Prise en charge d’une tumeur trophoblastique gestationnelle

Choriocarcinoma Presenting as Recurrent Intracranial Hemorrhage in an Adolescent Patient

BACKGROUND

Due to its highly metastatic and invasive nature, choriocarcinoma may affect other organ systems and mimic conditions not typical of gynecologic cancers. Recurrent intracranial hemorrhage secondary to rupture of multiple oncotic aneurysms is one of its rare initial presentations.

CASE

We report a 2-month postpartum, 16-year old girl who initially presented with sudden-onset left-sided weakness. Her plain cranial computed tomography scan showed a 16-mL hematoma in the right parietal area, and her 4-vessel angiogram (4VA) disclosed 4 saccular aneurysms in bilateral distal middle cerebral arteries (MCA). The β-human chorionic gonadotrophin (β-hCG) done 2 weeks later was 356,684.5 mIU, and her transvaginal ultrasound showed an ill-defined heterogenous myometrial mass measuring 1.6 × 1.3 × 1.2 cm. Due to the multiplicity of aneurysms and the patient's young age, surgical excision and brain irradiation were deferred. Nonetheless, she received chemotherapy with a regimen of etoposide, methotrexate, actinomycin-D, cyclophosphamide, and vincristine/oncovin.

SUMMARY AND CONCLUSION

Early consideration of oncotic aneurysm secondary to choriocarcinoma in a postpartum presenting with multiple intracranial hemorrhages may lead to earlier administration of proper chemotherapy and, in turn, to a better prognosis. Age and the number of aneurysms should be considered in choosing the appropriate therapy.

Invasive mole in a perimenopausal woman: a case report and systematic review

OBJECTIVE

Gestational trophoblastic disease (GTD) is a term used for a group of pregnancy-related tumors. We present a case of a perimenopausal woman with invasive mole. A systematic review was performed to identify reports on GTD in older women and to determine adequate treatment options.

CASE

A 51-year-old perimenopausal woman was admitted to hospital with abdominal feeling of pressure and nausea. Diagnostic curettage revealed hydatidiform mole. She also presented symptomatic hyperthyroidism with hypertensive blood pressure and uneasiness. After treatment with beta blockers and carbimazole, the patient underwent abdominal hysterectomy and bilateral oophorosalpingectomy. Histopathological examination confirmed an invasive hydatidiform mole (IHM). Serum β-hCG has decreased from initially 300,000-100 unit/L after 4 weeks.

DATA SOURCES

A systematic review was performed to identify all prior cases of GTD in women over 50. We searched in Medline, The Cochrane Library and Embase, to identify any articles published in the English language after 1970 and before Oct 31, 2013 pertaining to GTD in older woman (50 years or older).

TABULATION, INTEGRATION, AND RESULTS

Ten records were included in the systematic review, involving 203 cases of trophoblastic disease in older women. Although the diagnosis of GTD in older women is rare, it should be considered especially in patients with suspicious intrauterine findings in transvaginal ultrasound examinations. Different treatments were performed. In a limited number of reports, older women with GTD underwent initial hysterectomy. Benefits are avoidance of chemotherapy-induced toxicity and reduced risk of recurrence. Hysterectomy should be performed by an experienced surgeon.

CONCLUSION

It is concluded that GTD is very rare in peri- or postmenopausal women. Treatment has to be individualized, and hysterectomy can be considered as an appropriate option.

Placental site trophoblastic tumor: a case report and review of the literature

Placental site trophoblastic tumor is rare. They represent a rare form of gestational trophoblastic disease. They occur mainly in women who have a history of miscarriage, termination of pregnancy, or even a normal or pathological ongoing pregnancy. The clinical course is unpredictable. This malignancy has different characteristics from other gestational trophoblastic tumors. Following a clinical case that we encountered and treated, we conducted a literary research and review, focusing primarily on prognostic factors and treatment.