Gestational fallopian tubal choriocarcinoma cured surgically: a case report

Gestational fallopian tubal choriocarcinoma cured surgically: a case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Gestational fallopian tubal choriocarcinoma cured surgically: a case report Xiaoyan Xie, Meilian Peng, Yan Wang, Liangzhi Cai, Mu Xu, Yuequan Shi, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3324961/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Fallopian choriocarcinoma is extremely rare and is still treated with a combination of chemotherapy and surgery. We report a case of gestational fallopian tubal choriocarcinoma treated solely with surgery and describe its clinical characteristics, treatment, and follow-up prognosis. Case presentation We report a patient who developed fallopian tube choriocarcinoma during the perimenopausal period. After surgical treatment, the patient was diagnosed with histopathology using immunohistochemistry staining combined with short tandem repeatdetection, and the diagnosis was confirmed as Gestational fallopian tubal choriocarcinoma. Postoperative monitoring serum β- HCG levels, this patient’s β- HCG value showed an exponential decrease and dropped to the normal range within 6 weeks for 3 years. Therefore, the patient did not receive chemotherapy Conclusions This report provides ideas for the simple surgical treatment of gestational fallopian tubal choriocarcinoma that meets conditions, which can reduce unnecessary chemotherapy side effects for such patients. Fallopian tubal choriocarcinoma gestational surgery β-HCG histopathology Figures Figure 1 Figure 2 Figure 3 Background Choriocarcinoma is a rare but highly malignant trophoblastic neoplasia that originate in pregnancy or non pregnancy. Gestational choriocarcinoma is a malignant form of gestational trophoblastic neoplasia (GTN), consisting of mononuclear trophoblastic cells (cytotrophoblastic cells or intermediate trophoblastic cells) and syncytiotrophic cells [ 1 ] . Short tandem repeat (STR) analysis combined with immunohistochemistry can distinguish between gestational choriocarcinoma and non gestational choriocarcinoma, and can provide useful information about the types of etiological concepts [ 2 – 3 ] . Choriocarcinoma of the fallopian tubal is extremely rare, and currently comprehensive treatment with chemotherapy as the main treatment and surgery as the auxiliary treatment is still used. However, for choriocarcinoma caused by fallopian tubal pregnancy in which the β-Human chorionic gonadotropin (β-HCG) drops to normal without metastasis after surgery, can close monitoring of the β-HCG be considered without adjuvant chemotherapy? Case presentation A 45 year old woman who delivered a fetus 24 years ago in full term successfully was admitted with the main complaint of "one week fatigue". Physical examination: the life sign is stable, the blood pressure is 100 / 60 mmHg, and the pulse is 92 times / min. Gynecological examination: the uterus is slightly larger, floating, palpable mass in the right accessory area, about 5cm in diameter, mild tenderness, no abnormality in the left accessory area. The posterior fornix was punctured and extracted 5ml without coagulation. Auxiliary examination: abdominal CT showed peritoneal effusion (Fig. 1 ) and blood β-HCG 235303 mIU/mL, blood routine: HGB 56g/L, considering “ectopic pregnancy with rupture”, the “laparotomy exploration + right fallopian tube resection + left fallopian tube ligation” was performed on July 27, 2020 (June 15 of the last menstruation). After entering the abdominal cavity, the exploration: the peritoneum was purple blue, the blood accumulated in the abdominal cavity was 2500ml, the Ampulla of the right fallopian tube was enlarged and thickened, about 5×4cm in size, the fallopian tube cavity was completely ruptured, containing placental like tissue, and 5 units of red blood cells were infused after the operation, Plasma 400ml. After the pathological results come out, further skull MRI, chest CT and color Doppler ultrasound of the whole abdomen were performed to exclude distant metastasis of the tumor. Finally, the patient was classified as Federation International of Gynecology and Obstetrics(FIGO) phase I, with a who prognostic score of 11, representing high risk. The details of the prognostic score are as follows: age - score 1 (45 years), previous pregnancy - score 2 (full-term birth), interval from first pregnancy - score 4 (full-term birth 24 years ago), pretreatment - treatment β-HCG value - score at least 5 points (> 10 5 mIU/mL, no specific value), maximum tumor size - score 1 (about 5×4 cm), metastatic site - score 0 (none), number of metastatic lesions − 0 (none), previous chemotherapy failure − 0 (none). Postoperative monitoring β-HCG gradually decreased and fell to the normal range 41 days after the operation (Table 1 ). Considering that the patient's indicators have been normal, and there is no metastasis, there is no chemotherapy, but regular monitoring β-HCG. Table 1 Perioperative serum β- HCG level monitoring Date β -HCG (mIU/mL) Pre-operation 235303 6st day after operation 5855 9st day after operation 2485 13st day after operation 748 18st day after operation 372 22st day after operation 252.35 30st day after operation 92.1 34st day after operation 60.62 41st day after operation 2.55 Follow-up During the follow-up, the patient had no symptoms and normal menstruation. The follow-up content was β-HCG, gynecological color Doppler ultrasound and pulmonary CT were followed up for 3 year, and no recurrence was found. At present, the patient is still undergoing serum test regularly β-HCG test and imaging examination were followed up. Discussion and Conclusions The aim of this study is to investigate the etiology of fallopian tubal choriocarcinoma and evaluate the impact of surgical treatment on the prognosis of this patient. Fallopian tubal choriocarcinoma is a highly malignant trophoblastic tumor that can originate from pregnancy or non pregnancy. The difference between gestational and non gestational choriocarcinoma is very important, as the latter has a poor prognosis and requires more aggressive treatment. STR genotyping can assist in the identification of trisomy/monosomy syndrome and double male triploid. DNA polymorphism analysis at several STR loci is a reliable method to distinguish between gestational and non gestational tumors. The p57 [KIP2] gene is paternal imprinted and maternal expressed, and its protein product can serve as a substitute marker for the maternal nuclear genome. The combination of the two can make accurate diagnosis [ 4 – 6 ] . The difference between gestational and non gestational choriocarcinoma is very important because the latter has a poor prognosis and needs more active treatment. In this case, the clinical course of the patient is characterized by 45 years old, 24 years since the previous pregnancy. The time interval from the patient's last menstrual period to the tubal mass confirmed as choriocarcinoma is very short. These medical histories are important to determine the origin of the disease. In this case, choriocarcinoma may initially develop in the fallopian tube rather than the previous hydatidiform mole (HM). It also may be gestational choriocarcinoma from ectopic pregnancy. Immunohistochemical staining were used on the tissue in order to make a definite diagnosis. The result showed p57 (-) (Fig. 2 ) which means the tumor lacked maternal contribution. STR test were further used which result showed that it was bisexual monoandrogynous triploid (Fig. 3 ), indicating that the tumor contained maternal alleles. In rare cases, when complete HM was accompanied by trisomy 11 (one more maternal chromosome 11) or partial HM was accompanied by loss of maternal chromosome 11, the immunohistochemical staining results of p57 will be opposite to the aforementioned (because the imprinted gene CDKN1C is located on chromosome 11). This opposite conclusion can be corrected through ploidy analysis and STR genotype detection. Therefore, we still consider it as gestational fallopian tubal choriocarcinoma. For the clinical treatment of gestational fallopian tubal choriocarcinoma, a unified standard has not been formed at this stage. Due to the characteristics of tubal histology, fallopian tubal choriocarcinoma is easy to invade the blood and early metastasis early. The treatment is a comprehensive treatment mainly based on chemotherapy, supplemented by surgery, often using 5-fluorouracil + actinomycin combination chemotherapy [ 7 ] , and the therapeutic effect is still satisfactory. Ober and Maier reported that adjuvant chemotherapy increased the survival rate of choriocarcinoma in the fallopian tubes from 13–94%, but their study was published nearly 30 years ago. In addition, they also described five cases that could be cured by single surgical resection. A case report described that it was confirmed as androgenic primary tube choriocarcinoma after evaluation by combining p57 [KIP2] immunostaining and STR analysis in 2011, and was cured through surgery without adjuvant chemotherapy [ 8 ] . Due to postoperative complications β- HCG is rapidly decreasing, we are considering whether adjuvant chemotherapy is needed in this situation. This patient was diagnosed with ectopic pregnancy rupture upon admission and underwent salpingectomy on the affected side. After 6 days of surgery, blood was collected β- HCG decreased from 235303 mIU/ml before surgery to 5855 mIU/ml, and decreased to normal range 6 weeks after surgery without chemotherapy. Follow up monitoring β- HCG levels are normal for 3 years. This case report for the first time describes a rare case of triploid tube choriocarcinoma that was confirmed as rare after surgical treatment and cured without chemotherapy, evaluated by combining p57 [KIP2] immunostaining and STR analysis. According to relevant literature reports at home and abroad, patients with tube choriocarcinoma often undergo exploratory laparotomy due to "ectopic pregnancy", and postoperative chemotherapy is supplemented based on the examination results. Due to atypical clinical manifestations and similar symptoms to ectopic pregnancy, the two are easily confused, and differential diagnosis should be made by combining β-HCG level, MRI, vaginal ultrasound, and color Doppler flow imaging. Therefore, we believe that for this type of gestational fallopian tubal choriocarcinoma is particularly difficult to differentiate from ectopic pregnancy and requires exploratory laparotomy, chemotherapy may not be supplemented after the first surgical removal of the tumor. Subsequently, imaging follow-up and rigorous apple monitoring can be conducted to avoid any risk of metastasis and recurrence. It must meet the following conditions: there is no transfer in the early stage, the β-HCG shows an exponential decline and drops to the normal range within 6–8 weeks. The number of surgical cured cases without adjuvant chemotherapy is currently rare, and similar cases still need to be accumulated to provide a basis for our imagination. Abbreviations GTN：Gestational Trophoblastic Neoplasia GTN：Short Tandem Repeat β-HCG：beta-Human Chorionic Gonadotropin FIGO：Federation International of Gynecology and Obstetrics HM：Hydatidiform mole Declarations Not applicable Ethics approval and consent to participate This study was approved by the Ethics Committee of College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University(FMCH2021KRD020). Written informed consent was obtained from the patients to publish case characteristics and accompanying images. Consent for publication The patient or their close relatives agree to publish the case report and accompanying images. Obtained written informed consent from the patient to publish detailed clinical information. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests Funding This work was supported by Natural Science Foundation of Fujian Province (Grant No. 2021j01409) and Joint Funds for the innovation of science and Technology, Fujian province (Grant No. 2020y9155). Authors' contributions Conceptualization of research: XYX，MLP. Data collection: YW, LZC, MX, YQS, SXX, JSL. Manuscript preparation: XYX, MLP. Manuscript revisions: PMS and QBW. The author has read and agreed to the published version of the manuscript. Acknowledgements Not applicable Disclosure The author reports no conflicts of interest in this work References ranake-Chrisinger J, Huettner PC, Hagemann AR, Pfeifer JD. Use of short tandem repeat analysis in unusual presentations of trophoblastic tumors and their mimics. Hum Pathol. 2016 Jun;52:92-100. Popiolek DA, Yee H, Mittal K, Chiriboga L, Prinz MK, Caragine TA, Budimlija ZM. Multiplex short tandem repeat DNA analysis confirms the accuracy of p57(KIP2) immunostaining in the diagnosis of complete hydatidiform mole. Hum Pathol. 2006 Nov;37(11):1426-34. Namba A, Nakagawa S, Nakamura N, Takazawa Y, Kugu K, Tsutsumi O, Taketani Y. Ovarian choriocarcinoma arising from partial mole as evidenced by deoxyribonucleic acid microsatellite analysis. Obstet Gynecol. 2003 Nov;102(5 Pt 1):991-4. Ronnett BM. Hydatidiform Moles: Ancillary Techniques to Refine Diagnosis. Arch Pathol Lab Med. 2018 Dec;142(12):1485-1502. Hui P, Buza N, Murphy KM, Ronnett BM. Hydatidiform Moles: Genetic Basis and Precision Diagnosis. Annu Rev Pathol. 2017 Jan 24;12:449-485. Heller DS. Update on the pathology of gestational trophoblastic disease. APMIS. 2018 Jul;126(7):647-654. Flam F, Lundström V, Lindstedt J, Silfverswärd C. Choriocarcinoma of the fallopian tube associated with induced superovulation in an IVF program; a case report. Eur J Obstet Gynecol Reprod Biol. 1989 Nov;33(2):183-6. Nakayama M, Namba A, Yasuda M, Hara M, Ishihara O, Itakura A. Gestational choriocarcinoma of Fallopian tube diagnosed with a combination of p57KIP2 immunostaining and short tandem repeat analysis: case report. J Obstet Gynaecol Res. 2011 Oct;37(10):1493-6. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3324961","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":230916224,"identity":"d5df1afc-e54e-4305-8093-24ae5dbaca91","order_by":0,"name":"Xiaoyan Xie","email":"","orcid":"","institution":"Fujian Maternity and Child Health Hospital, Fujian Medical University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiaoyan","middleName":"","lastName":"Xie","suffix":""},{"id":230916225,"identity":"66620730-3a0f-4e43-9e5c-063adfac8902","order_by":1,"name":"Meilian Peng","email":"","orcid":"","institution":"Zhangzhou Municipal Hospital of 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15:14:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3324961/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3324961/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":42847251,"identity":"ddd7044c-d9d7-48ef-a777-5069c6c3c16f","added_by":"auto","created_at":"2023-09-08 18:15:18","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":269799,"visible":true,"origin":"","legend":"\u003cp\u003epreoperative abdominal CT scan.(A) Adnexal mass.(B) Pelvic effusion.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-3324961/v1/c5ceaeb04644cc63ab6e58bd.png"},{"id":42847248,"identity":"0bb6b7e5-d97b-4c7c-ab8b-efaf927d270c","added_by":"auto","created_at":"2023-09-08 18:15:18","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":2043172,"visible":true,"origin":"","legend":"\u003cp\u003eImmunohistochemistry.(A) Proliferative syncytiotrophoblast leaf cells and intermediate trophoblast cells are arranged alternately.(B) a large number of necrosis around tumor cells.(C-F) are immunohistochemical CK, hCG, HPL and Ki67, respectively. X400\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-3324961/v1/c8d5bff961b9d2dafa495e0b.png"},{"id":42847249,"identity":"f3b4afb7-ea55-4eaf-acc2-18aa3fe375fb","added_by":"auto","created_at":"2023-09-08 18:15:18","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":148501,"visible":true,"origin":"","legend":"\u003cp\u003eShort tandem repeat analysis.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-3324961/v1/92db9791c79d263631d684cc.png"},{"id":42867735,"identity":"c5360bc5-7d4a-4307-a8ab-6f9885bfbb2b","added_by":"auto","created_at":"2023-09-09 03:22:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2159730,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3324961/v1/281a0dab-8e5a-43f7-9160-01847a7d2603.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eGestational fallopian tubal choriocarcinoma cured surgically: a case report\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eChoriocarcinoma is a rare but highly malignant trophoblastic neoplasia that originate in pregnancy or non pregnancy. Gestational choriocarcinoma is a malignant form of gestational trophoblastic neoplasia (GTN), consisting of mononuclear trophoblastic cells (cytotrophoblastic cells or intermediate trophoblastic cells) and syncytiotrophic cells \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Short tandem repeat (STR) analysis combined with immunohistochemistry can distinguish between gestational choriocarcinoma and non gestational choriocarcinoma, and can provide useful information about the types of etiological concepts \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Choriocarcinoma of the fallopian tubal is extremely rare, and currently comprehensive treatment with chemotherapy as the main treatment and surgery as the auxiliary treatment is still used. However, for choriocarcinoma caused by fallopian tubal pregnancy in which the β-Human chorionic gonadotropin (β-HCG) drops to normal without metastasis after surgery, can close monitoring of the β-HCG be considered without adjuvant chemotherapy?\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 45 year old woman who delivered a fetus 24 years ago in full term successfully was admitted with the main complaint of \"one week fatigue\". Physical examination: the life sign is stable, the blood pressure is 100 / 60 mmHg, and the pulse is 92 times / min. Gynecological examination: the uterus is slightly larger, floating, palpable mass in the right accessory area, about 5cm in diameter, mild tenderness, no abnormality in the left accessory area. The posterior fornix was punctured and extracted 5ml without coagulation. Auxiliary examination: abdominal CT showed peritoneal effusion (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) and blood β-HCG 235303 mIU/mL, blood routine: HGB 56g/L, considering \u0026ldquo;ectopic pregnancy with rupture\u0026rdquo;, the \u0026ldquo;laparotomy exploration\u0026thinsp;+\u0026thinsp;right fallopian tube resection\u0026thinsp;+\u0026thinsp;left fallopian tube ligation\u0026rdquo; was performed on July 27, 2020 (June 15 of the last menstruation). After entering the abdominal cavity, the exploration: the peritoneum was purple blue, the blood accumulated in the abdominal cavity was 2500ml, the Ampulla of the right fallopian tube was enlarged and thickened, about 5\u0026times;4cm in size, the fallopian tube cavity was completely ruptured, containing placental like tissue, and 5 units of red blood cells were infused after the operation, Plasma 400ml.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAfter the pathological results come out, further skull MRI, chest CT and color Doppler ultrasound of the whole abdomen were performed to exclude distant metastasis of the tumor. Finally, the patient was classified as Federation International of Gynecology and Obstetrics(FIGO) phase I, with a who prognostic score of 11, representing high risk. The details of the prognostic score are as follows: age - score 1 (45 years), previous pregnancy - score 2 (full-term birth), interval from first pregnancy - score 4 (full-term birth 24 years ago), pretreatment - treatment β-HCG value - score at least 5 points (\u0026gt;\u0026thinsp;10\u003csup\u003e5\u003c/sup\u003e mIU/mL, no specific value), maximum tumor size - score 1 (about 5\u0026times;4 cm), metastatic site - score 0 (none), number of metastatic lesions \u0026minus;\u0026thinsp;0 (none), previous chemotherapy failure \u0026minus;\u0026thinsp;0 (none).\u003c/p\u003e \u003cp\u003ePostoperative monitoring β-HCG gradually decreased and fell to the normal range 41 days after the operation (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Considering that the patient's indicators have been normal, and there is no metastasis, there is no chemotherapy, but regular monitoring β-HCG.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePerioperative serum β- HCG level monitoring\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eβ -HCG (mIU/mL)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e235303\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6st day after operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5855\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9st day after operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2485\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13st day after operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e748\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18st day after operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e372\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22st day after operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e252.35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30st day after operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e92.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e34st day after operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41st day after operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eFollow-up\u003c/h3\u003e\n\u003cp\u003eDuring the follow-up, the patient had no symptoms and normal menstruation. The follow-up content was β-HCG, gynecological color Doppler ultrasound and pulmonary CT were followed up for 3 year, and no recurrence was found. At present, the patient is still undergoing serum test regularly β-HCG test and imaging examination were followed up.\u003c/p\u003e"},{"header":"Discussion and Conclusions","content":"\u003cp\u003eThe aim of this study is to investigate the etiology of fallopian tubal choriocarcinoma and evaluate the impact of surgical treatment on the prognosis of this patient.\u003c/p\u003e \u003cp\u003eFallopian tubal choriocarcinoma is a highly malignant trophoblastic tumor that can originate from pregnancy or non pregnancy. The difference between gestational and non gestational choriocarcinoma is very important, as the latter has a poor prognosis and requires more aggressive treatment. STR genotyping can assist in the identification of trisomy/monosomy syndrome and double male triploid. DNA polymorphism analysis at several STR loci is a reliable method to distinguish between gestational and non gestational tumors. The p57 [KIP2] gene is paternal imprinted and maternal expressed, and its protein product can serve as a substitute marker for the maternal nuclear genome. The combination of the two can make accurate diagnosis \u003csup\u003e[\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe difference between gestational and non gestational choriocarcinoma is very important because the latter has a poor prognosis and needs more active treatment.\u003c/p\u003e \u003cp\u003eIn this case, the clinical course of the patient is characterized by 45 years old, 24 years since the previous pregnancy. The time interval from the patient's last menstrual period to the tubal mass confirmed as choriocarcinoma is very short. These medical histories are important to determine the origin of the disease. In this case, choriocarcinoma may initially develop in the fallopian tube rather than the previous hydatidiform mole (HM). It also may be gestational choriocarcinoma from ectopic pregnancy. Immunohistochemical staining were used on the tissue in order to make a definite diagnosis. The result showed p57 (-) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) which means the tumor lacked maternal contribution. STR test were further used which result showed that it was bisexual monoandrogynous triploid (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), indicating that the tumor contained maternal alleles. In rare cases, when complete HM was accompanied by trisomy 11 (one more maternal chromosome 11) or partial HM was accompanied by loss of maternal chromosome 11, the immunohistochemical staining results of p57 will be opposite to the aforementioned (because the imprinted gene CDKN1C is located on chromosome 11). This opposite conclusion can be corrected through ploidy analysis and STR genotype detection. Therefore, we still consider it as gestational fallopian tubal choriocarcinoma.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFor the clinical treatment of gestational fallopian tubal choriocarcinoma, a unified standard has not been formed at this stage. Due to the characteristics of tubal histology, fallopian tubal choriocarcinoma is easy to invade the blood and early metastasis early. The treatment is a comprehensive treatment mainly based on chemotherapy, supplemented by surgery, often using 5-fluorouracil\u0026thinsp;+\u0026thinsp;actinomycin combination chemotherapy \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e, and the therapeutic effect is still satisfactory. Ober and Maier reported that adjuvant chemotherapy increased the survival rate of choriocarcinoma in the fallopian tubes from 13\u0026ndash;94%, but their study was published nearly 30 years ago. In addition, they also described five cases that could be cured by single surgical resection. A case report described that it was confirmed as androgenic primary tube choriocarcinoma after evaluation by combining p57 [KIP2] immunostaining and STR analysis in 2011, and was cured through surgery without adjuvant chemotherapy \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eDue to postoperative complications β- HCG is rapidly decreasing, we are considering whether adjuvant chemotherapy is needed in this situation. This patient was diagnosed with ectopic pregnancy rupture upon admission and underwent salpingectomy on the affected side. After 6 days of surgery, blood was collected β- HCG decreased from 235303 mIU/ml before surgery to 5855 mIU/ml, and decreased to normal range 6 weeks after surgery without chemotherapy. Follow up monitoring β- HCG levels are normal for 3 years. This case report for the first time describes a rare case of triploid tube choriocarcinoma that was confirmed as rare after surgical treatment and cured without chemotherapy, evaluated by combining p57 [KIP2] immunostaining and STR analysis.\u003c/p\u003e \u003cp\u003eAccording to relevant literature reports at home and abroad, patients with tube choriocarcinoma often undergo exploratory laparotomy due to \"ectopic pregnancy\", and postoperative chemotherapy is supplemented based on the examination results. Due to atypical clinical manifestations and similar symptoms to ectopic pregnancy, the two are easily confused, and differential diagnosis should be made by combining β-HCG level, MRI, vaginal ultrasound, and color Doppler flow imaging.\u003c/p\u003e \u003cp\u003eTherefore, we believe that for this type of gestational fallopian tubal choriocarcinoma is particularly difficult to differentiate from ectopic pregnancy and requires exploratory laparotomy, chemotherapy may not be supplemented after the first surgical removal of the tumor. Subsequently, imaging follow-up and rigorous apple monitoring can be conducted to avoid any risk of metastasis and recurrence. It must meet the following conditions: there is no transfer in the early stage, the β-HCG shows an exponential decline and drops to the normal range within 6\u0026ndash;8 weeks. The number of surgical cured cases without adjuvant chemotherapy is currently rare, and similar cases still need to be accumulated to provide a basis for our imagination.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eGTN：Gestational Trophoblastic Neoplasia\u003c/p\u003e\n\u003cp\u003eGTN：Short Tandem Repeat\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026beta;-HCG：beta-Human Chorionic Gonadotropin\u003c/p\u003e\n\u003cp\u003eFIGO：Federation International of Gynecology and Obstetrics\u003c/p\u003e\n\u003cp\u003eHM：Hydatidiform mole\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by\u0026nbsp;the Ethics Committee of College of Clinical Medicine for Obstetrics \u0026amp; Gynecology and Pediatrics, Fujian Medical University(FMCH2021KRD020). Written informed consent was obtained from the patients to publish case characteristics and accompanying images.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient or their close relatives agree to publish the case report and accompanying images. Obtained written informed consent from the patient to publish detailed clinical information.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by Natural Science Foundation of Fujian Province (Grant No. 2021j01409) and Joint Funds for the innovation of science and Technology, Fujian province (Grant No. 2020y9155).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization of research: XYX，MLP. Data collection: YW, LZC, MX, YQS, SXX, JSL. Manuscript preparation: XYX, MLP. Manuscript revisions: PMS and QBW. The author has read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author reports no conflicts of interest in this work\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eranake-Chrisinger J, Huettner PC, Hagemann AR, Pfeifer JD. Use of short tandem repeat analysis in unusual presentations of trophoblastic tumors and their mimics. Hum Pathol. 2016 Jun;52:92-100.\u003c/li\u003e\n\u003cli\u003ePopiolek DA, Yee H, Mittal K, Chiriboga L, Prinz MK, Caragine TA, Budimlija ZM. Multiplex short tandem repeat DNA analysis confirms the accuracy of p57(KIP2) immunostaining in the diagnosis of complete hydatidiform mole. Hum Pathol. 2006 Nov;37(11):1426-34.\u003c/li\u003e\n\u003cli\u003eNamba A, Nakagawa S, Nakamura N, Takazawa Y, Kugu K, Tsutsumi O, Taketani Y. Ovarian choriocarcinoma arising from partial mole as evidenced by deoxyribonucleic acid microsatellite analysis. Obstet Gynecol. 2003 Nov;102(5 Pt 1):991-4.\u003c/li\u003e\n\u003cli\u003eRonnett BM. Hydatidiform Moles: Ancillary Techniques to Refine Diagnosis. Arch Pathol Lab Med. 2018 Dec;142(12):1485-1502.\u003c/li\u003e\n\u003cli\u003eHui P, Buza N, Murphy KM, Ronnett BM. Hydatidiform Moles: Genetic Basis and Precision Diagnosis. Annu Rev Pathol. 2017 Jan 24;12:449-485.\u003c/li\u003e\n\u003cli\u003eHeller DS. Update on the pathology of gestational trophoblastic disease. APMIS. 2018 Jul;126(7):647-654.\u003c/li\u003e\n\u003cli\u003eFlam F, Lundstr\u0026ouml;m V, Lindstedt J, Silfversw\u0026auml;rd C. Choriocarcinoma of the fallopian tube associated with induced superovulation in an IVF program; a case report. Eur J Obstet Gynecol Reprod Biol. 1989 Nov;33(2):183-6.\u003c/li\u003e\n\u003cli\u003eNakayama M, Namba A, Yasuda M, Hara M, Ishihara O, Itakura A. Gestational choriocarcinoma of Fallopian tube diagnosed with a combination of p57KIP2 immunostaining and short tandem repeat analysis: case report. J Obstet Gynaecol Res. 2011 Oct;37(10):1493-6.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Fallopian tubal choriocarcinoma, gestational, surgery, β-HCG, histopathology","lastPublishedDoi":"10.21203/rs.3.rs-3324961/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3324961/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFallopian choriocarcinoma is extremely rare and is still treated with a combination of chemotherapy and surgery. We report a case of gestational fallopian tubal choriocarcinoma treated solely with surgery and describe its clinical characteristics, treatment, and follow-up prognosis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe report a patient who developed fallopian tube choriocarcinoma during the perimenopausal period. After surgical treatment, the patient was diagnosed with histopathology using immunohistochemistry staining combined with short tandem repeatdetection, and the diagnosis was confirmed as Gestational fallopian tubal choriocarcinoma. Postoperative monitoring serum β- HCG levels, this patient’s β- HCG value showed an exponential decrease and dropped to the normal range within 6 weeks for 3 years. Therefore, the patient did not receive chemotherapy\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis report provides ideas for the simple surgical treatment of gestational fallopian tubal choriocarcinoma that meets conditions, which can reduce unnecessary chemotherapy side effects for such patients.\u003c/p\u003e","manuscriptTitle":"Gestational fallopian tubal choriocarcinoma cured surgically: a case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-09-08 18:15:13","doi":"10.21203/rs.3.rs-3324961/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0413302f-4f51-481b-8dab-c84d01841564","owner":[],"postedDate":"September 8th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-09-09T03:14:16+00:00","versionOfRecord":[],"versionCreatedAt":"2023-09-08 18:15:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3324961","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3324961","identity":"rs-3324961","version":["v1"]},"buildId":"i_I_jhV-QviBjPLXJga9V","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}