April 23rd, 2017

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Title:
Primary Gestational Trophoblastic Disease of the Fallopian Tube: A Case Series Analysis and Literature Review
Authors:  Jiaqi Lu, M.D., Xiaoni Yue, M.D., Ph.D., Congjian Xu, M.D., Ph.D., and Xin Lu, M.D., Ph.D.
  OBJECTIVE: To review the clinicopathological characteristics, diagnosis, and treatment of tubal gestational trophoblastic disease (GTD) misdiagnosed as tubal pregnancy.

STUDY DESIGN: From January 1, 2004, to December 31, 2013, a total of 619 patients with GTD were recorded at the Obstetrics and Gynecology Hospital of Fudan University. Among them, 4 cases of tubal GTD were initially misdiagnosed as tubal pregnancies. We retrospectively analyzed the clinicopathologic characteristics, diagnosis, treatment, and prognosis of those 4 patients.

RESULTS: All 4 patients showed symptoms similar to those of tubal pregnancy. The serum human chorionic gonadotropin (β-hCG) level at presentation was elevated >50,000 mIU/mL. All cases were treated by laparoscopic surgery. Misdiagnosis of the 3 cases of complete hydatidiform mole (CHM) and 1 choriocarcinoma were identified by postoperational histopathology. At 7 days postoperation the β-hCG level decreased to 304–6,115 mIU/mL. One case of tubal CHM received a second operation, and 3 cases received chemotherapy due to the unsatisfactory decrease in β-hCG level. The patient with choriocarcinoma received routine adjuvant chemotherapy. All of the patients achieved complete remission, and none relapsed for a median of 20 months’ follow-up.

CONCLUSION: Tubal GTD is rare and is often misdiagnosed for tubal pregnancy. Salpingectomy, intraoperative frozen section, and close follow-up were recommended, and prophylactic chemotherapy was unnecessary.
Keywords:  choriocarcinoma; diagnosis; fallopian tube; gestational trophoblastic disease; hydatidiform mole, complete; hydatidiform mole, partial; molar pregnancy; placental-site trophoblastic tumor; pregnancy complications; treatment
   
   
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