Three Cases of Chorion Epithilioma

Reported by

Dr. Narayan M. Patel M.D.,D.G.O. FICS

Emeritus Professor Muni. Medical collegePostal address--

Mahalaxmi Institute of medical teaching,3, Shantiniketan park, Naranpura,

Nr.Sardar Patel Colony, AHMEDABAD- 380 014 (Gujarat) INDIA

T.N.(079) 27682572, Mobile;- 98252 95530E mail:- nmpatel1932@wilnetonline.net

All these three cases were seen by the author, Dr.Narayan M.Patel between year 1970 and 1990, during his active practice. I had the habit of always carrying a camera to hospital, where I was working and also, to carry it to operation theater. This helped me to document interesting cases, worth documenting, and hence these pictures were possible and case report.The first and second cases were seen by me in the medical college hospital, where I was working.

The next 2 cases, were seen by me in my private hospital.

This patient was referred toa general hospital with a note by aGynecologist.The writing of the note were like this with.

This Pt’ is referred for bleeding per vaginaH/O D&C done twice before.X-ray chest shows tuberculosis of Lungs and is under treatment for tuberculosisThere a growth in vagina? MalignancyKindly do the needful.

The photo copy of this letter is seenin the next slide

First case report :-

Slide showing vaginal metastasisas shown by arrow

X-ray chest of thesame patient showing multiplesecondary metastasisin lungs, which were mistaken and treatedas tuberculosis of lungs

Secondary metastasisin lungs

Abdominal totalhysterectomy withbilateral salpingo-ooperectomy was performed for this pt.This slide shows specimen after Operation.

The same specimenafter cutting it open.Biopsy report confirmed it as chorion epithilioma

This patient came withbleeding P.V.At that time facilityof estimation ofserum Bhcg was notavailable.Surgery was done on herand specimen is shownin next slide

Second case report:--

This specimen after operation of abdominaltotal hysterectomywith bil. Salpingo- -ooperectomy.A fungating growth is seenarising from funds ofuterus

The same specimenafter cutting it open.Biopsy report confirmed it as chorion epithilioma.Pt. was given Tab.Mithotraxate which was the only drug Available at that time.Pt. was lost to follow.

The next 2 cases I am reporting, were seen by me in my private hospital.

3rd case of Chorion epithiliomThe next third case, came with lump in abdomen and bleeding off and on per vagina. It was thought to due to big tumor, probably fibroid. Elective abdominal total hysterectomy was planned and, a professional photographer called to documents the operative procedure.

This pt. was suspected tohave fibroid of size of 5 months pregnant uterus.She had bleeding per vagina

Pt. was referred to a Sonologist, only one in the town at that time to haveonly trans abdominal scanmachine.He reported this caseas a degenerating fibroid.Pt. was taken for surgerythinking sonologist’s diagnosis as a right one.You see in next few slidesSteps of operation

Abdomen has been opened and you see the four bladed Crusener’s retractor in place and bigtumor brought out of abdominal cavity.

Hysterectomy is progress.Half the tumor is almost out.

Clamps were appliedone after another and uterus is seen coming out of abdominal cavity.Almost 4/5 of the tumoris out

Operation in progress.

Further dissectionand uterus Is almost at the lower end of the cervix. Two more clampsat angle of vaginaand uterus and tumor will be inhand.

You see me here (Author)holding the tumor in the hand.I was young at that time.May be of the age of fifty or so.I am now 75.In the next slide you see the tumor at a close view.

A close view of theSpecimen removed.There is a fungating growth coming out onanterior part of uterus.Both ovaries and fallopiantubes were removed.You will see bisected specimen in the next slide.

The previous specimen seenbisected.Biopsy reportconfirmed it, aschorion epithilioma.

The biopsy report of chorion epithilioma wasreceived from pathologist 7 days post operative.Pt. did well till that day. On 10th post operative day,she suddenly developed convulsions and become unconscious. She was transferred to cancer hospitalin the town.She was treated there by chemotheraphy- like Methtraxtat tables/ Methotrexate InjectionThis was the only drug available at that time .Pt. died in cancer hospital 15 days after admission.This case is reported to keep in mind not to mistake a case of chorion epithiliom as a case of degerating fibroid, even its appearance at sonography, may look like that of a degenerating fibroid..

4th case of Chorion epithilioma

This Pt. was seen in private for bleeding P.V.Bilateral cystic ovaries were noted before operation. Abdominal total hysterectomy with bil.salpingo ooperectomy was done. On bisecting the specimen a small growth was seen at isthmus of uterus. Biopsy was send.

Growth.

Pt. was given Mithotraxate tablets. She did well after surgery and was well for at least for15 years, as conveyed to me by her relatives.Bilateral lutin cyst are commonly seen in case of chorion epithelioma. In this case they are seen nicely.

Same specimen at a close up view. Biopsy report was Chorion epithelioma.

Growth

Lutin cyst