Re: Ectopics
From: art fougner, md (evsono@pipeline.com)
Fri Jun 2 14:09:13 2006
Joanne -
Sounds as if your patient had Placental-site Trophoblastic Tumor (PSTT).
The literature suggests that HPL might have been a useful marker.
Art
At Fri, 2 Jun 2006, Joanne Bulley, MD wrote:
>
>I think I had someone who had had 3.
>
>I had one person that I had taken care of her second one by laparoscopic
>linear salpingostomy. Then her HCG plateaued and then went up again -
>she had persistent trophoblastic tissue over the pelvis. The fact that
>it was following an ectopic made the issue of diagnosis (was this really
>GTD or was it just placenta that had implanted from the tube?) & staging
>tough. The path from the ectopic was normal withou characteristics of
>GTD (molar) (Gestational Trophoblastic Disease)
>
>She was treated for GTD with methotrexate per protocol for GTD (not the
>small single dose for an ectopic) and had no recurrence after that. No
>further pregnancies either.
>
>It was pretty interesting when the US (after the HCG did not resolve)
>showed a probable hemo-peritnoeum. The laparotomy (I am reaching back
>in the synapses - it was over 8 years ago before I went solo) was
>"interesting" She had her adhesions - but the pelvis had all this soft
>friable implants (?) of tissue - that we biopsied. But all sites (of
>course) all wanted to bleed so we did not try to remove all of it.
>
>My other strange case that started out as thinking ectopic:
>approx 30 ish woman arrives in ER - bellyful of blodd - heading back
>into shock even though 2 large bore IVs running wide open. 12 wks from
>LMP (but we all know how unreliable LMPs are when we are in the ER with
>a shocky patient in pain trying to give history) 2 prior full term
>deliveries and 2 prior terminations.
>
>Laparotomy: "ruptured" uterus -- actually it was a placenta percreta
>that had grown right out through the R fundus of the uterus. The
>pathologists sectioned the cornu to follow the interstitial tube all the
>way through and this was NOt an implantation into the interstitial tube
>that then ruptured. The implantation and subsequent track of placental
>growth was definitely through the myometrium.
>
>I did a world literature search and came up with no other cases similar.
>We guessed that she may have had an asymptomatic perf of the uterus with
>one of her terminations and this pregnancy implanted there - but
>caouldn't really tell that for sure. I presented this for me senior
>research. I never did the necessary steps to write it up for a journal.
>Could have been my only professional publication!
>
>Joanne
>
>At Thu, 01 Jun 2006, Dr Eberhard Lisse wrote:
>>
>>I just took out an ovarian ectopic, unfortunately I was unable to do it
>>by the scope so I did a minilap. I could conserve most ovarian tissue
>>that side, which is important because she had had two tubal ectopics on
>>the other side, where I did a salpingostomy in 2004 and a salpingectomy
>>in 2005.
>>
>>So, if she comes with her fourth ectopic in 2007 I'll write her up.
>>
>>That said, what was the most ectopics in one patient y'all had?
>>
>>Gail, don't answer this, so we don't have to explain to you what an
>>ectopic is.
>>
>>el
>>
>>--
>>Dr. Eberhard W. Lisse \ / Obstetrician & Gynaecologist (Saar)
>>el@lisse.NA el108-ARIN / * | Telephone: +264 81 124 6733 (cell)
>>PO Box 8421 \ / Please send DNS/NA-NiC related e-mail
>>Bachbrecht, Namibia ;____/ to dns-admin@na-nic.com.na
>>
>--
>Joanne Bulley, MD
>Keene, NH, USA
>
--
art fougner, md
"I drank what?" - Socrates
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