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Malignant trophoblastic cell tumor localized to the fallopian tube: a case report
European Journal oj Obste/rics & Gynecology and Reproductive
Biology, 39 (1991)
C 1991 Elsevier Science Publishers B.V. (Biomedical
0028-2243/91/$03.50
EUROBS
Division)
163- 164
163
01071
Malignant trophoblastic
cell tumor localized to the fallopian tube: a case report
J.J. Kjer, T. Iversen and I. Haarstad Department
oj Gynecologic Oncology, The Norwegian Radium Hospital, Oslo, and Department Leoanger Hospilal, Norway Accepted
Trophoblastic
cell tumor;
Fallopian
for publication
of Gynecology and Obsrerrrcs.
7 May 1990
tube; Malignancy
Introduction The incidence of ectopic pregnancy has increased [l-5], and may consequently lead to an increased number of ectopic malignant trophoblastic tumors. In Norway all patients with malignant trophoblastic cell tumors are treated at The Norwegian Radium Hospital in Oslo, and this paper deals with the only case of ectopic choriocarcinoma seen in Norway over a 18-year period (1970-1987).
found in the left parametrium and therefore laparotomy was performed 129 days after the last menstrual period. At the operation a tumor measuring 4 X 4 cm was found in the left fallopian tube, which was removed. Microscopic examination showed choriocarcinoma, radically removed. No metastases were found. She was treated with low-doses of methotrexate and actinomycin D, with two courses after normal serum-hCG value.
Discussion Case report The patient was 53 years old with three previous normal pregnancies and deliveries. After the last menstrual period she was bleeding continuously and had pain in the left side of the pelvis. A curettage was performed 85 days after the first day of the last menstrual period and microscopic examination revealed decidual tissue and Arias-Stellas phenomenon. Serum-hCG, 4 days after the curettage, was 160000 IU/l. The bleeding continued in spite of the curettage. The uterus was slightly enlarged and a tender mass was
Correspondence; lerup. Denmark.
Jens Jsrgen
Kjer,
Basehej
7, DK-2900
Hel-
By the number of deliveries, ectopic pregnancies and invasive trophoblastic tumors in Norway one should expect just one case of ectopic invasive mole/ choriocarcinoma in the period 1970-1987. This also is according to a previous report which showed that 3% of all choriocarcinemas were developed from ectopic pregnancies 161. In the material by Lurain et al. [7], 88% had abdominal pain and 75% had irregular vaginal bleeding with a palpable mass in half of the patients. A large proportion (75%) of the patients had metastases when the disease was diagnosed, which was misinterpreted as appendicitis in two cases and as an ovarian cyst in one case. One case was misinterpreted at microscopic examination. The patient in the present case report was 53
164
years old. The occurrence of trophoblastic cell tumors in women over 50 years is rare and only isolated cases are reported. Shiina and Ichinoe [8] reported that the incidence of hydatiform mole for women over 45 years of age is 25-times higher than that for women under 34. They also state that the secondary occurrence of malignant trophoblastic cell tumors following hydatiform mole increases after the age of 35. The high malignancy rate of trophoblastic cell tumors in women of high age has also been stressed by other authors [9,10]. Even though this particular ectopic gestational disease is rare, one has to be aware of its existence _ especially as to the increasing number of ectopic pregnancies observed in several countries. References 1 Hemminki E, Heinonen PK. Time trends of ectopic pregnancies. Br J Obstet Gynaecol 1974;94:322-327. LB. Ectopic pregnancy subsequent to 2 Kjer JJ. Knudsen laparoscopic sterilization. Am J Obstet Gynecol 1989;160: 1202-1204.
Rubin CL. Peterson HB, Dorfman SF et al. Ectopic pregnancy in the United States, 1970-1978. JAMA 1983;249: 17251729. Skjeldestad FE, Svare S. Sordal T, Haarstad I, Brobak H. Ectopic pregnancies. Tidskr Nor Laqeforen 1987;107: 2723-2726. Westrom L, Bengtsson LPH, Marhd P-A. Incidence, trends, and risks of ectopic pregnancy in a population of women. Br Med J 1981;282:15-19. Olive DL, Luran JR. Brewer JI. Choriocarcinoma associated with term gestation. Am J Obstet Gynecol 1984;148: 711-716. Lurain JR, Sand PK, Brewer JI. Choriocarcinoma associated with ectopic pregnancy. Obstet Gynecol 1986;68:286287. Shiina Y, Ichinoe K. The age incidence of hydatiform mole and the sexxndary occurrence rate of invasive mole and choriocarcinoma. Acta Obstet Gynaecol Japan 1979;31:8286. Jequier AM, Winterton WR. Diagnostic problems of trophoblastic disease in women aged 50 or more. Obstet Gynecol 1973;42:378-387. Tsukamoto N, Iwasaka T, Kashimura Y, Vehino H, Kashimura M, Matsuyama T. Gestational trophoblastic disease in women aged 50 or more. Gynecol Oncol 1985;20:53-61.
Biology, 39 (1991)
C 1991 Elsevier Science Publishers B.V. (Biomedical
0028-2243/91/$03.50
EUROBS
Division)
163- 164
163
01071
Malignant trophoblastic
cell tumor localized to the fallopian tube: a case report
J.J. Kjer, T. Iversen and I. Haarstad Department
oj Gynecologic Oncology, The Norwegian Radium Hospital, Oslo, and Department Leoanger Hospilal, Norway Accepted
Trophoblastic
cell tumor;
Fallopian
for publication
of Gynecology and Obsrerrrcs.
7 May 1990
tube; Malignancy
Introduction The incidence of ectopic pregnancy has increased [l-5], and may consequently lead to an increased number of ectopic malignant trophoblastic tumors. In Norway all patients with malignant trophoblastic cell tumors are treated at The Norwegian Radium Hospital in Oslo, and this paper deals with the only case of ectopic choriocarcinoma seen in Norway over a 18-year period (1970-1987).
found in the left parametrium and therefore laparotomy was performed 129 days after the last menstrual period. At the operation a tumor measuring 4 X 4 cm was found in the left fallopian tube, which was removed. Microscopic examination showed choriocarcinoma, radically removed. No metastases were found. She was treated with low-doses of methotrexate and actinomycin D, with two courses after normal serum-hCG value.
Discussion Case report The patient was 53 years old with three previous normal pregnancies and deliveries. After the last menstrual period she was bleeding continuously and had pain in the left side of the pelvis. A curettage was performed 85 days after the first day of the last menstrual period and microscopic examination revealed decidual tissue and Arias-Stellas phenomenon. Serum-hCG, 4 days after the curettage, was 160000 IU/l. The bleeding continued in spite of the curettage. The uterus was slightly enlarged and a tender mass was
Correspondence; lerup. Denmark.
Jens Jsrgen
Kjer,
Basehej
7, DK-2900
Hel-
By the number of deliveries, ectopic pregnancies and invasive trophoblastic tumors in Norway one should expect just one case of ectopic invasive mole/ choriocarcinoma in the period 1970-1987. This also is according to a previous report which showed that 3% of all choriocarcinemas were developed from ectopic pregnancies 161. In the material by Lurain et al. [7], 88% had abdominal pain and 75% had irregular vaginal bleeding with a palpable mass in half of the patients. A large proportion (75%) of the patients had metastases when the disease was diagnosed, which was misinterpreted as appendicitis in two cases and as an ovarian cyst in one case. One case was misinterpreted at microscopic examination. The patient in the present case report was 53
164
years old. The occurrence of trophoblastic cell tumors in women over 50 years is rare and only isolated cases are reported. Shiina and Ichinoe [8] reported that the incidence of hydatiform mole for women over 45 years of age is 25-times higher than that for women under 34. They also state that the secondary occurrence of malignant trophoblastic cell tumors following hydatiform mole increases after the age of 35. The high malignancy rate of trophoblastic cell tumors in women of high age has also been stressed by other authors [9,10]. Even though this particular ectopic gestational disease is rare, one has to be aware of its existence _ especially as to the increasing number of ectopic pregnancies observed in several countries. References 1 Hemminki E, Heinonen PK. Time trends of ectopic pregnancies. Br J Obstet Gynaecol 1974;94:322-327. LB. Ectopic pregnancy subsequent to 2 Kjer JJ. Knudsen laparoscopic sterilization. Am J Obstet Gynecol 1989;160: 1202-1204.
Rubin CL. Peterson HB, Dorfman SF et al. Ectopic pregnancy in the United States, 1970-1978. JAMA 1983;249: 17251729. Skjeldestad FE, Svare S. Sordal T, Haarstad I, Brobak H. Ectopic pregnancies. Tidskr Nor Laqeforen 1987;107: 2723-2726. Westrom L, Bengtsson LPH, Marhd P-A. Incidence, trends, and risks of ectopic pregnancy in a population of women. Br Med J 1981;282:15-19. Olive DL, Luran JR. Brewer JI. Choriocarcinoma associated with term gestation. Am J Obstet Gynecol 1984;148: 711-716. Lurain JR, Sand PK, Brewer JI. Choriocarcinoma associated with ectopic pregnancy. Obstet Gynecol 1986;68:286287. Shiina Y, Ichinoe K. The age incidence of hydatiform mole and the sexxndary occurrence rate of invasive mole and choriocarcinoma. Acta Obstet Gynaecol Japan 1979;31:8286. Jequier AM, Winterton WR. Diagnostic problems of trophoblastic disease in women aged 50 or more. Obstet Gynecol 1973;42:378-387. Tsukamoto N, Iwasaka T, Kashimura Y, Vehino H, Kashimura M, Matsuyama T. Gestational trophoblastic disease in women aged 50 or more. Gynecol Oncol 1985;20:53-61.