Endometrial carcinoma with trophoblastic differentiation: an aggressive form of uterine cancer

Article Abstract:

During the normal process of development, different cells take different paths of differentiation. Some cells develop into liver cells, some into brain cells, and so forth. In some cancers, the genetic programs that guide this sort of differentiation can go awry. Often, the appearance of cancerous cells under the microscope can provide insight into the behavior that might be expected of the cancer, aggressive or slowly progressive. Cancers of genital tissues sometimes develop characteristics resembling the trophoblast, the membrane formed by the developing embryo which implants in the uterine wall and contributes to the nutrition of the embryo. Rarely, these same trophoblast features may be found in other sorts of cancer, including stomach cancer, colon cancer, and bladder cancer. In such cases, large amounts of chorionic gonadotrophin may be measured in the patient's blood; this is the same hormone secreted by the normal trophoblast to signal the beginning of pregnancy. Three cases have now been seen in which women developed uterine cancers with trophoblastic features. The cancers were endometrial adenocarcinomas, or cancers arising from the endometrial lining of the uterus in which the cancerous cells have the appearance of secretory cells. Within these adenocarcinomas, however, were areas which differentiated into choriocarcinomas, or cancers with trophoblastic features. Staining with antibodies revealed the presence of chorionic gonadotrophin within the choriocarcinomas, and blood tests demonstrated that the patients had high levels of chorionic gonadotrophin in their blood. In all three cases, the endometrial cancer with these trophoblastic components proved to be especially aggressive and all three patients had an unusually rapid progression of disease. Two of the patients have died of metastatic disease and massive recurrences, while the third patient has developed metastatic disease in the lungs two months after treatment for the primary uterine cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Physiological aspects, Prognosis, Endometrial cancer, Uterine cancer, Trophoblastic tumors

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Neoplastic venous involvement and pulmonary embolism in patients with germ cell tumors

Article Abstract:

Prior to the introduction of cisplatin as a chemotherapeutic drug, few men with testicular tumors lived long enough to develop any complications of this cancer. This is no longer the case; indeed, many men with testicular cancer may enjoy long-term disease-free survival. However, there are indications that coagulation abnormalities may be a problem for some patients with testicular cancer. The authors report the cases of three men who developed obstruction of the inferior vena cava (which carries blood back to the heart) or pulmonary embolism, in which a blood clot blocks arteries in the lungs. In one of the three cases, the resulting pulmonary embolism resulted in death following successful surgery. These three cases prompted a search of the medical literature for similar cases; nine similar cases from the medical journals are discussed along with the three cases seen by the authors. the features of these cases argue against the notion that the blood coagulation problems may be a complication of chemotherapy. In several of the cases, the coagulation problems occurred prior to chemotherapy, and therefore could not be caused by this treatment. The authors suggest that patient factors which suggest a likelihood of coagulation problems should not be taken as a reason for postponing chemotherapeutic treatment. Considering the life-saving potential of chemotherapy for testicular cancer, this treatment should not be altered or delayed. The authors recommend that the decisions about the treatment of coagulation problems be made on a case-by-case basis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Complications and side effects, Risk factors, Germ cell tumors, Germinoma, Blood clotting disorders, Blood coagulation disorders, Pulmonary embolism, Thromboembolism, Testicular cancer

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