Choriocarcinoma; An Unusual Case Recurring Nine Years After Subtotal Hysterectomy And Followed By Spontaneous Regression Of Pulmonary Metastases
American Journal of Obstetrics and Gynecology 82(3): Sept 1961; 654-659
View Original Source →Abstract
Papillary cystadenocarcinoma of the ovary is a malignant epithelial growth. The prognosis is very poor. Early diagnosis is essential, and treatment should be as radical as circumstances permit, followed by x-ray therapy. A case of papillary cystadenocarcinomas of the ovary, diagnosed approximately one year after the onset of symptoms, is reported. The patient had actual surgical, but not radical, treatment four years after the onset of symptoms and without postoperative x-ray therapy. Yet after more than eight years she feels well, works every day, and is apparently cured.
Case Details
Personal Characteristics
51-year-old housewife, gravida viii, para vi
Clinical Characteristics
Vaginal bleeding, sense of tension in the hypogastrium, slightly pale but well nourished, bloodstained discharge, hypertrophic portio, ulcer on the posterior cervical lip, firm mass 7 to 8 centimeters in diameter extending from the cervical stump and adhering to the anterior wall of the rectum, red blood count 4 million, white blood count 7,800, hemoglobin level 95%, urinalysis normal, erythrocyte sedimentation rate 13, malignant tumor of the cervical stump, elastic tumor arising from the cervical stump, hemorrhage and necrosis, remnants of trophoblastic nuclei, round and polyhedral cells (resembling langerhans cells), multinucleated giant cells (resembling mostly syncytial cells), embolic trophoblastic cells in the lumina of vessels in the vicinity of the tumor, anaplasia, leukocytes (mainly lymphocytes), no clear fibrinoid layer, no villous pattern, 100 rat units of chorionic gonadotropin per liter, no abnormalities on chest x-ray, erythrocyte sedimentation rate 44, negative friedman test at 100 rbu, hemoptysis, slight dyspnea, numerous snowball-like shadows in both lungs (interpreted as metastases from the choriocarcinoma), positive friedman test with a titer as high as 100 rbu, blood-stained sputum, chorionic gonadotrophin titer of urine increased to 50,000 rbu, deterioration of condition, expectoration of about 100 cc of blood, slight pains in the chest and the lower part of the back, complete disappearance of the shadows, negative friedman test, no abnormalities on follow-up examinations, x-rays, and friedman tests
Remission Characteristics
Complete disappearance of the shadows, negative friedman test, no abnormalities on follow-up examinations, x-rays, and friedman tests
Treatment & Mechanisms
Proposed Remission Mechanisms
Not discussed
Clinical Treatment
Subtotal hysterectomy, curettage, supravaginal hysterectomy, trachelectomy, chlortetracycline
Additional Notes
The patient had a history of chorioadenoma destruens. The choriocarcinoma recurred nine years after a subtotal hysterectomy. Despite the spread of the disease and an increase in the chorionic gonadotrophin titer of urine, the patient's condition gradually improved and she was considered completely cured.