1/5. Percutaneous transcatheter embolization for control of life-threatening pelvic hemorrhage from gestational trophoblastic disease.Pelvic hemorrhage from gestational trophoblastic disease remains a common and vexing problem. Traditional surgical therapy, including hysterectomy and hypogastric artery ligation, may be technically difficult as well as hazardous to debilitated patients. In contrast, percutaneous transcatheter embolization specifically occludes the vessels that directly contribute to bleeding. Other potential advantages include avoidance of general anesthesia and major surgery, a rapid recovery period, and preservation of fertility. Various embolic materials allow one to tailor the duration of occlusion to the underlying disorder. Reported complications are rare and generally involve aberrant emboli or inadequate collateral circulation leading to ischemic injury. We believe that transcatheter embolization should be considered an alternative to operative intervention for control of pelvic hemorrhage from gestational trophoblastic disease.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/5. Placental site trophoblastic tumor: immunohistochemical and nuclear dna study.A rare case of placentae site trophoblastic tumor (PSTT) studied by immunohistochemistry and nuclear dna analysis is reported. The patient, a 24-year-old Japanese female, complained of amenorrhea. dilatation and curettage revealed a small specimen that contained trophoblastic cells and caused intractable bleeding. Pelvic sonography revealed a 5-cm mass in the posterior uterine wall with multiple cystic lesions of several sizes. The cystic lesions were shown to be dilated vessels by magnetic resonance imaging (MRI) and digital subtraction angiography (DSA). serum beta-hCG (beta subunit of human chorionic gonadotropin) was 3.7 ng/ml. Total abdominal hysterectomy revealed a well-circumscribed, yellow, soft mass in the posterior uterine wall. Microscopic findings were consistent with PSTT and the mitotic count was extremely low. Immunohistochemically, most of the tumor cells were intensely stained with human placental lactogen, whereas few were stained with human chorionic gonadotropin. The nuclear dna content of the trophoblastic cells showed a sharp peak at the triploid range coexistent with a few cells of higher ploidy. This is the first report of sonographic findings and nuclear dna analysis by spot cytometry in a case of PSTT.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/5. Non-resolution of pelvic sonographic abnormality after chemotherapy for persistent trophoblastic disease--a word of caution.A case of persistent trophoblastic disease (PTD) is presented in whom pelvic sonography demonstrated persistent uterine abnormality and dilated adnexal vessels after cessation of chemotherapy. hysterectomy was performed on account of subsequent uterine bleeding. A viable tumour was not demonstrated in the hysterectomy specimen. In the absence of haemorrhagic complications persistent sonographic abnormality should not necessarily indicate hysterectomy, especially when hCG levels are normal.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/5. Metastatic trophoblastic disease presenting as a subarachnoid hemorrhage: report of two cases and review of the literature.Trophoblastic tumors may present as subarachnoid or intracerebral hemorrhages in women of childbearing age. Although uncommon in Western countries, they constitute a significant percentage of metastatic lesions to the nervous system among Oriental women and usually follow molar pregnancies. Malignant transformation may occur at any time, but most frequently within a year of pregnancy. For this reason, close follow-up of women with molar pregnancies and subsequent prevention of pregnancy for one year is mandatory. Persistent serum human chorionic gonadotropin elevations are seen at some stage. Eighty percent of hydatidiform moles remit spontaneously, and the prognosis for persistent molar disease treated with chemotherapy and irradiation is good. The prognosis for choriocarcinoma, however, is less favorable. subarachnoid hemorrhage may be the first and only sign of intracerebral bleeding into a metastatic lesion or leakage from a damaged vessel in which trophoblastic tissue has lodged. The triad of menstrual abnormalities, recent or remote pregnancy or abortion, and an acute cerebrovascular event with evidence of a mass lesion should suggest the diagnosis of metastatic trophoblastic disease in a woman of childbearing age.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/5. hysteroscopy provides proof of trophoblastic tumors in three cases with negative color Doppler images.color Doppler sonography has replaced pelvic arteriography as well as real-time ultrasound in the assessment of patients with gestational trophoblastic disease. In about 25% of patients in whom human chorionic gonadotropin (hCG) levels are suggestive of trophoblastic disease, there will be no evidence of abnormal vessels in the uterus. In these cases it is assumed that hCG was produced by metastatic lesions. We present here three cases in which color Doppler examination was negative and where myometrial biopsies containing tumor were obtained by means of hysteroscopy. The fact that color Doppler, in its present form, does not detect small areas of trophoblastic tumor might also have implications for other kinds of tumors. knowledge of the exact microscopic diagnosis in molar patients with persistent disease may have an impact on management.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |