Browsing by Author "Dobrosavljević, Aleksandar (57193973944)"

Introduction. Epithelioid trophoblastic tumor (EТТ) is an extremely rare form and unusual type of trophoblastic tumor. In 1998 ЕТТ became an independent entity because it possesses specific histological and immunohistochemical features which make it different from placental site tumor and choriocarcinoma. ЕТТ origins from intermediate trophoblast and it can overlap with the squamous cell carcinoma as per differential diagnosis. The relevant literature data suggest that surgical treatment is a treatment of choice for ETT considering that its response to chemotherapy is considerably poor. Case report. A 35-years-old patient G3 P2 came to an examination due to the low pelvic pain and absence of menstrual cycle. She reported that menstrual cycles were irregular during the past year. During the bimanual pelvic examination, a painful tumefaction being approximately 8 cm was palpated in the pouch of Douglas. The patient was operated on as being suspected for ectopic pregnancy when it was noticed that the aforementioned tumefaction was located retroperitoneally immediately against rectosigmoid part of the colon. After the histopathological analysis of the sample, in order to make the final diagnosis, the immunohistochemical test was performed and it found that this EТТ. Due to an inadequate response to administered chemotherapy, both resection of rectosigmoid colon with appurtenant tumor and left hepatectomy with salpingectomy on both sides were performed considering a possibility of gestational trophoblastic neoplasia (GTN) after ectopic pregnancy. Because of dehiscence of colorectal anastomosis, relaparotomy with colostomy bag fitting was performed. The patient died on the day 40 after surgical treatment due to hepatic insufficiency. Conclusion. In order to make as much adequate treatment method of ETT as possible, it is necessary to organize a team work with multidisciplinary approach. Surgical resection of the tumor is a primary method for treating ETT. © 2019 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Introducton. Frequency of malignant gestational trophoblastic neoplasms (GTN) is estimated at 1.03 cases in 1,000 deliveries with 5 fold greater risk in patients younger than 20 and older than 40 years. Serum value of human chorionic gonadotropin is the most relevant parameter in diagnosis of GTN. In placental site trophoblastic tumor (PSTT), serum levels of chorionic gonadotropin do not have the same significance as they do in other malignant GTN. Definite diagnosis of PSTT is almost always confirmed by immunohistochemistry. Case report. In the course of just a few months (August 2016 to January 2017) in the Clinic for Obstetrics and Gynecology “Narodni front” in Belgrade, two GTN patients were admitted and treated, with almost equal ultrasonography (pictures), operative findings and postoperative outcome. Due to histopathological and immunohistochemical examinations two different types of malignant GTN were confirmed. The first patient (admitted in August 2016), 26 years old, was admitted for uterine bleeding 11 months after vaginal delivery and histopathological examination confirmed PSTT. The second patient (admitted in January 2017), 27 years old, was admitted 4 months after vaginal delivery because of uterine bleeding. Histopathological examination confirmed choriocarcinoma. Conclusion. Considering the fact that malignant GTN can appear in different types, with different ultrasonography pictures, this report is significant because two distinctly different malignant GTN entities could appear with equal clinical manifestations and equal ultrasound pictures even when they may have very different course of the disease treatment and outcome. Such cases need correct diagnosis which may be reached only after immunohistochemical analysis. The ultrasound patterns, both in gray scale, color flow, and Doppler values, were almost equal in both cases and guided the diagnostic procedures to the final treatment, even regardless of their very different histopathology. © 2020 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Introduction. Fetomaternal hemorrhage (FMH) is a transfusion of fetal blood into the maternal circulation. A volume of transfused fetal blood required to cause severe, life-threatening fetal anemia, is not clearly defined. Some authors suggest volumes of 80 mL and 150 mL as a threshold which defines massive FMH. Therefore, a rate of massive FMH is 1: 1,000 and 1: 5,000 births, respectively. Fetal and neonatal anemia is one of the most serious complications of the FMH. Clinical manifestations of FMH are nonspecific, and mostly it presented as reduced fetal movements and changes in cardiotocography (CTG). The standard for diagnosing FMH is Kleihaurer-Betke test. Case report. A 34-year-old gravida (G) 1, para (P) 1 was hospitalized due to uterine contractions at 39 weeks of gestation. CTG monitoring revealed sinusoidal fetal heart rate and clinical examination showed complete cervical dilatation. Immediately after admission, the women delivered vaginally. Apgar scores were 1 and 2 at the first and fifth minute, respectively. Immediately baby was intubated and mechanical ventilation started. Initial analysis revealed pronounced acidosis and severe anemia. The patient received intravenous fluid therapy with sodium-bicarbonate as well as red cell transfusion. With all measures, the condition of the baby improved with normalization of hemoglobin level and blood pH. Kleihaurer-Betke test revealed the presence of fetal red cells in maternal circulation, equivalent to 531 mL blood loss. The level of maternal fetal hemoglobin (HbF) and elevated alpha fetoprotein also con-firmed the diagnosis of massive FMH. Conclusion. For the successful diagnosis and management of FMH direct communication between the obstetrician and the pediatrician is necessary as presented in this report. © 2016, Institut za Vojnomedicinske Naucne Informacije/Documentaciju. All rights reserved.