Three Cases of

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Three Cases of Chorion Epithilioma
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Reported by Dr. Narayan M. Patel M.D.,D.G.O.
FICS Emeritus Professor Muni. Medical
college Postal address-- Mahalaxmi Institute of
medical teaching, 3, Shantiniketan park,
Naranpura, Nr.Sardar Patel Colony, AHMEDABAD-
380 014 (Gujarat) INDIA T.N.[phone],
Mobile- 98252 95530 E mail- nmpatel1932_at_wilneton
line.net
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All these three cases were seen by the author,
Dr.Narayan M.Patel between year 1970 and 1990,
during his active practice. I had the habit of
always carrying a camera to hospital, where I was
working and also, to carry it to operation
theater. This helped me to document interesting
cases, worth documenting, and hence these
pictures were possible and case report. The first
and second cases were seen by me in the medical
college hospital, where I was working. The next 2
cases, were seen by me in my private hospital.
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First case report -
This patient was referred to a general hospital
with a note by a Gynecologist. The writing of
the note were like this with. This Pt is
referred for bleeding per vagina H/O DC done
twice before. X-ray chest shows tuberculosis of
Lungs and is under treatment for
tuberculosis There a growth in vagina?
Malignancy Kindly do the needful. The photo copy
of this letter is seen in the next slide
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(No Transcript)
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Slide showing vaginal metastasis as shown by
arrow
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Secondary metastasis in lungs
X-ray chest of the same patient showing
multiple secondary metastasis in lungs, which
were mistaken and treated as tuberculosis of
lungs
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Abdominal total hysterectomy with bilateral
salpingo- ooperectomy was performed for this
pt. This slide shows specimen after Operation.
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The same specimen after cutting it open. Biopsy
report confirmed it as chorion epithilioma
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Second case report--
This patient came with bleeding P.V. At that time
facility of estimation of serum Bhcg was
not available. Surgery was done on her and
specimen is shown in next slide
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This specimen after operation of abdominal total
hysterectomy with bil. Salpingo- -ooperectomy. A
fungating growth is seen arising from funds
of uterus
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The same specimen after cutting it open. Biopsy
report confirmed it as chorion epithilioma. Pt.
was given Tab. Mithotraxate which was the only
drug Available at that time. Pt. was lost to
follow.
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The next 2 cases I am reporting, were seen by
me in my private hospital. 3rd case of
Chorion epithiliom The next third case, came with
lump in abdomen and bleeding off and on per
vagina. It was thought to due to big tumor,
probably fibroid. Elective abdominal total
hysterectomy was planned and, a professional
photographer called to documents the operative
procedure.
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This pt. was suspected to have fibroid of size of
5 months pregnant uterus. She had bleeding per
vagina Pt. was referred to a Sonologist, only
one in the town at that time to have only trans
abdominal scan machine. He reported this case as
a degenerating fibroid. Pt. was taken for
surgery thinking sonologists diagnosis as a
right one. You see in next few slides Steps of
operation
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Abdomen has been opened and you see the four
bladed Cruseners retractor in place and
big tumor brought out of abdominal cavity.
Hysterectomy is progress. Half the tumor is
almost out.
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Operation in progress.
Clamps were applied one after another and
uterus is seen coming out of abdominal
cavity. Almost 4/5 of the tumor is out
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Further dissection and uterus Is almost at the
lower end of the cervix. Two more clamps at
angle of vagina and uterus and tumor will be
in hand.
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You see me here (Author) holding the tumor in the
hand. I was young at that time. May be of the age
of fifty or so. I am now 75. In the next slide
you see the tumor at a close view.
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A close view of the Specimen removed. There is a
fungating growth coming out on anterior part of
uterus. Both ovaries and fallopian tubes were
removed. You will see bisected specimen in the
next slide.
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The previous specimen seen bisected. Biopsy
report confirmed it, as chorion epithilioma.
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The biopsy report of chorion epithilioma
was received from pathologist 7 days post
operative. Pt. did well till that day. On 10th
post operative day, she suddenly developed
convulsions and become unconscious. She was
transferred to cancer hospital in the town. She
was treated there by chemotheraphy- like
Methtraxtat tables/ Methotrexate Injection This
was the only drug available at that time . Pt.
died in cancer hospital 15 days after
admission. This case is reported to keep in mind
not to mistake a case of chorion epithiliom as a
case of degerating fibroid, even its appearance
at sonography, may look like that of a
degenerating fibroid..
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4th case of Chorion epithilioma
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Growth.
This Pt. was seen in private for bleeding
P.V. Bilateral cystic ovaries were noted before
operation. Abdominal total hysterectomy with
bil.salpingo ooperectomy was done. On bisecting
the specimen a small growth was seen at isthmus
of uterus. Biopsy was send.
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Same specimen at a close up view. Biopsy report
was Chorion epithelioma.
Lutin cyst
Growth
Pt. was given Mithotraxate tablets. She did well
after surgery and was well for at least for15
years, as conveyed to me by her
relatives. Bilateral lutin cyst are commonly seen
in case of chorion epithelioma. In this case
they are seen nicely.
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Thank You