Chorioadenoma and choriocarcinoma of uterus

882 DR.

THE

AMERICAN

SAMUEL A. WOLFE and ~horiooaroinoma

JOUR1*‘AL

OF

OBSTETRICS

APiD

GYNECOLOGY

presented a case report entitled Chmimxkmm of Uterus. (For original article see page 8%. j DISCUSSIOP;

1)R. 0. A. GORDON, JR. said that we are very likely to be misled as to the frequency of hydatidiform mole; it is far more frequent than is usually supposed. The fact that Greenpoint and St. Catherine’s Hospitals out of 15,000 deliveries have noted but 14 cases has vary little bearing on the frequency of hydatidiform mole, because most of the cases reported were from three months pregnancies or earlier. It has been very well demonstrated that if all the products of conception in an abortion are carefully examined under water, it will be found that there are a large number of cases of this condition in the early stages of pregnancy which on casual examination escape entirely. It has been pointed out by many that even microscopic areas of hydatidiform mole are just as great au etiologic factor in the production of choriocarcinoma as a mole the size of a five months’ gestation. It is natural that most, cases of hydatidiform mole escape attention because they are the type of cases that result in early abortion. They occur at homes, and nobody notices the products of the abortion, and naturally they escape entirely. In regard to the relative infrequency of chorioepithelioma, it can safely be said that choriocarcinomas would be noted at Bellevue if they were at all frequent. Out of 3,000 autopsies at Bellevue IIospital by Dr. Simmers, he discovered only one choriocarcinoma, and that case occurred in the past year. They are t,he type of case with signs of pulmonary metastasis and distant metastases that the other and more elite hospitals do not care to take in. As to the diagnosis, it is pretty well agreed that curettage in relation to diagnosis and prognosis is useless. It is the gross examination that is of far greater value; that is to say, the penetrating tumor tissue from curettage is likely not to show anything in the hydatidiform mole, even though the case may later develop ehorioepithelioma. Therefore, cases of hydatidiform mole resulting in termination of pregnancy need not be operated by curettage in an effort to establish a diagnosis of chorioepithelioma, because that is generally considered of very little value. All this tends to establish the conservative treatment of hydatidiform mole, which Dr. Abbene’s ease report also establishes. They had so many thousand pregnancies and only one case of choriocarcinoma. Therefore, to argue that these hydatidiform moles occurring in women of 40 years or more should be followed by hysterectomy, seems to be rwthcr radical treatment fog a condition which usually is benign. A type of treatment which is applicable to these cases and which has come up recently is radiation. Tlrhen choriocarcinoma does develop in these cases, it is an embryonal tissue growth; therefore, it is very susceptible to radiation, either A moderate amount of radiation might be by radium or deep x-ray therapy. applied to the case without the danger to the woman which is associated with radical operation.