We present the case of a year-old Caucasian patient, para 2, presenting a cervical well vascularised tumor in the uterine cervix, causing vaginal bleeding that occurred after an evacuated uterine curettage and hemostatically for incomplete abortion. The diagnosis of suspected cervical pregnancy was established based on the imaging aspect: the transvaginal ultrasound showed a parenchymal mass protruding into the cervical canal with intense peripheral vascular network.
The histopathological results correlated with elevated levels of β-hCG uterine cancer nursing diagnosis the diagnosis of choriocarcinoma. Full interaxial hysterectomy was performed.
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- Coriocarcinom gestaţional al colului uterin – prezentare de caz
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Choriocarcinoma has a uterine cancer nursing diagnosis good prognosis, even in advanced stages, because it is a very chemosensitive tumor. Keywords gestational choriocarcinoma of the cervix, gestational uterine cancer nursing diagnosis neoplasia, vaginal bleeding Rezumat Coriocarcinomul primar al colului uterin este o condiţie extrem de rară, care ar trebui luată în considerare în diagnosticul diferenţial al unei formaţiuni de col uterin cu sângerare abundentă, în special din cauza vascularizaţiei intense, mai ales la femeile tinere.
Prezentăm cazul unei paciente în vârstă de 31 de ani, secundipară, care prezintă o formaţiune tumorală bine vascularizată la nivelul colului uterin, cauzatoare de sângerări vaginale debutate în urma unui chiuretaj uterin evacuator şi hemostatic pentru uterine cancer nursing diagnosis spontan incomplet. Diagnosticul cancer col uterin evolutie suspiciune de sarcină cervicală a fost stabilit pe baza aspectului imagistic: ecografia transvaginală arată o masă parenchimatoasă care uterine cancer nursing diagnosis în canalul cervical, cu reţea vasculară periferică intensă.
Rezultatele histopatologice corelate cu nivelurile crescute de β-hCG au sugerat diagnosticul de coriocarcinom. A fost efectuată histerectomie totală interanexială. Coriocarcinomul are un prognostic foarte bun, chiar şi în stadii avansate, deoarece este o tumoare foarte chimiosensibilă. Cuvinte cheie coriocarcinom gestaţional al colului uterin neoplazie trofoblastică gestaţională sângerări vaginale Introduction Gestational trophoblastic neoplasia GTN includes invasive moles, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor.
These tumors develop almost always with or after a certain form of pregnancy. In the absence of tissues for a definitive histopathological diagnosis, the disease GTN is diagnosed as a result of persistent human chorionic gonadotropin β-hCG after evacuation of a molar pregnancy.
Gestational choriocarcinoma is the most uterine cancer nursing diagnosis type of trophoblastic neoplasm following a term pregnancy or spontaneous abortion, and only a third of cases occur after a molar pregnancy.
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Choriocarcinoma consists of reminiscent cells of early cytotrophoblasty and syncytiotrophoblast, but it does not contain vilosities. Choriocarcinomas are usually accompanied by luteal ovarian cysts 1. Gestational choriocarcinoma usually occurs in the uterine cavity and is associated with the coincidence or antecedent of pregnancy. Extrauterine choriocarcinomas are very rare, and most of them are located in the cervix 2.
Case report A year-old patient with uterine cancer nursing diagnosis DUM was uterine cancer nursing diagnosis in our clinic September 4, with vaginal bleeding which had started about half a month before, for investigations and specialised treatment.
Following the clinical examination after uterine cancer nursing diagnosis in our clinic, the local exam showed the vulva and vaginal examination of normal appearance, the posterior cervix through which polyposis injuries externalized, the vaginal tact revealed uterus in AVF of quasi-normal dimensions, without tact sensitivity and cervix mobilizing, impalpable annexes, free Douglas.
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A transvaginal ultrasound showed a parenchymal mass protruding into the cervical canal with intense peripheral vascular network. Colposcopic examination: exocol circumscribed by the mammalian ectropion area, at the left epithelium acetoalb epithelium; in the cervical canal polypoid formation with vascular changes at the touch. Biopsy and β-hCG were recommended in dynamics. On September 11,endocervical curettage endocervical curettage with sending of extracted material to the histopathological examination, maneuver performed after placing two stitches on the cervicovaginal for hemostatic purposes, placed a Foley probe in the endocolus, minimum metrorrhagia established the diagnosis of choriocarcinoma endocolar.
The uterine cancer nursing diagnosis was discharged, with good general condition, smooth, uterine cancer nursing diagnosis metrorrhagia. Approximately two weeks after dispensing from our clinic, the patient was hospitalized with minimal metrorrhagia.
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On November 8,at about two uterine cancer nursing diagnosis after the last endocervical curettage, it was intervened surgically and decided to perform the interaxial total hysterectomy. Uterine body with hypertrophied muscle fibers. The endometrium with glands in the proliferative and intermediate phase glands, numerically enhanced, like the simple endometrial glandular hyperplasia, dense corion, without atypia.
Leiomyomatous node with interstitial hialinization, 3 cm in diameter pT1 Nx Mx. Figure 1. Choriocarcinoma of the endocervix macroscopic aspect Figure 2. Discussion Gestational trophoblastic neoplasia includes invasive moles, choriocarcinoma, trophoblastic placental tumor, and epithelioid trophoblastic tumor. Half of the cases occur after a hidatiform molar, a quarter after a spontaneous abortion or a tubal ectopic pregnancy, and another quarter develop after a premature or late delivery.
Although these four types of tumors are histologically distinct, they are usually diagnosed only by the persistence of elevated serum levels of β-hCG, as tissue fragments are not always available for uterine cancer nursing diagnosis.
The criteria for the diagnosis of gestational trophoblastic neoplasia after a molar uterine cancer nursing diagnosis are the following: The serum level of β-hCG in the plateau ±10 uterine cancer nursing diagnosis at four determinations over a period of three weeks or longer — days 1, 7, 14, and The serum level of β-hCG remains detectable for six months or longer.
Histological criteria for choriocarcinoma 3. In women, choriocarcinoma usually arises in the uterine cavity, and is associated with coincident or previous pregnancy 2. Extrauterine choriocarcinoma is a rare entity, with the uterine cervix being the most common site and only a few cases reported in literature to date 2.
Several hypotheses have been postulated to explain the pathogenesis of cervical choriocarcinoma. It may develop from cervical metastases from a primary tumor in the corpus that later spontaneously regresses, it is a malignant transformation of a cervical pregnancy, or it is due to uterine cancer nursing diagnosis of chorionic cells from a previous pregnancy that undergo malignant transformations after a dormant period 4.
The accurate diagnosis is difficult because of its rarity. Furthermore, the majority of cases present abnormal vaginal bleeding that could be caused by other more common conditions, including threatened abortion, cervical polyp, cervical pregnancy, or cervical cancer, leading to a potential misdiagnosis 5.
Histology with immunohistochemical evaluation remains the mainstay for diagnosis in most cases 5. Considering that choriocarcinoma is a highly chemosensitive tumor with a general good prognosis even endometrial cancer kidney function advanced stages, the conservation of reproductive function should be considered, if possible 6. Choriocarcinoma is a malignant disease characterized by abnormal trophoblastic hyperplasia and anaplasia, absence of chorionic villi, hemorrhage and necrosis Uterine cancer nursing diagnosis 3rectal cancer hcc direct invasion into the myometrium and vascular invasion resulting in spread to distant sites, most commonly to the lungs, brain, liver, pelvis, vagina, kidney, intestines, and spleen.
Choriocarcinoma has been reported to occur in association with any pregnancy event. Figure 3.
These placental tumors are clinically characterized by aggressive invasion in the myometrium and the tendency to metastasis. The most common uterine cancer nursing diagnosis of gestational trophoblastic neoplasm are irregular bleeding associated with uterine sub-stimulation.
Bleeding may be continuous or intermittent, with sudden and sometimes severe bleeding. Myometrial perforation caused by trophoblastic proliferation may cause uterine cancer nursing diagnosis haemorrhage. In some women, metastases of the inferior genital tract are revealed, while in others there are only distant metastases without signs of a uterine tumor 7.
The recognition of the possibility of gestational trophoblastic neoplasia is the most important element for its diagnosis.
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Unusual persistent bleeding after any type of pregnancy should promptly lead to the measurement of serum levels of β-hCG and to a diagnosis of uterine curettage. The size of the uterus is evaluated along with careful examination of the inferior genital tract for the detection of metastasis, which usually appears as vivid vascular masses.
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There is no need for tissue diagnosis, which is why biopsy is not required, because it can cause significant bleeding 8,9.
With the confirmation of the diagnosis, in addition to the initial determination of serum levels of β-hCG and the result of the blood count, investigations are needed to establish the extent of local disease and metastasis, including liver and kidney function tests, transvaginal ultrasound, CT scan or thoracic radiography, CT scan or cranial and abdominal-pelvic MRI.
Less commonly used for the detection of metastasis are positron-emission tomography PET scanning and determination of the β-hCG level in the cerebrospinal fluid 10, Gestational trophoblastic neoplasia is clinically staged using the score system of the Federation of the International Federation of Gynecology and Obstetrics FIGO It should be stressed again that the diagnosis of trophoblastic neoplasia is uterine cancer nursing diagnosis due to the persistence of elevated serum levels of β-hCG without anatomopathological confirmation.
The clinical staging is performed without taking into account the histological findings, even when available Conclusions Uterine cancer nursing diagnosis is a malignant variant of trophoblastic gestational disease and may arise from a long-term pregnancy, complicated pregnancy by a molar, ectopic pregnancy or abortion.
The diagnosis of choriocarcinoma is only histopathological. The present case uterine cancer nursing diagnosis a year-old woman with a history of evacuation of a pregnancy outgrowth, two months before. During irregular follow-up, misleading ultrasonographic findings and clinical features delayed the diagnosis of choriocarcinoma until there were external changes in the cervix. We report this case because of its unusual presentation, which has led to a diagnostic dilemma and maladministration.
Conflict of interests: The authors declare no conflict of uterine cancer nursing diagnosis Bibliografie 1. Lurain JR. Gestational trophoblastic disease I: epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of hydatidiform mole. Am J Obstet Gynecol. Primary gestational choriocarcinoma of the uterine cervix. Report of a case and review of the literature.
Int J Gynecol Cancer. Hemschemeyer H, Eastman NJ. Williams Obstetrics. The American Journal of Nursing.
Unusual clinical presentations of choriocarcinoma: A systematic review of case reports. Taiwan J Obstet Gynecol.