Spontaneous Uterine Perforation in a Choriocarcinoma Presenting with Pyoperitoneum

Pushpalatha, Kameshwarachari; Singh, Bharti; Devalla, Anusha; Sasidharan, Sashmi; Panwar, Hemlata

doi:10.5005/jp-journals-10006-1946

Cited by 3 publications

(2 citation statements)

References 4 publications

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“…Spontaneous uterine perforation can be seen (as seen in our patient) as an initial choriocarcinoma presentation and also when resolution occurs while the patient is on follow-up for continuation of chemotherapy [10].…”

Section: Discussionsupporting

confidence: 50%

A Case Report of a Rare Cause of Diagnostic Dilemma in the Management of Gestational Choriocarcinoma

Muhammad,

Aminu,

Dattijo

et al. 2024

Sch Int J Obstet Gynec

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Choriocarcinoma belongs to one extreme of molar pregnancy, the other end is hydatidiform mole. It is a fast-growing tumor that occurs in a woman’s uterus but can easily metastasize to the lungs, liver, and brain. The abnormal tumor cells start in the tissue that would normally become the placenta. Choriocarcinoma developed after a normal pregnancy in 1 in 50,000, miscarriages in 1 in 15,000, and complete mole 1 in 40. The tumor may mimic uterine fibroid, especially when it presents as a uterine mass (which is not the common presentation) posing an initial diagnostic dilemma, as seen in our patient. The patient was an 18years P0+1 whose last normal menstrual period was a year before presentation. She presented with a history of loss of 14-week conception, then followed by 11months history of abnormal scanty vaginal bleeding lasting 21-27 days monthly, the patient was found to be mildly pale but had stable vital signs, she had a uterine mass of about 22weeks size, abdominal ultrasound scan revealed uterine fibroid. In the process of investigation serum pregnancy test was done and was found to be positive, with markedly elevated serum beta hcg. We made an assessment of choriocarcinoma and we commenced her on chemotherapy, she received 4 courses but with no decline in beta HCG. She had a total abdominal hysterectomy and histology confirmed choriocarcinoma, serum beta HCG was then immediately noticed to decline, she had further chemotherapy, and the patient did well subsequently. Huge choriocarcinoma may be mistaken for uterine fibroid, hence a high index of suspicion for choriocarcinoma is important if a patient presents with a recent history of miscarriage, uterine mass, vaginal bleeding, and a positive pregnancy test.

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Section: Discussionsupporting

confidence: 50%

A Case Report of a Rare Cause of Diagnostic Dilemma in the Management of Gestational Choriocarcinoma

Muhammad,

Aminu,

Dattijo

et al. 2024

Sch Int J Obstet Gynec

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“…The surgery is required in cases of intraperitoneal hemorrhage due to uterine perforation or uncontrolled vaginal bleeding, or to treat chemo-resistant tumors like placental site trophoblastic tumors and epithelioid trophoblastic tumors. 17,18…”

Section: Discussionmentioning

confidence: 99%

Successful management of vascular invasive mole by uterine artery embolization and hysterectomy - A case report

Devalla¹,

Kalra²,

Kumar³

et al. 2023

IJOGR

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Gestational Trophoblastic Neoplasia (GTN) is a rare disease originating from pregnancy events that have varied incidences and clinical manifestations based on regional variation. We are reporting a case of a 36-year-old woman with Invasive mole from Central India who presented with abnormal uterine bleeding with severe anemia. She had three full-term vaginal deliveries and 2 spontaneous abortions, the last conception being an abortion around 7 years back. MRI pelvis demonstrated a hypervascular uterine mass suggestive of an Invasive Mole, supported by increased serum β-hCG levels of 31.8 IU/ml. There was no evidence of any metastases on adjunct radiological investigations. After a thorough counselling, the enlarged vascular uterine mass was managed by uterine artery embolization (UAE) followed by simple hysterectomy. Histopathology report confirmed the diagnosis of invasive mole with villi lying in the fibrinous blood clot sheath of the syncytial, and cytotrophoblasts were seen invading the myometrium foci. The patient being in the low risk FIGO scoring, calculated was 5, chemotherapy was not deemed necessary for the patient. Serial post operative β-hCG along with ultrasound pelvis and chest radiogram surveillance showed favourable results with no evidence of metastases even on 6 months follow up. Being a very rare condition, a high index of suspicion with prompt timely management ensures optimum care.

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Multiple drugs

2022

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Spontaneous Uterine Perforation in a Choriocarcinoma Presenting with Pyoperitoneum

Cited by 3 publications

References 4 publications

A Case Report of a Rare Cause of Diagnostic Dilemma in the Management of Gestational Choriocarcinoma

A Case Report of a Rare Cause of Diagnostic Dilemma in the Management of Gestational Choriocarcinoma

Successful management of vascular invasive mole by uterine artery embolization and hysterectomy - A case report

Multiple drugs

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