Two cases of rare choriocarcinoma Phase IIa. A hysterectomy, oophorotomy + bilateral ovarian artery and vein high ligation were performed. The Chinese Communists lost 400ml of whole blood, red cell suspension 4U; an anthracycline antibiotic (ACM) regimen sequential chemotherapy was prescribed, including the day of surgery. Postoperative recovery of patients. Paraffin sections reported: uterine choriocarcinoma, superficial myometrial infiltration of the uterus, right uterine horn serosa infiltration depth, chronic cervicitis, ovaries, tubes without obvious abnormalities. After the end of the first chemotherapy treatment, blood HCG level was 175.0mU/ml, Hb 103g/L. Before the start of the second course of treatment, serum HCG had returned to normal. Patients continued with ACM regimen for 3 courses of chemotherapy, with persistently normal serum HCG levels. Boils showed mild poison reaction but still followed up.
Two female patients, 16 years old, married, not using contraception, progesterone production at 0. For menopause 74 days, lower abdominal pain for one day upon admission. Upon admission, the patient appeared in pain, conscious, with normal vital signs. X-ray lung examination showed a left-attachment fluid mass measuring 88mm x 50mm x 63mm, Annex liquid mass 50mm x 35mm x 40mm, pelvic plot power 49mm; mHCG 77494mU/ml; 5ml dark red blood. Suspected: ectopic pregnancy? Left tube, choriocarcinoma? Emergency surgery was performed. Intraoperative exploration revealed: on the left side, the isthmus to the ampulla of a violet-blue mass measuring 8cm x 5cm, surface broken; fimbria slightly active bleeding; pelvic sidewall, rectum, sigmoid adhesions, right fallopian tube thickening 3cm swelling distorted. Water umbrella side closed obviously; pelvic hemorrhage 500ml. Rapid frozen section: left tubal choriocarcinoma. Performed left tubal resection + right fallopian tube stoma + adhesion decomposition technique. All cases received ACM sequential chemotherapy on the day of surgery, postoperative recovery was good. Paraffin sections reported: left input d 58 choriocarcinoma. Serum HCG returned to normal after the first course of treatment, liver function abnormal: alanine aminotransferase (ALT) ll5U/L, aspartate aminotransferase (AST) 88U/L. Routine therapy has been symptomatic, Xu function gradually improved. Second course of chemotherapy to 6 days, liver function was abnormal: ALT278U/L, ASTl23U/L; blood, serum HCG was normal. Patients experienced severe headache and insisted on stopping chemotherapy. Outside hospital head and chest CT scan showed no abnormalities. Comprehensive analysis led us to stop chemotherapy and follow up closely. During follow-up, liver function returned to normal, serum HCG remained normal with no other clinical symptoms or signs of metastasis.
Discussion of two cases of patients compared with a rare type of disease. According to Beijing Union Medical College Hospital information, mole choriocarcinoma incubation period of 1 year accounted for 1%; abortion and full-term incubation period of 1 year accounted for 1/2 up to 1 case with an incubation period of 13 years... The patients in this article were separated by more than 18 years from their last pregnancy compared to reports from Beijing Union Medical College Hospital. Example 2 involved ectopic choriocarcinoma. Ectopic choriocarcinoma refers to primary choriocarcinoma outside the uterus rather than secondary transfer to the input d tube or ovarian metastatic cancer. Although there are case literature reports, it is rare, and some yet to be confirmed by pathology. Both special cases in the hospital were confirmed by surgery and pathology. Choriocarcinoma treatment involves chemotherapy combined with surgery, radiotherapy, and other treatments. If there is active bleeding, early laparotomy should be considered. Literature reports indicate that malignant trophoblastic tumor cure rates exceed 90%, preserving fertility can still achieve an 80% pregnancy rate]. In this paper, both cases of patients were admitted to the hospital with acute abdomen, pelvic ultrasound prompted a large amount of free liquid, and clinical considerations of active bleeding led to initial surgery followed by chemotherapy. Case 1 is expected to complete chemotherapy. Example 2, at the end of the first course of treatment, serum HCG returned to normal, but liver dysfunction was evident, severe headache was unbearable, and could not complete the second course of chemotherapy. Based on the second course of chemotherapy, indications suggest that after the end of the first course of chemotherapy, serum HCG did not decrease within 3 weeks or increased or decreased less than 1 pair within 18 days, so chemotherapy was stopped and close follow-up initiated, with no clinical symptoms of metastasis or signs.
In summary, I believe that in clinical work involving rare diseases, enough focus should be placed on identifying the characteristics of rare diseases and how targeted therapy can avoid detours and better relieve patient pain.