There are many malignant tumors that are characterized by uncontrolled proliferation of abnormal cellular structures.
Malignant tumors are classified into several groups: carcinomas, melanomas, sarcomas, lymphomas and leukemias, gliomas and teratomas, chorion carcinomas.
These tumors differ in the nature of the tissues from which they form. Some are often found, others are considered a rarity, such as, for example, chorion carcinoma.
What is chorion carcinoma?
So, the chorion carcinoma is a malignant version of trophoblastic pathology, which develops as a result of malignant degeneration of the chorionic epithelium.
The growth of such cells is usually restrained by protective mechanisms such as immunity, the uterine membrane, etc. However, in cases of impaired protection or the penetration of germ cells into the bloodstream and beyond the uterus, chorion carcinoma develops.
Similar tumors are malignant in nature and are characterized by early and transient metastasis of lymphogenous and hematogenous pathways into the pulmonary system, vagina and other organic structures.
Tumor localization in men and women
Women suffer from chorion carcinoma predominantly. They have a similar tumor localized in the uterine body. Significantly less often the neoplasm develops in the fallopian tubes or ovaries.
When a tumor sprouts through the uterine body, it can completely cover the low-tidal space. With this, there can be absolutely no symptoms.
The photo depicts the chorionic carcinoma of the uterus
In some cases, the chorion carcinoma is formed by their embryonic cellular structures of the sex male or female gonads. Such tumors are localized in the bladder, retroperitoneal cavity, gastric or pulmonary tissues, mediastinum or epiphysis. Choriocarcinomas can also develop in the tissues of male testes.
Classification of
Chorionic carcinomas are classified according to the stages or depending on the location of the primary tumor site. Specialists distinguish 4 stages in the development of the tumor process:
- Stage 1 - the tumor is localized in the cavity of the uterine body;
- Stage 2 - the tumor process extends beyond the uterine body, however, does not cross the border of the genitals;
- Stage 3 - metastases are found in the tissues of the pulmonary system;
- Stage 4 - metastasis is extensive, malignant cells are found in organs far from the original focus.
Depending on the location of the initial tumor focus, the chorion carcinoma is classified into:
- Teratogenic;
- Heterotopic;
- Orthotopic chorionic carcinoma.
Teratogenic tumor is not dependent on pregnancy, being a mixed embryonic origin. Such tumors are localized in the mediastinum, urinary tissues, stomach, etc. Chorionic carcinoma of the heterotopic form is initially localized outside the uterine body, being formed in the vagina, brain or lung tissue.
Orthotopic formation is found in the tissues of the uterus, fallopian tubes or peritoneum. Gradually, the tumor grows and penetrates into the vaginal tissues, bladder, pulmonary and intestinal structures, parameters, etc.
Causes of development of
At present, experts have not yet decided definitively with the causes of the chorion carcinoma.
There are suggestions that in the development of choriocarcinoma can contribute:
- Viral diseases , which the patient has had during pregnancy;
- Pathologically low immune status of , as a result of which the system is unable to recognize malignant cells and destroy them in a timely manner;
- Penetration of germ cells into the bloodstream beyond the uterine body ( vagina or tubes), which often happens with the artificial termination of pregnancy, etc.;
- Early regular sexual relations , started before the age of 15;
- Complications of previous pregnancies such as miscarriages, ectopic pregnancy, abortion, frozen pregnancy, etc.;
- Late arrival of the first monthly after 15 years of age;
- Bubble skid. Similar pathology occurs during pregnancy, it is inherent in the germination of placental tissue inside the uterine wall in the form of vesicles.
According to statistics, the cause of chorion carcinoma in 40% of cases is a bladder drift, in a quarter of patients - abortion or childbirth, and 2.5% - ectopic pregnancy. Women after 40 years and Asian women are classified as a risk of such a tumor.
Symptoms of
The main manifestation of choriocarcinoma in its initial stages are vaginal discharge of bloody nature, which patients are often confused with natural secretions characteristic of the postpartum period, after abortions or miscarriages.
Similar discharges are distinguished by periodicity. Scraping, as a rule, does not eliminate this phenomenon.
The bleeding in this tumor occurs in almost 80% of cases. In addition, patients have serous or purulent bleach, which are caused by infection or necrosis of tumor tissue.
When a tumor grows into the uterine walls, the patient experiences pronounced soreness in the lower half of the peritoneum and lumbar region. If the stage of the tumor has reached metastasis, then when spreading into the pulmonary structures, hemoptysis disturbs, in the brain - headaches and other neurological problems.
Chorionepithelioma of the uterus
Chorionepithelioma is a uterine tumor of the trophoblast arising from pregnancy, miscarriage, abortion, ectopic pregnancy, etc.
A characteristic symptom of the chorionic epilepsy is abnormal bleeding from the uterus or vagina, an increased content of p-chorionic gonadotropin.
Typically, these tumors are characterized by aggressive progression, early metastasis and rapid germination in other organs.
In the absence of metastases, prognosis for cure is favorable even without the use of hysterectomy.
With a metastatic chorioepithelioma, a favorable outcome can be expected only if treatment has been initiated in the first 4 months since the beginning of the development of the tumor process.
If metastasis is observed in the pelvis, pulmonary tissues or brain, bone and liver structures, the prognosis is unfavorable. Treatment is based on chemotherapeutic treatment and hysterectomy.
Diagnostics
Diagnostic processes are based on a variety of procedures like:
- Survey. Such a procedure includes the collection of anamnesis, a patient interview, a bimanual vaginal examination;
- Laboratory diagnosis - urine test for hCG;
- Histology. Such a study is usually performed after a diagnostic scraping of the uterine cavity, resulting in a biomaterial. It is in the future that it is subjected to histological examination;
- X-ray study;
- Ultrasound diagnosis;
- Immunological samples;
- Hysteroscopic examination;
- MRI or CT;
- Research on oncomarkers like trophoblastic β-globulin, etc.
Treatment of chorion carcinoma
The main treatment for chorion carcinoma is chemotherapy with one or more antitumor drugs.
The main agents of treatment are Methotrexate, Actinomycin, Leucovorin, Cyclophosphamide, Cisplatinum and others. Such drugs can be administered alone or in combination combinations. The course is a week or two, which is repeated several times.
Operative measures are used for non-stop bleeding, extensive uterine or parasitic lesions, sepsis, and lack of therapeutic efficacy against chemotherapeutic treatment. A uterine extirpation or hysterectomy is performed.
After the operation, chemotherapy is again performed. The cure is said if the content of the chorionic gonadotropin is normalized in three consecutive analyzes taken with a weekly interval.
Prophylaxis and prognosis of
If the treatment was wrong or the oncology progressed to a neglected stage, then the possibility of developing various kinds of complications such as extensive metastasis to the brain tissues is great, which is manifested by a loss of sensitivity or immobility of certain parts of the body.
If metastasis occurs in the liver, then there are painful manifestations in the right hypochondrium. A similar condition is dangerous by rupturing the tissues of the organ and abundant internal bleeding.
With pulmonary metastasis, patients suffer from hemoptysis, chest pains, dyspnoea or an uncontrollable cough, and vaginal metastasis is accompanied by purulent-bloody discharge.
With large sizes of education, there is a high probability of squeezing adjacent structures, which leads to a drawing pain in the abdomen, frequent calls for defecation( false) and rapid urination.
The prognosis in the presence of metastasis is about 70% of the healing. When the tumor is localized in the appendages, the forecast is negative, because such cases do not respond to the chemotherapeutic effect.
After the end of treatment for the prevention of relapse, patients are recommended to be systematically examined by a gynecologist and undergo an X-ray examination procedure. During the first year after therapy, a specialist must be visited every three months.
Usually for this period the patient is prescribed hormonal contraceptives to exclude pregnancy, which is fraught with pathology.
Also for the prevention of such a tumor experts recommend avoiding abortions and planning pregnancy, abandoning unhealthy hobbies like alcohol abuse or smoking, eating healthy foods, etc.
Ultrasound diagnostic ultrasound of choriocarcinoma of testes: