Laparoscopic hysterectomy as a treatment modality for gestational trophoblastic neoplasms: a report of two cases
Abstract
Introduction. Measuring the serum levels of human chorionic gonadotropin beta isoform (β-hCG) remains a crucial marker for diagnosing gestational trophoblastic neoplasms (GTNs). Choriocarcinoma is commonly diagnosed due to extremely high levels of β-hCG, but the presence of distant metastasis is not uncommon. Placental site trophoblastic tumors and epithelioid trophoblastic tumors remain an enigma because the levels of β-hCG are usually low. Case report. The first case report describes a 44-year-old woman, P2G3, admitted to the Clinic under the suspicion of molar pregnancy. She had vaginal bleeding with variable intensity, and her β-hCG was 1,837,787 mIU/mL. After two explorative curettages, the level of β-hCG declined, and a partial hydatidiform mole (HM) was diagnosed histopathologically. The patient was admitted to the Clinic on two occasions due to the increasing values of β-hCG. Since β-hCG failed to drop after two explorative curettages, a hysteroscopic biopsy, and one chemotherapy cycle, along with the suspicious ultrasonographic feature of metastatic GTN, and the fact that the patient has refused further chemotherapy, a total laparoscopic hysterectomy was performed. Choriocarcinoma was diagnosed after a histopathological exam was done. The second patient, a 50-year-old woman, P2G4, was admitted to the Clinic under the ultrasonographic suspicion of molar pregnancy. She was complaining of pelvic discomfort and frequent urination. Initial levels of β-hCG were 128,359 mIU/mL. Instrumental revision of the uterine cavity was performed, and partial HM was diagnosed histopathologically. Because of the increasing levels of β-hCG, ultrasonographical suspicion of the development of GTN in the uterine corpus, in accordance with the patient’s age and the fact that she has regular menstrual cycles, total laparoscopic hysterectomy was performed, and a histopathological exam made the diagnosis of the placental site trophoblastic tumor. Conclusion. Laparoscopic hysterectomy could be a treatment of choice for the chemotherapy-resistant GTNs but also for choriocarcinoma in patients who have finished their reproductive activity and refuse to be treated with chemotherapeutics.
References
1. Ning F, Hou H, Morse AN, Lash GE. Understanding and management of gestational trophoblastic disease. F1000Res 2019; 8:F1000 Faculty Rev-428.
2. Shaaban AM, Rezvani M, Haroun RR, Kennedy AM, Elsayes KM, Olpin JD, et al. Gestational Trophoblastic Disease: Clinical and Imaging Features. Radiographics 2017; 37(2): 681‒700.
3. Hui P. Gestational Trophoblastic Tumors: A Timely Review of Diagnostic Pathology. Arch Pathol Lab Med 2019; 143(1): 65‒74.
4. Lima LLA, Padron L, Câmara R, Sun SY, Rezende J Filho, Braga A. The role of surgery in the management of women with gestational trophoblastic disease. Rev Col Bras Cir 2017; 44(1): 94‒101. (English, Portuguese)
5. Froeling FE, Seckl MJ. Gestational trophoblastic tumours: an update for 2014. Curr Oncol Rep 2014; 16(11): 408.
6. Ranade M, Aguilera-Barrantes I, Quiroz FA. Gestational Trophoblastic Disease and Choriocarcinoma. Ultrasound Q 2015; 31(3): 221‒3.
7. Strohl AE, Lurain JR. Nonmetastatic Excised Gestational Choriocarcinoma: To Treat or Not to Treat. Gynecol Oncol 2018; 148(2): 237‒8.
8. Horowitz NS, Goldstein DP, Berkowitz RS. Placental site trophoblastic tumors and epithelioid trophoblastic tumors: Biology, natural history, and treatment modalities. Gynecol Oncol 2017; 144(1): 208–14.
9. Feng X, Wei Z, Zhang S, Du Y, Zhao H. A Review on the Pathogenesis and Clinical Management of Placental Site Trophoblastic Tumors. Front Oncol 2019; 9: 937.
10. Chiofalo B, Palmara V, Laganà AS, Triolo O, Vitale SG, Conway F, et al. Fertility Sparing Strategies in Patients Affected by Placental Site Trophoblastic Tumor. Curr Treat Options Oncol 2017; 18(10): 58.