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Table of Contents
CASE REPORT
Year : 2019  |  Volume : 10  |  Issue : 1  |  Page : 81-82

Tubal choriocarcinoma in a ruptured ectopic pregnancy


1 Department of Pathology, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
2 Department of Obstetrics and Gynecology, Federal Medical Centre, Birnin Kebbi, Nigeria

Date of Web Publication14-May-2019

Correspondence Address:
Dr. Kabir Aliyu Suleiman
Department of Pathology, University of Ilorin Teaching Hospital, Ilorin, Kwara State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/atp.atp_39_18

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  Abstract 

Choriocarcinoma represents the most malignant entity in the spectrum of gestational trophoblastic disease. It can result from molar gestation in most instances and occasionally can arise after a term pregnancy, abortion, and ectopic pregnancy. Choriocarcinoma associated with tubal pregnancy is extremely rare and aggressive in its course with the incidence of 0.76%–0.4% of all ectopic pregnancies. This case report is from a 32-year-old female G2P1 + 0A1 whose last menstrual period was 4 months before presentation. She presented with a 2-day history of lower abdominal pain and vomiting. Histological sections of the fallopian tubal tissue showed extensive hemorrhage, necrosis and invasion by bizarre trophoblastic cells with large pleomorphic nuclei, irregular nuclear borders, and clumped chromatin.

Keywords: Choriocarcinoma, ectopic pregnancy, fallopian tube


How to cite this article:
Suleiman KA, Lawal I, Abubakar-Akanbi SK. Tubal choriocarcinoma in a ruptured ectopic pregnancy. Ann Trop Pathol 2019;10:81-2

How to cite this URL:
Suleiman KA, Lawal I, Abubakar-Akanbi SK. Tubal choriocarcinoma in a ruptured ectopic pregnancy. Ann Trop Pathol [serial online] 2019 [cited 2019 May 27];10:81-2. Available from: http://www.atpjournal.org/text.asp?2019/10/1/81/258157


  Introduction Top


Gestational trophoblastic disease is a spectrum of pathological diseases in which choriocarcinoma represents the most malignant entity that usually arise following a molar gestation and to a lesser frequency could result after a term pregnancy abortion or ectopic pregnancy.[1] Choriocarcinoma associated with ectopic pregnancy is very aggressive and is extremely rare with the incidence of 0.76%–0.4% of all ectopic pregnancies.[2] In a study carried out by Rettenmaier et al., the incidence of choriocarcinoma was 1 in 5333 tubal pregnancies and 1 in 1.6 million normal intrauterine pregnancies.[3]


  Case Report Top


A 32-year-old female G2P1 + 0A1 presented with a 2-day history of lower abdominal pain and vomiting. Her last menstrual period was 4 months before presentation. The ultrasound scan suggested a ruptured ectopic pregnancy and the patient had surgery done and salpingectomy specimen was submitted for histopathology analysis.

Macroscopy

The  Fallopian tube More Details specimen measured 5 cm in length and 2.5 cm in width. There is an area of rupture measuring about 1 cm in diameter. The accompanied blood clot aggregated to 3 cm in diameter. The whole specimen was processed [Figure 1]. Histological sections showed fallopian tubal tissue with extensive hemorrhage, necrosis and invasion by bizarre trophoblastic cells with large pleomorphic nuclei, irregular nuclear borders, and clumped chromatin. A histological diagnosis of tubal choriocarcinoma was made [Figure 2] and [Figure 3].
Figure 1: Gross finding

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Figure 2: Histologic features

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Figure 3: x40 magnification of the lesion showing bizarre trophoblastic cells

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  Discussion Top


Tubal ectopic choriocarcinoma is a very rare disease with the incidence of 1 in 5333 tubal pregnancies. Only two cases of tubal ectopic choriocarcinoma have been reported in the English literature and these were by Venturini et al. and Rotas et al. as of the year 2007.[4],[5] Only two reported cases were found in Nigerian literature search.[6],[7] The index case being presented is the first of its kind in our facility established over a decade ago. There are no clinical features specific for tubal choriocarcinoma; the diagnosis can only be made histologically. The patients typically present with features suggestive of ectopic like it was reported in this case. Clinically, ectopic pregnancy was suspected, and the ultrasound scan suggested the same. Hence, emergency laparotomy was done. The operative findings of 1.2 L of hemoperitoneum and a disrupted right fallopian tube were still in keeping with a diagnosis of ectopic, but the friability of the tissues raised concerns intraoperatively. It was, therefore, not surprising when the histology confirmed tubal choriocarcinoma. The case would have been missed if the sample was not submitted for histological evaluation, which is the common practice in this part of the country where tissue specimens are discarded by the patient's relative as a result of ignorance or financial incapacity to pay for histological services. It is, thus, important to submit all surgical specimens for histological analysis as this could unravel sinister disease conditions that would otherwise have been missed portending grave consequences for the patient in the future. Ideally, surgical excision of the tube would have been sufficient treatment in most cases of tubal choriocarcinoma, the patient presented late, and the HCG was raising postoperatively necessitating for chemotherapy. She responded well to chemotherapy and planned for scheduled follow-up.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Muto MG, Lage JM, Berkowitz RS, Goldstein DP, Bernstein MR. Gestational trophoblastic disease of the fallopian tube. J Reprod Med 1991;36:57-60.  Back to cited text no. 1
    
2.
Nayama M, Lucot JP, Boukerrou M, Collinet P, Cosson M, Vinatier D, et al. Tubal choriocarcinoma: A case report and review of the literature. J Gynecol Obstet Biol Reprod (Paris) 2007;36:83-6.  Back to cited text no. 2
    
3.
Rettenmaier MA, Khan HJ, Epstein HD, Nguyen D, Abaid LN, Goldstein BH, et al. Gestational choriocarcinoma in the fallopian tube. J Obstet Gynaecol 2013;33:912-4.  Back to cited text no. 3
    
4.
Venturini PL, Gorlero F, Ferraiolo A, Valenzano M, Fulcheri E. Gestational choriocarcinoma arising in a cornual pregnancy. Eur J Obstet Gynecol Reprod Biol 2001;96:116-8.  Back to cited text no. 4
    
5.
Rotas M, Khulpateea N, Binder D. Gestational choriocarcinoma arising from a cornual ectopic pregnancy: A case report and review of the literature. Arch Gynecol Obstet 2007;276:645-7.  Back to cited text no. 5
    
6.
Ogunlaja AO, Ano-Edward HG, Fehintola OA, Alao M, Awotunde TO, Ogunlaja PI, et al. Ectopic choriocarcinoma in a preteen in Ogbomosho, South-West Nigeria: A case report. Sanamed 2016;11:217-20.  Back to cited text no. 6
    
7.
Ikponwosa O, Victor JE. Ectopic gestation trophoblastic disease: A20 year histopathological review in a tertiary centre. Ann Trop Pathol 2018;9:59-63.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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