Speaker
Description
My patient is Mrs.Bhamma bai,35yr/Female,residing at hinodiya nagar,Vidisha,belong to lower socioeconomic status
•Referred for continuous bleeding p/v from 4wks to PCMS, post abortion bleeding in spite of curettage.No histology of curetting,No h/o passing clots,breathlessness,tremors,excess of vomiting,Pregnancy test positive after admission
Family history/Personal history -Nil
Obs History–Married life-11 yrs,Non consanguisous marriage,second gravida,ABORTION 2
1-Spontaneous abortion at 2months with h/o suction evacuation done.5 yrs back,Male partner-oilgospermia
2-Present pregnancy-8 wks pregnancy,According to Record–IUI done with donor insemination,Check curettage were done twice at interval of 2wks for incomplete abortion confirmed by USG
On examination
Patient-sick,NoPallor,Afebrile,No goitre,
exophthalmoses,tremors
P/S examination-Blood stained discharge+
P/V examination-Uterus 6-8 weeks soft,fornices clear,cervical motion tenderness absent
Patient was investigated and check curettage was done
Under USG guidance all products were badly adherent and removed with curette
No bleeding in post operative period,After 1wk HPE of products was s/O choriocarcinoma-Atypical Syncytiotrophoblast and Cytotrophoblast,Extensive necrosis and hemorrherage,No chorionic villis
INVESTIGATIONS
HCG titer-51000 mIU/ml
CBC-Hb-11.3gm/dl,Wbc-5600,Plt-396
Blood grop-B POSITIVE
USG Pelvis-Large echogenic content 4 x 3.1 cm in cavity at fundus region with internal vascularity i/v/o ,H/o Dilation and Curettage is suggestive of retained product of conception
S.TSH-2μg
LFT-Bilirubin-0.24-0.17-0.41
S.ALP-64,SGOT/SGPT-32-23U/L
KFT-Blood Urea 24mg/dl
S.Creatinine-.081mg/dl
CT Scan-brain-No intracranial SOL
No focal vasogennic edema
No abnormal meningeal enhancement
CT Scan-chest abdomen and pelvis-Bulky uterus with large hetrogenously enhancing mass lesion 3.1X4cm in right side uterine myometrium with preserved parametrial flat planes – malignant neoplastic mass,It appears inseparable from endometrial cavity
Small hypodense nodular lesion in posterior segment of right upper lobe of lung –metastasis?
FINAL DIAGNOSIS CHORIOCARCINOMA WITH RETAINED TUMOUR MASS /PRODUCTS IN CAVITY? WITH SECONDARIES IN LUNGS(No live issue )
FOLLOW UP
Patient is on EMACO REGIMEN IS GIVEN FOR 2 WKS,Follow up for PERSISTENT GTN AND PERSISTENT BLEEDING
