Re: Ectopics
From: Joanne Bulley, MD (islesannie@yahoo.com)
Fri Jun 2 20:52:38 2006
That case was 23 years ago ... so not sure we knew that then!
Always good to learn new things, though!
Joanne
At Fri, 2 Jun 2006, art fougner, md wrote:
>
>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
>
--
Joanne Bulley, MD
Keene, NH, USA
"Love is indescribable and unconditional.
I could tell you a thousand things that it is not, but not one that it is."
— Duke Ellington, American jazz artist (1899-1974).
