Non-gestational uterine choriocarcinoma inside a leiomyoma: importance of early suspicion in prognosis

Uterine choriocarcinoma is a trophoblastic neoplasm most commonly related to pregnancy. However, there are already cases of non-gestational uterine choriocarcinoma (NGC) described in literature. The difficult diagnosis may delay treatment and threaten patient survival. We report the case of a 37-year-old patient presenting with abnormal haemorrhage and moderate levels of beta-human chorionic gonadotropin (β-hCG). As imaging exams did not show any suspicious site for the origin, choriocarcinoma was not considered so the treatment was delayed. Anatomopathological diagnosis was given both from the surgical sample of hysterectomy and from a skin lesion. The lesion was discovered inside a myoma. At this point, β-hCG levels were substantially high and she presented with respiratory distress due to pulmonary metastasis. The patient was transferred to an intensive care unit and underwent mechanical ventilation as well as life-saving chemotherapy. At 10 months after diagnosis, she is well and in remission. The delay from not suspecting the diagnosis was almost fatal for the patient.

Menstrual pattern and contraceptive choices of Portuguese athletes

OBJECTIVES

Menstrual symptoms are commonly cited barriers to physical activity in women. Delay or avoidance of menstruation through hormonal contraceptives may mitigate those barriers. Our purpose is to identify the uterine bleeding patterns of Portuguese athletes, their contraceptive choices and the impact of contraceptive methods in sports performance. We aim also to compare the outcomes between users and non-users of contraception.

METHODS

Observational, descriptive and comparative study based on a customised self-assessment online survey aimed at Portuguese athletes. Athletes had to be at least 16 years old and competing at a national, international or professional level.

RESULTS

A total of 256 athletes from 18 modalities were eligible. The mean age was 29 years and the mean age of menarche was 12.8 years. Monthly bleeding pattern was prevailing and 50% presented dysmenorrhoea. More than 85% experience fluctuations in sports performance throughout the month. The majority (71.5%) used contraceptive methods. Only 16% believed that contraception decreased sports performance. Contraceptive users exhibit a lower mean body mass index, blood loss and percentage of dysmenorrhoea than the non-users.

CONCLUSION

Most athletes had the perception that performance varies throughout the month. The majority of participants do not report amenorrhoea and have monthly menses. The use of contraceptive methods is reportedly high, benefit cycle control and apparently without any physical inconvenience.