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Early diagnosis of chorionepithelioma after the birth of viable children
234
THE
AMERiCAN
JOURNAL
OF
OBSTETRI68
AND
GKNECOLXlY
ing in detail the characteristic picture of such a lesion. According to Warthin, the tissue changes due to primary syphilis are more typical in the cervix than in any other tissue. R. E, Wonva.
Fi 1920, lxxxiii,
of gie,
iagnosis of ~h~r~~~e~~t~elioma Zeitsehrift ftir Geburtshilf 63.
The author believes that chorionepithelioma develops in all ca.ses in the early months of pregnancy while Langhan’s layer aud the synStium are both present. The tumor usually leads to abortion and :lenee the great majority of ea.ses are reported following abortion or hydatiform moles. Occasionally, however, pregnancy may continue There 60 near term, though the labor is usnally somewhat premature. !s frequently atonic bleeding immediately postpartum with acute or -chronic hemorrhages in the puerperium and subinvolution of the uterus. Any tissue removed from cases giving such a history should Se examined most carefully microscopically with this point in view. The author reports such a ease in a twenty-one-year old primipara who had had a severe attack of influenza in the second ha.lf of pregnancy. The labor was 3 to 4 weeks premature, severe bleeding followed the spontaneous separation of the placenta. Lochia still bloody and uterus subinvoluted on the elevent,h day postpartum. Severe hemorrhage on 18th day with removal on 20th da,y of polypoid growth from uterus, histologically suspicious of ehorionepithelioma. Cessation of bleeding until 40th day when she had another severe hemorrhage. Renewed examination of tissue confirmed diagnosis and .the uterus with left adnexa was removed by vaginal hysterectomy on the 43rd day. ~\IARGARI~T Xcmwm. ,&se : iagn,osis and Treatment of hQrio”~pi~~e~~Qma. gery, Gynecology and Obstetrics, 1921, xxxii, 426.
Sur-
WThile adhering to the eksifieation of Marehand, Geist prefers to term typical chorioepithelioma as choriocarcinoma and the atypical form as syneytioma. Between these, there are numerous transition stages and: in addition, there is a form presenting an exaggerated reaction to pregnancy without definite tumor formation, which he terms syncytial hyperplasia. The diagnosis from curetted or expelled material is extremely difficult except in the clear-cut cases of the two groups. In the transitional types prognosis is doubtful. A positive diagnosis of syncytioma would call for conservatism, yet, the clinical course might still necessit;ate hysterectomy. In choriocarcinoma and the transitional types, abdominal hysterectomy is indicated and offers a fair prognosis evea in the malignant type. R. E. Wosus. : r~p~y~i~ in a,rcin~~a ical Journal, 1921, cxiv, 384.
miley
of the
er-vix.
New
York
Med-
According to Bland’s statistics, one woman of every eight dies of taneer; one-third of all cancers in women are of uterine origin; 85 90 per cent of uterine carcinoma are cervical in type. Cervical careinomas are found almost exclusively (97 per cent) in women who have
THE
AMERiCAN
JOURNAL
OF
OBSTETRI68
AND
GKNECOLXlY
ing in detail the characteristic picture of such a lesion. According to Warthin, the tissue changes due to primary syphilis are more typical in the cervix than in any other tissue. R. E, Wonva.
Fi 1920, lxxxiii,
of gie,
iagnosis of ~h~r~~~e~~t~elioma Zeitsehrift ftir Geburtshilf 63.
The author believes that chorionepithelioma develops in all ca.ses in the early months of pregnancy while Langhan’s layer aud the synStium are both present. The tumor usually leads to abortion and :lenee the great majority of ea.ses are reported following abortion or hydatiform moles. Occasionally, however, pregnancy may continue There 60 near term, though the labor is usnally somewhat premature. !s frequently atonic bleeding immediately postpartum with acute or -chronic hemorrhages in the puerperium and subinvolution of the uterus. Any tissue removed from cases giving such a history should Se examined most carefully microscopically with this point in view. The author reports such a ease in a twenty-one-year old primipara who had had a severe attack of influenza in the second ha.lf of pregnancy. The labor was 3 to 4 weeks premature, severe bleeding followed the spontaneous separation of the placenta. Lochia still bloody and uterus subinvoluted on the elevent,h day postpartum. Severe hemorrhage on 18th day with removal on 20th da,y of polypoid growth from uterus, histologically suspicious of ehorionepithelioma. Cessation of bleeding until 40th day when she had another severe hemorrhage. Renewed examination of tissue confirmed diagnosis and .the uterus with left adnexa was removed by vaginal hysterectomy on the 43rd day. ~\IARGARI~T Xcmwm. ,&se : iagn,osis and Treatment of hQrio”~pi~~e~~Qma. gery, Gynecology and Obstetrics, 1921, xxxii, 426.
Sur-
WThile adhering to the eksifieation of Marehand, Geist prefers to term typical chorioepithelioma as choriocarcinoma and the atypical form as syneytioma. Between these, there are numerous transition stages and: in addition, there is a form presenting an exaggerated reaction to pregnancy without definite tumor formation, which he terms syncytial hyperplasia. The diagnosis from curetted or expelled material is extremely difficult except in the clear-cut cases of the two groups. In the transitional types prognosis is doubtful. A positive diagnosis of syncytioma would call for conservatism, yet, the clinical course might still necessit;ate hysterectomy. In choriocarcinoma and the transitional types, abdominal hysterectomy is indicated and offers a fair prognosis evea in the malignant type. R. E. Wosus. : r~p~y~i~ in a,rcin~~a ical Journal, 1921, cxiv, 384.
miley
of the
er-vix.
New
York
Med-
According to Bland’s statistics, one woman of every eight dies of taneer; one-third of all cancers in women are of uterine origin; 85 90 per cent of uterine carcinoma are cervical in type. Cervical careinomas are found almost exclusively (97 per cent) in women who have