Laparoscopic hysterectomy as a treatment modality for gestational trophoblastic neoplasia - report of two cases

Abstract

Introduction. Measurement of the serum levels of human chorionic gonadotropin?s beta isoform (bhCG) remains a crucial marker for diagnosing the GTN. Choriocarcinoma is commonly diagnosed due to extremely high levels of bhCG, but the presence of distant metastasis is not uncommon. Placental site trophoblastic tumor and epithelioid trophoblastic tumor remain some sort of an enigma because the levels of bhCG are usually low. Case report. A 44-year old patient, P2G3,was admitted to the Clinic under the suspicion of molar pregnancy, vaginal bleeding with variable intensity, and levels of bhCG of 1 837 787 mIU/mL. After two explorative curettages, bhCG saw a decline and a partial hydatidiform mole was diagnosed histopathologically. The patient was admitted to the Clinic on two occasions due to the increasing values of bhCG. Since bhCG failed to drop after two explorative curettages, hysteroscopic biopsy, 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. Histopathological exam made the diagnosis of choriocarcinoma. A 50-year old patient, 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 bhCG were 128 351 mIU/mL. Instrumental revision of the uterine cavity was performed and partial hydatidiform mole was diagnosed histopathologically. Because of the increasing levels of bhCG, ultrasonographical suspicion of the development of GTN in the uterine corpus, in accordance with 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 the choricarcinoma in patitent?s who have finished their reproductive activity and refuse to be treated with chemotherapeutics.