of GTD was 1 per 769 pregnancies. The age of the women with GTD ranged from 15-50 years. Half of the cases were below 25 years. Most of the women presented between 8-12 weeks of gestation and below third gravida. Amenorrhea with vaginal bleeding was seen in 49 (90%) patients.Conclusions: The most common GTD observed in this study was molar pregnancy. Vaginal bleeding was the common complaints at presentation.Journal of Patan Academy of Health Sciences, Vol. 2, No. 1, 2015. page: 3-6

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A rare case of invasive mole following evacuation of molar pregnancy and its management

10.1055/s-0039-1685366 ◽

2016 ◽

Author(s):

Krati Gandhi ◽

Pushpa Dahiya

Keyword(s):

Hydatidiform Mole ◽

Gestational Trophoblastic Disease ◽

Molar Pregnancy ◽

Mri Findings ◽

Loss To Follow Up ◽

Abnormal Growth ◽

Trophoblastic Disease ◽

Placental Site ◽

Β Hcg ◽

Invasive Mole

Introduction: Gestational trophoblastic disease (GTD) is a spectrum of abnormal growth and proliferation of trophoblasts that continue even beyond the end of pregnancy. It comprises of hydatidiform mole, invasive mole, choriocarcinoma and placental site tumor. Invasive mole (Choreoadenoma destruens) comprises about 5-8% of all GTD. It has invasive and destructive potentialities. Case Report: We report a case of 22 yr old female, G3P0A2, with 3 months amenorrhea with c/o pain abdomen since 4 days with no c/o bleeding p/v, with raised level of β hcg after two spontaneous abortions. On clinical examination vitals were stable. P/A ut 16-18 wks, doughy feel, slight tender. P/V os closed, ut 16-18 wks, bpv+. Ultrasonography shows multicystic lesion in cervix and vagina with loss of fat planes with UB. β hcg level was more than 5,00,000. Suction evacuation was done and products sent for histopathology. MRI Pelvis was also done in which invasive mole was diagnosed. 4 doses of inj. Methotrexte f/b folinic acid was given but β hcg levels did not fall by log 10. On histopath there was no evidence of invasive mole but 2nd line chemotherapy (EMACO) was started on the basis of MRI findings. Patient has received 5 cycles of EMACO REGIME with β hcg level being followed and is on decreasing trend, has reached to 5.90 mIU/ml. Conclusion: Patient of molar pregnancy should be followed regularly for early diagnosis of persistent gestational trophoblastic disease and adequate management as loss to follow up patients may land up into complications.

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THE RISK FACTORS OF MOLAR PREGNANCY

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2017.1.8 ◽

2017 ◽

pp. 53-58

Author(s):

Lam Huong Le

Keyword(s):

High Risk ◽

Gestational Trophoblastic Disease ◽

Living Standard ◽

Control Group ◽

Uterine Perforation ◽

Molar Pregnancy ◽

Health It ◽

Pregnancy Risk ◽

History Of ◽

And Control

Objectives: Molar pregnancy is the gestational trophoblastic disease and impact on the women’s health. It has several complications such as toxicity, infection, bleeding. Molar pregnancy also has high risk of choriocarcinoma which can be dead. Aim: To assess the risks of molar pregnancy. Materials and Methods: The case control study included 76 molar pregnancies and 228 pregnancies in control group at Hue Central Hospital. Results: The average age was 32.7 ± 6.7, the miximum age was 17 years old and the maximum was 46 years old. The history of abortion, miscarriage in molar group and control group acounted for 10.5% and 3.9% respectively, with the risk was higher 2.8 times; 95% CI = 1.1-7.7 (p<0.05). The history of molar pregnancy in molar pregnancy group was 9.2% and the molar pregnancy risk was 11.4 times higher than control group (95% CI = 2.3-56.4). The women having ≥ 4 times births accounted for 7.9% in molar group and 2.2% in control group, with the risk was higher 3.8 times, 95% CI= 1.1-12.9 (p<0.05). The molar risk of women < 20 and >40 years old in molar groups had 2.4 times higher than (95% CI = 1.1 to 5.2)h than control group. Low living standard was 7.9% in molar group and 1.3% in the control group with OR= 6.2; 95% CI= 1.5-25.6. Curettage twice accounted for 87.5%, there were 16 case need to curettage three times. There was no case of uterine perforation and infection after curettage. Conclusion: The high risk molar pregnancy women need a better management. Pregnant women should be antenatal cared regularly to dectect early molar pregnancy. It is nessecery to monitor and avoid the dangerous complications occuring during the pregnancy. Key words: Molar pregnancy, pregnancy women

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A Study of Molar Pregnancy at Low Resource Settings of Tertiary Care Hospital Sindh

10.53350/pjmhs211571547 ◽

2021 ◽

Vol 15 (7) ◽

pp. 1547-1549

Author(s):

Sabahat Fatima ◽

A. G.ul Shaikh ◽

Tahmina Mahar ◽

Hameed-Ur-Rehman Bozdar ◽

Sameena Memon ◽

...

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Economic Status ◽

Gestational Trophoblastic Disease ◽

Common Symptom ◽

Care Hospital ◽

Molar Pregnancy ◽

Socio Economic Status ◽

Trophoblastic Disease

Aim: To determine the epidemiological factors/characteristics and clinical presentation of molar pregnancy Study design: Qualitative observational / retrospective study Place and duration: Department of Obstetrics and Gynaecology Unit-II, Ghulam Muhammad Mahar Medical College Sukkur from 1st January 2016 to 31st December 2020. Methodology: Forty five diagnosed cases with molar pregnancy and aged between 18-40 years were enrolled. Patient’s details demographics age, body mass index, parity and socio economic status were recorded. The total birth records and gynecological admission for the study period were also collected from the gynaecology and labour room record books case and operational registration data were obtained, descriptive statistics examined . Results: Mean age of the patients was 31.15±7.41 years with mean body mass index 26.16±7.22 kg/m2. Mean gestational age of the patients were 25.62±9.19 weeks. Twenty seven (60%) patients were multiparous and 18 (40%) were primiparous. 30 (66.7%) were illiterate and 15(33.3%) cases were literate. There were 14(31.11%) patients belonged lower class, 18 (40%) patients belonged middle and 13(28.9%) had high socioeconomic status. Twenty nine (64.4%) were from rural area and 16 (35.6%) were from urban area. Five (11.1%) patients had previous history of gestational trophoblastic disease. Abnormal vaginal bleeding was the most common symptom found in 34(75.5%) cases followed by lower abdominal pain found in 30 (66.7%) patients, hyperemesis found in 14(31.1%) and dyspnea in 9 (20%). Thirty six (80%) patients received suction evacuation and 9 (20%) cases referred. Forty one (91.1%) patients were recovered but the rest 4 (8.9%) were lost during follow up. Conclusion: Low/middle socio-economic status, illiteracy and cases from rural areas had multiparous parity was highly effected by molar pregnancy disease and it can be controlled by early diagnose to take regular follow-up by using suction evacuation. Key words: Gestational trophoblastic disease (GTD), Molar pregnancy, Primiparous, Multiparous

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Ultrasound diagnosis of molar pregnancy

Ultrasound ◽

10.1177/1742271x17748514 ◽

2018 ◽

Vol 26 (3) ◽

pp. 153-159 ◽

Cited By ~ 9

Author(s):

Jackie A. Ross ◽

Alina Unipan ◽

Jackie Clarke ◽

Catherine Magee ◽

Jemma Johns

Keyword(s):

Likelihood Ratio ◽

Gestational Trophoblastic Disease ◽

Ultrasound Diagnosis ◽

Histopathological Diagnosis ◽

Molar Pregnancy ◽

Diagnostic Challenge ◽

Trophoblastic Disease ◽

Post Test ◽

Post Test Probability ◽

Test Probability

Introduction The primary aims of this study were to establish what proportion of ultrasonically suspected molar pregnancies were proven on histological examination and what proportion of histologically diagnosed molar pregnancies were identified by ultrasound pre-operatively. The secondary aim was to review the features of these scans to help identify criteria that may improve ultrasound diagnosis. Methods This was a retrospective observational study conducted in the Early Pregnancy Unit at King’s College Hospital London over an 11-year period. Cases of ultrasonically suspected molar pregnancy or other gestational trophoblastic disease were identified and compared with the final histopathological diagnosis. In addition, cases which were diagnosed on histopathology that were not suspected on ultrasound were also examined. In discrepant cases, the images were reviewed unblinded by two senior sonographers. Statistical analysis for likelihood ratio and post-test probabilities was performed. Results One hundred eighty-two women had gestational trophoblastic disease suspected on ultrasound examination (1:360, 0.3%); 106/182 (58.2%, 95% CI 51.0 to 65.2%) had histologically confirmed gestational trophoblastic disease. The likelihood ratio for gestational trophoblastic disease after a positive ultrasound was 607.27, with a post-test probability of 0.628.The sensitivity of ultrasound for gestational trophoblastic disease was 70.7% (95% CI 62.9% to 77.4%) with an estimated specificity of 99.88% (95% CI 99.85% to 99.91%); 102/143 (71.3%, 95% CI 63.4 to 78.1%) molar pregnancies were suspected on pre-op ultrasound; 60/68 (88.2%, 95% CI 78.2 to 94.2%) of complete moles were suspected on pre-op ultrasound, compared with 42/75 (56.0%, 95% CI 44.7 to 66.7%) of partial moles. On retrospective review of the pre-op ultrasound images, there were cases that could have been suspected prior to surgery. Conclusion Detecting molar pregnancy by ultrasound remains a diagnostic challenge, particularly for partial moles. These data suggest that there has been an increase in both the predictive value and the sensitivity of ultrasound over time, with a high LR and post-test probability; however, the diagnostic criteria remain ill-defined and could be improved.

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AN UNUSUAL CASE OF POSTPARTUM CHORIOCARCINOMA WITH VAGINAL METASTASIS AND UTERINE PERFORATION

10.36106/ijsr/9600591 ◽

2021 ◽

pp. 15-16

Author(s):

Ashritha Ravindran ◽

Richi Chauhan ◽

Rajeev Sood ◽

Kalpna Negi

Keyword(s):

Unusual Case ◽

Gestational Trophoblastic Disease ◽

Uterine Perforation ◽

Term Pregnancy ◽

Patient Reports ◽

Trophoblastic Disease ◽

Heterogenous Group ◽

Villous Trophoblast ◽

Vaginal Metastasis ◽

Irregular Bleeding

Gestational trophoblastic disease is a heterogenous group of interrelated lesions that arise from abnormal proliferation of placental 1 trophoblasts . Choriocarcinoma differs from any type of villous trophoblast and is the most aggressive GTN and is highly chemosensitive. When a patient reports with irregular bleeding during her postpartum or postabortion, pregnancy related causes should be ruled out. We describe a patient who presented to us after a term pregnancy and was diagnosed to have stage III choriocarcinoma.

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