Chorionepithelioma (Chorionepithelioma)

The possibility of transition of a molar in the horionepiteliome, the most malignant form of all tumors that occur in the human body (M. N. Nikiforov), requires a physician accurate, skilful and timely recognition of this kind of tumor.
Chorionepithelioma, as its name indicates, is developing from the epithelium of the chorion. History of patients with this tumor, always a pregnancy; syncytium can't be there where there was no pregnancy. In 15% of cases (according to efficiency UNESCO-Stroganov 50%) source development horionepitelioma gallbladder is skidding. However, chorionepithelioma may develop in women who have not had of a molar. Especially predisposed to developing this kind of tumor women who had repeatedly miscarriage! According to T. A. Bardinskogo, chorionepithelioma develops in 42% of cases out of a molar, 33% - after miscarriage and 25% - upon term or premature birth. According to contemporary authors (E. I. Quater), rebirth of a molar in the horionepiteliome observed in 5% of all cases of a molar.
Most women chorionepithelioma detected within the first year after the earlier of pregnancy and, moreover, 75% of all cases in the first three months (A. E. Mandelstam). However, the emergence of horionepitelioma may not come until after a longer period - in limits from one year to 15 and more years.
It was stated above that pregnant women who had cystic skidding, are subject to long-term (at least one year) continuous medical supervision. They each month for at least six months urine is examined by biological method Asheim - Condeca to the presence of gonadotropin-releasing hormone. With this method you can accurately diagnose not only of a molar, but also to recognize developing horionepiteliome. Molar quantity of estrogen in ten times more than in a normal pregnancy.
When negative reaction in the next six months study at gonadotropic. a hormone is produced every 2-3 months.
After emptying the uterus from of a molar most women have control examinations of urine on the content of gonadotropic hormone his title immediately begins to decline, and after about two or three weeks reaction Asheim - Condeca becomes negative. However, a number of patients, on the contrary, the positive response continues to 3-4 months, and only then starts to gradually decrease the content of gonadotropin-releasing hormone. It is seen in those women who have a well-developed cysts yellow bodies of the ovaries; the latter includes a significant amount of luteinizing gonadotropic hormone; slow its secretion leads to increased concentration in the urine and after removal of a molar without its rebirth in the horionepiteliome. In this regard, it is easy to fall in diagnostic mistake in thinking that develops chorionepithelioma. Therefore, R. M. Israelson believes that it is necessary to make quantitative determination not only gonadotropic, but hormones oestrogen in women with cystic skidding.
In his opinion, the increase excretion of hormones oestrogen in the presence in the urine of gonadotropin will indicate the lack of a malignant degeneration of the chorion.
In those cases, when the title gonadotropic hormone gradually decreased and the reaction of Asheim - Condeca became negative, and then, at a later study, the titer of gonadotropic hormone began to rise again, consider the possibility of developing horionepitelioma. Here are urgently needed comprehensive examination of the patient (clinical, radiological, histological) by paying attention not only to sexual matters, but also on the respiratory organs (lungs) and other bodies, which most often can metastasize chorionepithelioma. When carrying out differential diagnosis should be excluded again onset and properly developing pregnancy. Chorionepithelioma can develop not only from the rear, body elements eggs after abortion, childbirth, but during pregnancy (both normal and pathological).
A. E. Mandelstam in the monograph, devoted to cancer chorionepithelioma, results in 9 cases, personally, they traced, in which the development of malignant tumors and metastases in the vagina was observed during the presence of a molar in the uterine cavity.
The reasons for the development of horionepitelioma the same molar; weakening of protective forces of an organism at her even more pronounced. In a normal pregnancy, the hairs sprouting occurs only to the border, well-educated decidual cells and necrotic layer. In some cases, delaying the impact of these layers is insufficient, epithelial elements of the villi penetrate deeper, resulting develop metastases, sometimes almost in all organs. In addition to local safety devices, in pregnant develop specific immune body - sinzitialnaya that destroy elements of chorionic villi, recorded in different parts of the body. When horionepiteliome these cinitializer in the body are missing (serum are not able to dissolve young placental cells) and reborn elements Vorsin not die.
When horionepiteliome in most cases primarily affected the uterus, much less commonly, tubes and ovaries. In some cases, the primary tumor develops outside the uterus; the latter remains healthy.
In the case observed by me, and also included in the monograph by A. E. Mandelstam, the tumor is primarily developed on the front wall of the vagina to the left from the middle line, and later (a few days) - in the field of the right bertolinelli cancer.
Chorionepithelioma more often seen in nagaragawa at the age of 21-40 years. In the literature there are indications of the development of this kind of neoplasms even a few years after menopause, from 3 to 22 years (the HP Persianinov). When horionepiteliome, just like molar, there chistovodnoe rebirth of the ovaries.


Fig. 43. Chorionepithelioma cancer.

Macroscopically chorionepithelioma (Fig. 43) represented either as separate units, more or less jutting out into the uterus or in the form of diffuse enlargement in the thick uterine wall (atypical form>. The tumor is the size from a pea to a fist. A. E. Mandelstam results in the case where the tumor was the size of his head by an adult. In both cases the tumor tissue is friability, blood-soaked, from the periphery there was marked tendency towards disintegration and suppuration. Bleeding tissue horionepitelioma so great that often hosts macroscopically can be taken for hemorrhagic foci.
In any tumor is not observed this tendency to metastasis, as if horionepiteliome.
The location of the tumor in maternal blood vessels and the fragility of fabrics create favorable conditions for exclusion of the pieces of the tumor and transfer them into different parts of the body. Skid Torgovlya pieces occurs mainly venous way. Most often metastases occur in the lungs, in the vagina and brain, and so on
For the first time chorionepithelioma vagina was described by C. K. Porembski.
The microscopic picture of horionepitelioma is diverse. In a typical tumor syncytium and laganovskis layer type and location similar to those seen in the early period of pregnancy; in atypical tumor epithelium occurs only in isolated cells. The tumor tissue is built of cells and syncytium laganovska cells; in rare cases, the composition of the tumor include connective tissue angkoriana. In breast tissue adjacent to the periphery of the tumor are various forms of large cells, the so-called wandering, syncytial elements.
In addition, the tumor has necrotic lesions, small cell infiltration about vascular cavities, within which are placed the tumor accumulation; you also see lots of fresh and clotted blood.