Metastasia Lesion of Gestation Trophoblastic Tumor in Abdominopelvic Cavity Diagnosed by Sonographic and Doppler Imaging
Affiliation(s)
Department of Ultrasound Diagnostics, The First Affiliated Hospital of the Baotou Medical College, Baotou, China.
Department of Ultrasound Diagnostics, The First Affiliated Hospital of the Baotou Medical College, Baotou, China.
ABSTRACT
Objective: The purpose of this study was to review clinical data of metastasia lesion of gestation trophoblastic tumor (GTT) in abdominopelvic cavity by color Doppler ultrasound. Subjects and Methods: A retrospective analysis of 13 cases of GTT in China was performed. Clinical appearances, serum human chorionic gonadotropin (hCG) levels, sonographic findings, Doppler waveforms, and patient outcomes were followed up. Color Doppler ultrasound was performed to diagnose the presence of GTT, detect metastasia lesion in abdominopelvic cavity, assess disease recurrence, and monitor the efficacy of chemotherapy. Results: Of the 13 patients with GTT, 4 had choriocarcinoma which 3 cases occurred after an abortion, 1 after a year of dilation and suction evacuation for the hydatidform mole. Metastasia lesion in abdominopelvic cavity was detected by color Doppler ultrasound in all cases of choriocarcinoma, among which the metastasia lesion were found at uterine fundus, near uterus, colon and cystic vascular space near the uterus, repectively. 9 cases with an invasive hydatidiforn mole (IHM) occurred after one to three months of dilation and suction evacuation for the hydatidform mole, consistant with the hCG levels markedly elevating. Metastasia lesion in abdominopelvic cavity was also detected by color Doppler ultrasound besides invasive lesion in uterine muscular layer in all cases of IHM, among which 3 cases showed metastasia lesion in cystic vascular space near the uterus, 2 cases were detected in side wall of pelvic cavity, while the rest were found in abdominal cavity, right kidney, colon and near uterus, respectively. Meanwhile, the image of metastasia lesion with IHM was similar to choriocarcinoma’s. And the reticular structure, the cystic vascular space and solid lesion may be showed by ultrasound. The metastasia lesion had abundant flow. Doppler waveforms showed resistive indices of 0.34 (SD 0.07) for metastasia lesion. There was the same lower-impedance as invasive lesion in uterine muscular layer. Except an IHM with the renal metastasia lesion having been followed, abnormal sonographic and Doppler findings in other metastasia disease all disappeared after surgical operation or chemotherapy were successful. Conclusions: Sonography and Doppler imaging were helpful in detecting metastasia lesion in abdominopelvic cavity, and in following the effectiveness of chemotherapy. And it should be taken full examination for GTT by Color Doppler ultrasound in order to avoid mistake.
Objective: The purpose of this study was to review clinical data of metastasia lesion of gestation trophoblastic tumor (GTT) in abdominopelvic cavity by color Doppler ultrasound. Subjects and Methods: A retrospective analysis of 13 cases of GTT in China was performed. Clinical appearances, serum human chorionic gonadotropin (hCG) levels, sonographic findings, Doppler waveforms, and patient outcomes were followed up. Color Doppler ultrasound was performed to diagnose the presence of GTT, detect metastasia lesion in abdominopelvic cavity, assess disease recurrence, and monitor the efficacy of chemotherapy. Results: Of the 13 patients with GTT, 4 had choriocarcinoma which 3 cases occurred after an abortion, 1 after a year of dilation and suction evacuation for the hydatidform mole. Metastasia lesion in abdominopelvic cavity was detected by color Doppler ultrasound in all cases of choriocarcinoma, among which the metastasia lesion were found at uterine fundus, near uterus, colon and cystic vascular space near the uterus, repectively. 9 cases with an invasive hydatidiforn mole (IHM) occurred after one to three months of dilation and suction evacuation for the hydatidform mole, consistant with the hCG levels markedly elevating. Metastasia lesion in abdominopelvic cavity was also detected by color Doppler ultrasound besides invasive lesion in uterine muscular layer in all cases of IHM, among which 3 cases showed metastasia lesion in cystic vascular space near the uterus, 2 cases were detected in side wall of pelvic cavity, while the rest were found in abdominal cavity, right kidney, colon and near uterus, respectively. Meanwhile, the image of metastasia lesion with IHM was similar to choriocarcinoma’s. And the reticular structure, the cystic vascular space and solid lesion may be showed by ultrasound. The metastasia lesion had abundant flow. Doppler waveforms showed resistive indices of 0.34 (SD 0.07) for metastasia lesion. There was the same lower-impedance as invasive lesion in uterine muscular layer. Except an IHM with the renal metastasia lesion having been followed, abnormal sonographic and Doppler findings in other metastasia disease all disappeared after surgical operation or chemotherapy were successful. Conclusions: Sonography and Doppler imaging were helpful in detecting metastasia lesion in abdominopelvic cavity, and in following the effectiveness of chemotherapy. And it should be taken full examination for GTT by Color Doppler ultrasound in order to avoid mistake.
Cite this paper
Yan, G. , Yuan, Y. , Liu, Y. , Lv, Y. and Li, A. (2015) Metastasia Lesion of Gestation Trophoblastic Tumor in Abdominopelvic Cavity Diagnosed by Sonographic and Doppler Imaging. Open Journal of Clinical Diagnostics, 5, 24-31. doi: 10.4236/ojcd.2015.51005.
Yan, G. , Yuan, Y. , Liu, Y. , Lv, Y. and Li, A. (2015) Metastasia Lesion of Gestation Trophoblastic Tumor in Abdominopelvic Cavity Diagnosed by Sonographic and Doppler Imaging. Open Journal of Clinical Diagnostics, 5, 24-31. doi: 10.4236/ojcd.2015.51005.
References
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http://dx.doi.org/10.1016/j.crad.2007.03.009 [4] Suprasert, P., Eua-Throngchit, J., Srisomboon, J., Charoenkwan, K., Siriaree, S. and Phongnarisorn, C. (2005) Radiologic Features and Treatment Outcomes of Pulmonary Metastasis in Gestational Trophoblastic Neoplasia. Journal of the Medical Association of Thailand, 88, 875-880. [5] Park, S.G., Chang, J.Y., Kim, S.H. and Bang, D. (2005) Cutaneous Metastasis of Choriocarcinoma: A Case Report. Journal of Korean Medical Science, 20, 683-686.
http://dx.doi.org/10.3346/jkms.2005.20.4.683 [6] Zhang, Y., Xiang, Y., Ren, T., Wan, X.R. and Yang, X.Y. (2005) Study on the Indication of Surgical Resection of Pulmonary Metastasis of Malignant Trophoblastic Tumor. Chinese Journal of Obstetrics and Gynecology, 40, 83-86. [7] Perroni, D., Grecchi, G.L., La Ciura, P. and Landoni, F. (1993) Right Ventricular Metastasis from Choriocarcinoma: Report of a Rare Case and Review of the Literature. European Journal of Surgical Oncology, 19, 378-381. [8] Yamamoto, N., Shinoda, I., Takeuchi, T., Matsuda, S., Kuriyama, M., Ban, Y. and Kawada, Y. (1988) A Case of Pure Choriocarcinoma of the Testis with Cerebellar Metastasis. Hinyokika Kiyo/Acta Urologica Japonica, 34, 1475-1478. [9] Ren, T., Xiang, Y., Yang, X.Y., et al. (2000) Treatment and Prognosis Gestation Trophoblastic Tumor in Bladder Metastasis. Chinese Journal of Obstetrics and Gynecology, 1, 36-38. [10] Zhou, Q., Lei, X.Y., Xie, Q. and Cardoza, J.D. (2005) Sonographic and Doppler Imaging in the Diagnosis and Treatment of Gestational Trophoblastic Disease: A 12-Year Experience. Journal of Ultrasound in Medicine, 24, 15-24. [11] Lei, X.Y., Xi, M.Y., Liu, J., et al. (1996) Study of Trophoblastic Disease by Color Doppler Flow Imaging. Journal of Xi’an Medical University, 17, 328-329. [12] Song, H.Z., Wu, B.Z. and Tang, M.Y. (1983) The Diagnosis and Therapy in Trophoblastic Tumor. People’s Sanitation Publish Company, Beijing, 110-115. [13] Ho, H.N., Gill III, T.J., Klionsky, B., Ouyang, P-C., Hsieh, C-Y., Seski, J., et al. (1989) Differences between White and Chinese Populations in Human Leukocyte Antigen Sharing and Gestational Trophoblastic Tumors. American Journal of Obstetrics and Gynecology, 161, 942-948.
http://dx.doi.org/10.1016/0002-9378(89)90758-8 [14] Chan, F.Y., Chau, M.T., Pun, T.C., Lam, C., Ngan, H.P. and Wong, R.L. (1995) A Comparison of Color Doppler Sonography and the Pelvis Arteriogram in Assessment of Patients with Gestational Trophoblastic Disease. British Journal of Obstetrics and Gynaecology, 102, 702-725. [15] Xiang, Y., Yang, X., Yang, N. and Song, H. (1998) A Comparative Study of Transvaginal Ultrasonograhy and Pelvic Arteriogram in Assessment of Patients with Gestational Trophoblastic Tumour. Chinese Medical Sciences Journal, 13, 45-48. [16] Taylor, K.J., Schwartz, P.E. and Kohorn, E.I. (1987) Gestational Trophoblastic Neoplasia: Diagnosis with Doppler US. Radiology, 165, 445-448.
http://dx.doi.org/10.1148/radiology.165.2.2821575 [17] Carter, J., Fowler, J., Carlson, J., Saltzman, A., Byers, L., Carson, L., et al. (1993) Transvaginal Color Flow Doppler Sonography in the Assessment of Gestational Trophoblastic Disease. Journal of Ultrasound in Medicine, 12, 595-599. [18] Flam, F. (1994) Colour Flow Doppler for Gestational Trophoblastic Neoplasia. European Journal of Gynaecological Oncology, 15, 443-448. [19] Sui, X.F., Li, M.G., Zhao, Z.H. and Ye, X.J. (2006) Value of Color Doppler Flow Imaging in Malignant Gestational Trophoblastic Tumors. Chinese Journal of Ultrasound Diagnosis, 7, 446-448. [20] Shi, Y.F., Ye, D.F., Lu, W.G., et al. (2001) Dynamic Observation of Uterine Lesion Gestational Trophoblastic Tumor with Color Doppler Blood Flow Imaging. Journal Practical Obstetrics and Gynecology, 17, 90-92. [21] Hong, Y., Zhong, W.J. and Fu, X.Y. (2004) Value of Transvaginal Color Doppler Flow Imaging in Diagnosing Choriocarcinoma. Chinese Journal of Ultrasound Diagnosis, 5, 193-195. [22] Chen, Z.N. (1992) Gestational Trophoblastic Diseases. In: Du, X.G., Ed., Pathology of Obstetrics and Gynecology, Shanghai Medical University, Shanghai, 50-57. [23] Jauniaux, E. (1997) Diagnosis and Follow-Up of Gestational Trophoblastic Disorders. In: Rumak, C.M., Wilson, S.R. and Charboneau, J.W., Eds., Diagnostic Ultrasound, 2nd Edition. Mosby Co., St. Louis, 847-856. [24] Cole, M.E., Broaddus, R., Thaker, P., Landen, C. and Freedman, R.S. (2008) Placental-Site Trophoblastic Tumors: A Case of Resistant Pulmonary Metastasis. Nature Clinical Practice Oncology, 5, 171-175.
http://dx.doi.org/10.1038/ncponc1042 [25] Milingos, D., Doumplis, D., Savage, P., Seckl, M., Lindsay, I. and Smith, J.R. (2007) Placental Site Trophoblastic Tumor with an Ovarian Metastasis. International Journal of Gynecological Cancer, 17, 925-927.
http://dx.doi.org/10.1111/j.1525-1438.2007.00881.x [26] Aoki, Y., Kase, H., Kashima, K., Yahata, T. and Tanaka, K. (2005) Placental site Trophoblastic Tumor Presenting as Subaponeurotic Metastasis. International Journal of Gynecological Cancer, 15, 385-388.
http://dx.doi.org/10.1111/j.1525-1438.2005.15235.x [27] Metindir, J., Pak, I., Ozdilekcan, C. and Eren, E. (2005) Chemoresistant Placental Site Trophoblastic Tumor with Hilar Lymph Lesion Metastasis: An Unusual Site of Involvement. Gynecologic Oncology, 96, 552-555.
http://dx.doi.org/10.1016/j.ygyno.2004.10.030 [28] Guvendag, G.E.S., Guven, S., Esinler, I., Ayhan, A., Kucukali, T. and Usubutun, A. (2004) Placental site Trophoblastic Tumor in a Patient with Brain and Lung Metastases. International Journal of Gynecological Cancer, 14, 558-563.
http://dx.doi.org/10.1111/j.1048-891x.2004.014322.x [29] Bruni, R., Nigita, G., Pagani, G.B.V., Petrocca, S. and Terenzi, A. (2003) Adrenal Metastatic Placental Site Trophoblastic Tumor. Case Report. Chirurgia Italiana, 55, 257-260.
[1] Xie, X. (2003) Gestation Trophoblastic Disease. In: Le, J., Ed., Gynecology and Obstetrics, 6th Edition, People’s Sanitation Publish Company, Beijing, 319-328. [2] Fox, H. (1991) Female Reproductive System. In: Anderson, M.C., Ed., Systemic Pathology, Volume 6, 3rd Edition, Churchill Livingstone, New York, 435-445. [3] Xu, X.J., Lou, F.L., Zhang, M.M., Pan, Z.M. and Zhang, L. (2007) Usefulness of Low-Dose CT in the Detection of Pulmonary Metastasis of Gestational Trophoblastic Tumours. Clinical Radiology, 62, 998-1003.
http://dx.doi.org/10.1016/j.crad.2007.03.009 [4] Suprasert, P., Eua-Throngchit, J., Srisomboon, J., Charoenkwan, K., Siriaree, S. and Phongnarisorn, C. (2005) Radiologic Features and Treatment Outcomes of Pulmonary Metastasis in Gestational Trophoblastic Neoplasia. Journal of the Medical Association of Thailand, 88, 875-880. [5] Park, S.G., Chang, J.Y., Kim, S.H. and Bang, D. (2005) Cutaneous Metastasis of Choriocarcinoma: A Case Report. Journal of Korean Medical Science, 20, 683-686.
http://dx.doi.org/10.3346/jkms.2005.20.4.683 [6] Zhang, Y., Xiang, Y., Ren, T., Wan, X.R. and Yang, X.Y. (2005) Study on the Indication of Surgical Resection of Pulmonary Metastasis of Malignant Trophoblastic Tumor. Chinese Journal of Obstetrics and Gynecology, 40, 83-86. [7] Perroni, D., Grecchi, G.L., La Ciura, P. and Landoni, F. (1993) Right Ventricular Metastasis from Choriocarcinoma: Report of a Rare Case and Review of the Literature. European Journal of Surgical Oncology, 19, 378-381. [8] Yamamoto, N., Shinoda, I., Takeuchi, T., Matsuda, S., Kuriyama, M., Ban, Y. and Kawada, Y. (1988) A Case of Pure Choriocarcinoma of the Testis with Cerebellar Metastasis. Hinyokika Kiyo/Acta Urologica Japonica, 34, 1475-1478. [9] Ren, T., Xiang, Y., Yang, X.Y., et al. (2000) Treatment and Prognosis Gestation Trophoblastic Tumor in Bladder Metastasis. Chinese Journal of Obstetrics and Gynecology, 1, 36-38. [10] Zhou, Q., Lei, X.Y., Xie, Q. and Cardoza, J.D. (2005) Sonographic and Doppler Imaging in the Diagnosis and Treatment of Gestational Trophoblastic Disease: A 12-Year Experience. Journal of Ultrasound in Medicine, 24, 15-24. [11] Lei, X.Y., Xi, M.Y., Liu, J., et al. (1996) Study of Trophoblastic Disease by Color Doppler Flow Imaging. Journal of Xi’an Medical University, 17, 328-329. [12] Song, H.Z., Wu, B.Z. and Tang, M.Y. (1983) The Diagnosis and Therapy in Trophoblastic Tumor. People’s Sanitation Publish Company, Beijing, 110-115. [13] Ho, H.N., Gill III, T.J., Klionsky, B., Ouyang, P-C., Hsieh, C-Y., Seski, J., et al. (1989) Differences between White and Chinese Populations in Human Leukocyte Antigen Sharing and Gestational Trophoblastic Tumors. American Journal of Obstetrics and Gynecology, 161, 942-948.
http://dx.doi.org/10.1016/0002-9378(89)90758-8 [14] Chan, F.Y., Chau, M.T., Pun, T.C., Lam, C., Ngan, H.P. and Wong, R.L. (1995) A Comparison of Color Doppler Sonography and the Pelvis Arteriogram in Assessment of Patients with Gestational Trophoblastic Disease. British Journal of Obstetrics and Gynaecology, 102, 702-725. [15] Xiang, Y., Yang, X., Yang, N. and Song, H. (1998) A Comparative Study of Transvaginal Ultrasonograhy and Pelvic Arteriogram in Assessment of Patients with Gestational Trophoblastic Tumour. Chinese Medical Sciences Journal, 13, 45-48. [16] Taylor, K.J., Schwartz, P.E. and Kohorn, E.I. (1987) Gestational Trophoblastic Neoplasia: Diagnosis with Doppler US. Radiology, 165, 445-448.
http://dx.doi.org/10.1148/radiology.165.2.2821575 [17] Carter, J., Fowler, J., Carlson, J., Saltzman, A., Byers, L., Carson, L., et al. (1993) Transvaginal Color Flow Doppler Sonography in the Assessment of Gestational Trophoblastic Disease. Journal of Ultrasound in Medicine, 12, 595-599. [18] Flam, F. (1994) Colour Flow Doppler for Gestational Trophoblastic Neoplasia. European Journal of Gynaecological Oncology, 15, 443-448. [19] Sui, X.F., Li, M.G., Zhao, Z.H. and Ye, X.J. (2006) Value of Color Doppler Flow Imaging in Malignant Gestational Trophoblastic Tumors. Chinese Journal of Ultrasound Diagnosis, 7, 446-448. [20] Shi, Y.F., Ye, D.F., Lu, W.G., et al. (2001) Dynamic Observation of Uterine Lesion Gestational Trophoblastic Tumor with Color Doppler Blood Flow Imaging. Journal Practical Obstetrics and Gynecology, 17, 90-92. [21] Hong, Y., Zhong, W.J. and Fu, X.Y. (2004) Value of Transvaginal Color Doppler Flow Imaging in Diagnosing Choriocarcinoma. Chinese Journal of Ultrasound Diagnosis, 5, 193-195. [22] Chen, Z.N. (1992) Gestational Trophoblastic Diseases. In: Du, X.G., Ed., Pathology of Obstetrics and Gynecology, Shanghai Medical University, Shanghai, 50-57. [23] Jauniaux, E. (1997) Diagnosis and Follow-Up of Gestational Trophoblastic Disorders. In: Rumak, C.M., Wilson, S.R. and Charboneau, J.W., Eds., Diagnostic Ultrasound, 2nd Edition. Mosby Co., St. Louis, 847-856. [24] Cole, M.E., Broaddus, R., Thaker, P., Landen, C. and Freedman, R.S. (2008) Placental-Site Trophoblastic Tumors: A Case of Resistant Pulmonary Metastasis. Nature Clinical Practice Oncology, 5, 171-175.
http://dx.doi.org/10.1038/ncponc1042 [25] Milingos, D., Doumplis, D., Savage, P., Seckl, M., Lindsay, I. and Smith, J.R. (2007) Placental Site Trophoblastic Tumor with an Ovarian Metastasis. International Journal of Gynecological Cancer, 17, 925-927.
http://dx.doi.org/10.1111/j.1525-1438.2007.00881.x [26] Aoki, Y., Kase, H., Kashima, K., Yahata, T. and Tanaka, K. (2005) Placental site Trophoblastic Tumor Presenting as Subaponeurotic Metastasis. International Journal of Gynecological Cancer, 15, 385-388.
http://dx.doi.org/10.1111/j.1525-1438.2005.15235.x [27] Metindir, J., Pak, I., Ozdilekcan, C. and Eren, E. (2005) Chemoresistant Placental Site Trophoblastic Tumor with Hilar Lymph Lesion Metastasis: An Unusual Site of Involvement. Gynecologic Oncology, 96, 552-555.
http://dx.doi.org/10.1016/j.ygyno.2004.10.030 [28] Guvendag, G.E.S., Guven, S., Esinler, I., Ayhan, A., Kucukali, T. and Usubutun, A. (2004) Placental site Trophoblastic Tumor in a Patient with Brain and Lung Metastases. International Journal of Gynecological Cancer, 14, 558-563.
http://dx.doi.org/10.1111/j.1048-891x.2004.014322.x [29] Bruni, R., Nigita, G., Pagani, G.B.V., Petrocca, S. and Terenzi, A. (2003) Adrenal Metastatic Placental Site Trophoblastic Tumor. Case Report. Chirurgia Italiana, 55, 257-260.