Tratamiento quirúrgico de un tumor trofoblástico mixto, Reporte de Caso Clínico

Abstract

Choriocarcinoma is a rare, highly malignant gestational trophoblastic neoplasia; it originates from trophoblast cells, although its presence is aggressive and with a high tendency toward early metastasis, which can mainly occur in the lungs, brain, liver, and gastrointestinal tract. We report the case of a 40-year-old woman with a gynecological-obstetric history of 4 pregnancies, 2 cephalovaginal births, and 2 abortions treated with uterine curettage, the last one 40 days prior to her hospital admission. She presented with a 48-hour clinical picture of heavy genital bleeding, accompanied by dizziness and hypogastric pain. A transvaginal ultrasound was performed which showed thickened endometrium (12mm) with apparent chorioplacental remnants and BETA HCG values ​​of 103139. Uterus in AVF increased in size measuring 119x58x57 mm, so a cervical dilation + MVA + endouterine curettage + transoperative ultrasound was performed. A mixed trophoblastic tumor was obtained: choriocarcinoma + epitheloid trophoblastic tumor; in the auxiliary immunohistochemical studies, HCG was found: diffuse positive in syncytiotrophoblast tumor cells, P63 positive in cytotrophoblast tumor cells, KI 67 positive in 70% of the tumor cells, after which a radical hysterectomy + bilateral iliac emptying was performed by the oncological surgery service. After scheduled surgery, the clinical evolution was favorable and the patient was followed up for 2 years with negative BETA HCG values ​​and no evidence of metastasis or lymphovascular invasion.