RESUMEN
Choriocarcinoma has been reported in association with endometrial carcinoma and as a metaplastic change in multiple carcinomas, including liver, urinary bladder, lung, and the gastrointestinal tract. We report choriocarcinoma in conjunction with a carcinosarcoma (also called malignant müllerian mixed tumor) in a 71-year-old woman whose hysterectomy specimen revealed two polypoid lesions of the endometrium, one arising from the anterior endometrium and one arising from the posterior endometrium. Histologic examination revealed three histologic patterns. The anterior endometrial lesion showed a FIGO grade 2 endometrioid endometrial adenocarcinoma. The posterior endometrial lesion showed a carcinosarcoma composed of a high-grade adenocarcinoma and scant homologous stromal sarcoma. In addition, a choriocarcinoma was identified intermixed with the adenocarcinoma. The syncytiocytotrophoblasts and cytotrophoblasts stained strongly with 0 human chorionic gonadotropin (beta-hCG) and human placental lactogen (hPL). The patient's beta-hCG levels on postoperative days 14, 27, and 42 were 283, 32, and 7 mIU/mL, respectively. This unusual case suggests the importance of identifying the choriocarcinomatous component, since the serum beta-hCG can serve as a marker of tumor recurrence postoperatively.
Asunto(s)
Carcinoma Endometrioide/patología , Carcinosarcoma/patología , Coriocarcinoma/complicaciones , Coriocarcinoma/patología , Neoplasias Endometriales/patología , Tumor Mulleriano Mixto/patología , Neoplasias Ováricas/patología , Neoplasias Uterinas/complicaciones , Neoplasias Uterinas/patología , Anciano , Biomarcadores de Tumor/aislamiento & purificación , Carcinoma Endometrioide/complicaciones , Carcinosarcoma/complicaciones , Coriocarcinoma/cirugía , Gonadotropina Coriónica Humana de Subunidad beta/sangre , Neoplasias Endometriales/complicaciones , Femenino , Humanos , Histerectomía , Tumor Mulleriano Mixto/complicaciones , Neoplasias Ováricas/complicaciones , Resultado del Tratamiento , Neoplasias Uterinas/cirugíaRESUMEN
Fibroepithelial polyps of the ureter are rare, benign tumors often not easily distinguished from malignant transitional-cell carcinomas by radiologic means. Historically, many patients have undergone unnecessary nephroureterectomy for these lesions. With recent advancement in endourologic instrumentation, a biopsy-proven diagnosis of suspect upper-tract lesions can be made prior to definitive therapy. We describe a typical case of fibroepithelial ureteral polyp wherein the diagnosis and surgical treatment was accomplished entirely by endoscopic means.