Friday, January 30, 2009

Advanced Maternal Age

This is related to a case suggestion I got from "CodeDog." Thanks!
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A 40 year old woman 12 weeks postpartum presents with irregular vaginal bleeding. Physical examination shows an enlarged uterus. A beta-hCG level is elevated. Imaging shows bilateral ovarian cysts as well as hypervascular heterogeneous mass in the uterus with areas of necrosis and hemorrhage.

Challenge: This is a tough one, what's your impression?

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3 comments:

  1. AlexJanuary 31, 2009 at 1:49 PM

    PCOS -> elevated estrogen/androgens -> feeding some sort of tumor

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  2. AnonymousFebruary 1, 2009 at 8:36 AM

    Choriocarcinoma. The USG findings sound suspiciously like a tumour....elevated hcg levels after pregnancy also point to choriocarcinoma.

    ReplyDelete
  3. CraigFebruary 2, 2009 at 5:42 PM

    yes it is a tumor - chorioCA is the right diagnosis.
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    Advanced Maternal Age

    Gestational trophoblastic disease refers to a group of lesions arising from the trophoblast epithelium of the placenta and includes the hydatidiform mole (noninvasive local tumors), gestational trophoblastic neoplasia, choriocarcinoma, and placental site trophoblastic tumors. This is a choriocarcinoma, a highly malignant germ cell tumor that can be associated with normal pregnancy.

    Source: UpToDate.

    ReplyDelete

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