Öz
Objective: To present an intramural atypical trophoblastic tumor case diagnosed by ultrasound guided biopsy. Case: A 31 years old patient gravidity 3, parity 1 referred to our tertiary center with the diagnosis of an incomplete abortion who had been performed dilatation and curretage in another healthcare unit. Her referrel reason was the plateau and elevation of ‚- hCG levels in her check-ups. When we repeated the tests the patients ‚- hCG values were decreased and we planned methotrexate therapy. Unfortunately the patient did not respond to methotrexate treatment and her ‚- hCG levels started to elevate. We decided to perform an ultrasound guided biopsy direct to the lesion. An epithelioid trophoblastic type tumor diagnose was confirmed by hystopathological examination. Then hysterectomy was performed and she discharged without any complication. She was free of disease in her follow-up period. Conclusions: Epithelioid trophoblastic type tumors should be kept in mind for the patients with a diagnosis of gestational trophoblastic disease and has low ‚- hCG levels who do not respond to chemotherapy.
Anahtar Kelimeler
Kaynakça
- Lurain JR.: Gestational trophoblastic disease I: epide- miology, pathology, clinical presentation and diagno- sis of gestational trophoblastic disease, and manage- mentof hydatidiform mole. American Journal of Obs- tetrics & Gynecology. 2010
- Shih IM, Kurman RJ.: Epithelioid trophoblastic tumor: a neoplasm distinct from choriocarcinoma and pla- cental site trophoblastic tumor simulating carcinoma. Am J Surg Pathol. 1998; 22: 1393-1403.
- Shih IM, Kurman RJ.: The pathology of intermediate trophoblastic tumors and tumor-like lesions. Int J Gynecol Pathol. 2001; 20: 31-47.
- Allison KH, Jason E. Love JE,.Garcia RL.: Epithelioid Trophoblastic Tumor Review of a Rare Neoplasm of the Chorionic-Type Intermediate Trophoblast. Arch Pathol Lab Med. 2006; 130: 1875-877.
- Coulson LE, Kong CS, Zaloudek C.: Epithelioid trop- hoblastic tumor of the uterus in a postmenopausal woman: a case report and review of the literature. Am J Surg Pathol 2000; 24: 1558-1562.
- Kuo KT, Chen MJ, Lin MC..: Epithelioid trophoblastic tumor of the broad ligament: a case report and revi- ew of the literature. Am J Surg Pathol 2004; 28: 405. P M L H Vencken, P C Ewing, R P.: Zweemer Epithe- lioid trophoblastic tumour: a case report and review of the literature J Clin Pathol 2006; 59: 1307-1308.
- Shih IM, Kumaran RJ. p63 expression useful in the dis- tinction of epithelioid trophoblastic and placental site trophoblastic tumors by profiling trophoblastic subpo- pulations. Am J Surg Pathol 2004; 28: 1177-1183.
- Fadare O, Parkash V, Carcangiu ML, Hui P.: Epithelio- id trophoblastic tumor: clinicopathologic features with an emphasis on uterine cervical involvement. Mod Pathol. 2006;19: 72-74.
- )Narita F, Takeuchi K, Haman S, et al.: Epithelioid trop- hoblastic tumor (ETT) initially interpreted as cervicalcancer. Int J Gynecol Caner. 2003; 13: 551-554.
Öz
Amaç: Ultrasonografi eşliğinde biopsi ile tanı konulan, atipik trofoblastik tümör olgusunun sunulmasıdır. Olgu: 31 yaşında, Gravidesi 3, Paritesi 1 olan olguya dış merkezde incomplet abortus tanısıyla, D/C işlemi uygulanmıştır. ‚- hCG kontrollerinde yükselme saptanması üzerine kliniğimize refere edilmiştir. Kliniğimizde hCG düzeyleri plato çizmesi nedeniyle metotreksat uygulanmıştır. Metotreksat tedavisine yanıt alınmadığından ve hCG değerlerinin yükselmesinden dolayı, ultrasonografi eşliğinde uterin lezyona girilerek yapılan biopsi sonucunda epiteloid trofoblastik tip tümör saptanmıştır. Olguya histerektomi uygulanmıştır. Hastanın operasyon sonrası yapılan takiplerinde şu ana kadar herhangi bir problem ile karşılaşılmamıştır. Sonuç: Gestasyonel trofoblastik hastalık düşünülen bir hastada hCG değerleri düşük ve kemoterapiye cevap yoksa, ileri histolojik inceleme yapılarak epiteloid trofoblastik tip tümör mutlaka akılda tutulmalıdır.
Anahtar Kelimeler
Kaynakça
- Lurain JR.: Gestational trophoblastic disease I: epide- miology, pathology, clinical presentation and diagno- sis of gestational trophoblastic disease, and manage- mentof hydatidiform mole. American Journal of Obs- tetrics & Gynecology. 2010
- Shih IM, Kurman RJ.: Epithelioid trophoblastic tumor: a neoplasm distinct from choriocarcinoma and pla- cental site trophoblastic tumor simulating carcinoma. Am J Surg Pathol. 1998; 22: 1393-1403.
- Shih IM, Kurman RJ.: The pathology of intermediate trophoblastic tumors and tumor-like lesions. Int J Gynecol Pathol. 2001; 20: 31-47.
- Allison KH, Jason E. Love JE,.Garcia RL.: Epithelioid Trophoblastic Tumor Review of a Rare Neoplasm of the Chorionic-Type Intermediate Trophoblast. Arch Pathol Lab Med. 2006; 130: 1875-877.
- Coulson LE, Kong CS, Zaloudek C.: Epithelioid trop- hoblastic tumor of the uterus in a postmenopausal woman: a case report and review of the literature. Am J Surg Pathol 2000; 24: 1558-1562.
- Kuo KT, Chen MJ, Lin MC..: Epithelioid trophoblastic tumor of the broad ligament: a case report and revi- ew of the literature. Am J Surg Pathol 2004; 28: 405. P M L H Vencken, P C Ewing, R P.: Zweemer Epithe- lioid trophoblastic tumour: a case report and review of the literature J Clin Pathol 2006; 59: 1307-1308.
- Shih IM, Kumaran RJ. p63 expression useful in the dis- tinction of epithelioid trophoblastic and placental site trophoblastic tumors by profiling trophoblastic subpo- pulations. Am J Surg Pathol 2004; 28: 1177-1183.
- Fadare O, Parkash V, Carcangiu ML, Hui P.: Epithelio- id trophoblastic tumor: clinicopathologic features with an emphasis on uterine cervical involvement. Mod Pathol. 2006;19: 72-74.
- )Narita F, Takeuchi K, Haman S, et al.: Epithelioid trop- hoblastic tumor (ETT) initially interpreted as cervicalcancer. Int J Gynecol Caner. 2003; 13: 551-554.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Case Report |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Nisan 2011 |
| Yayımlandığı Sayı | Yıl 2011 Cilt: 3 Sayı: 1 |