López-Carpintero N, de la Fuente-Valero J, Salazar-Arquero FJ, Casado-Fariñas I, Hernández-Aguado JJ

Language: Spanish
References: 20
Page: 253-258
PDF size: 364.41 Kb.

ABSTRACT

Exaggerated placental site, a trophoblastic benign lesion, is characterized by an extensive infiltration of the endometrium, myometrium and arterial walls by intermediate trophoblast cells. Trophoblastic benign lesions are often an incidental finding in the anatomopathological study, but may be associated with severe bleeding especially in relation to trauma.
Case report: Multigravida 39 years old with excessive uterine bleeding after medical treatment of abortion. Once expelled gestational vesicle is seen sonographically a uterine cavity occupied by a heterogeneous endometrium with maximum anteroposterior diameter of 21 mm, plenty of color map, reaching myometrium. B-HCG serum is 164 mIU/ml. During hysteroscopy a massive bleeding happens and its necesary to use an intrauterine catheter to stop it. Computed tomography angiography shows suggestive findings of uterine vascular malformation. A hysterectomy as a diagnostic and definitive treatment is made and pathology reports an exaggerated placental site.

REFERENCES

1. Horn LC, Vogel M. Gestational trophoblastic disease. Non-villous forms of gestational trophoblastic disease. Pathology 2004; 25:281-291.

2. Yeasmin S, Nakayama K, Katagiri A, Ishikawa M et al. Exaggerated placental site mimicking placental site trophoblastic tumor: case report and literature review. Eur J Gynaecol Oncol 2010; 31:586-589.

3. Liu G, Yuan B,Wang Y. Exaggerated placental site leading to postpartum hemorrhage: a case report. J Reprod Med 2013; 58:448-450.

4. Baergen, RN. Gestational trophoblastic disease: Pathology. In: UpToDate, Goff B (Ed), UpToDate, Waltham, MA, 2014.

5. Rincón AE, Torres RM, Torres CO, Ávila CE, Martínez HV. Incidencia de enfermedad trofoblásica gestacional detectada mediante estudio histopatológico de rutina en especímenes obtenidos de aborto. Ginecol Obstet Mex 2008;76: 81-87.

6. Chen X, Shi Y, Xie X. The clinical and pathological characteristics of exaggerated placental site. Zhonghua Fu Chan Ke Za Zhi 1998; 33:352-354.

7. Martin BH, Kim JH. Changes in gestational trophoblastic tumors over four decades. A Korean experience. J Reprod Med 1998; 43:60-68.

8. Altman AD, Bentley B, Murray S, Bentley JR. Maternal agerelated rates of gestational trophoblastic disease. Obstet Gynecol 2008; 112: 244-250.

9. Smith HO. Gestational trophoblastic disease epidemiology and trends. Clin Obstet Gynecol. 2003;46:541-556.

10. Chiang JW, Berek JS. Gestational trophoblastic disease: Epidemiology, clinical manifestations and diagnosis. In: UpToDate, Goff B (Ed), UpToDate, Waltham, MA, 2014

11. Nasu K, Fujisawa K, Yoshimatsu J, Miyakawa I. Uterine arteriovenous malformation: ultrasonographic, magnetic resonance and radiological findings. Gynecol Obstet Invest 2002;53:191-194.

12. Huang MW, Muradali D, Thurston WA, Burns PN et al. Uterine arteriovenous malformations: gray-scale and Doppler US features with MR imaging correlation. Radiology 1998;206:115-23.

13. Hasegawa T, Matsui K, Yamakawa Y, Ota S et al. Exaggerated placental site reaction following an elective abortion. J Obstet Gynaecol Res 2008; 34:609-612.

14. Emoto M, Sadamori R, Hachisuga T, Kawarabayashi T et al. Clinical usefulness of contrast-enhanced color Doppler ultrasonography in invasive and noninvasive gestational trophoblastic diseases: a preliminary study. J Reprod Med 2011; 56:224-234.

15. Lim AK, Agarwal R, Seckl MJ, Newlands ES et al. Embolization of bleeding residual uterine vascular malformations in patients with treated gestational trophoblastic tumors. Radiology 2002; 222:640-644.

16. Pisal N, North C, Tidy J, Hancock B. Role of hysterectomy in management of gestational trophoblastic disease. Gynecol Oncol 2002; 87:190-2.

17. Kaunitz AM. Differential diagnosis of genital tract bleeding in woman. In: UpToDate, Barbieri RL (Ed), UpToDate, Waltham, MA, 2014.

18. Motoyama T,Ohta T,Ajioka Y,Watanabe H. Neoplasticandnonneoplastic intermediate trophoblasts: an immunohistochemical and ultrastructuralstudy. Pathol Int 1994; 44:57-65.

19. Shen DH, Liao XY, Liu YL, Wang H et al. Clinicopathological study of intermediate trophoblastic non-tumor lesions: exaggerated placental site and placental site nodule. Zhonghua Bing Li Xue Za Zhi 2004; 33:441-444.

20. Shih IM, Kurman RJ. Ki-67 labeling index in the differential diagnosis of exaggerated placental site, placental site trophoblastic tumor, and choriocarcinoma: a double immunohistochemical staining technique using Ki-67 and Mel-CAM antibodies. Hum Pathol 1998; 29:27-33.