Lege Artis Medicinae

[OVARIAN CHORIOCARCINOMA - A MOLECULAR PATHOLOGIC APPROACH TO DIFFERENTIAL DIAGNOSIS]

ERÉNYI Éva, SZIGETVÁRI Iván, ANDRIKOVICS Hajnalka, TORDAI Attila, URBÁN Márta, SIMON Károly

FEBRUARY 21, 2006

Lege Artis Medicinae - 2006;16(02)

[INTRODUCTION - Gestational and non-gestational choriocarcinoma, the two types of choriocarcinoma with distinct aetiologies, cannot be differentiated by conventional histological or immunohistochemical methods. In certain cases the verification of the origin of the tumour by molecular biological techniques is essential for prognostic and therapeutic reasons. CASE REPORT - A 22-year-old woman presenting with acute abdominal pain was examined and operated on. During surgery a tumour was found in the right ovary. “Pure” choriocarcinoma was histologically diagnosed and gestational origin was supposed based on the distinct clinical features and histological picture. This was subsequently confirmed by molecular genetic testing. Parallel VNTR (variable number of tandem repeats) analysis by PCR of DNA from the tumour tissue and the patient's peripheral blood was performed. The pattern showed the presence of an allele presumed to be of paternal origin. (Blood sample from the father was not available.) One regimen of Vepesid, Cisplatina and Bleomycin was applied, and more than three years after the diagnosis the patient is free of disease. CONCLUSION - Multidisciplinary cooperation led to an accurate diagnosis and successful treatment. Non-radical surgery with the preservation of fertility followed by proper early chemotherapy provided excellent results.]

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[When “Hard” Science Softens Up...]

BÁNFALVI Attila

Lege Artis Medicinae

[Music Therapy in the Treatment of Patients with Alzheimer’s]

KOLLÁR János

Lege Artis Medicinae

[A Bit of Astronomy]

GRÉTSY Zsombor

Lege Artis Medicinae

[Sustainable Healthcare Elemér Bugovics: Sustainable Healthcare, or the Pathology of Healthcare]

FRENKL Róbert

Lege Artis Medicinae

[Medical Research, Human Rights]

ZSUZSA Gábor

All articles in the issue

Related contents

Clinical Neuroscience

[LADA type diabetes, celiac diasease, cerebellar ataxia and stiff person syndrome. A rare association of autoimmune disorders]

SOÓS Zsuzsanna, SALAMON Mónika, ERDEI Katalin, KASZÁS Nóra, FOLYOVICH András, SZŰCS Anna, BARCS Gábor, ARÁNYI Zsuzsanna, SKALICZKI József, VADASDI Károly, WINKLER Gábor

[Celiac disease - in its typical form - is a chronic immunemediated enteropathy with typical clinical symptoms that develops against gliadin content of cereal grains, and is often associated with other autoimmune diseases. In cases of atypical manifestation classic symptoms may be absent or mild, and extra-intestinal symptoms or associated syndromes dominate clinical picture. The authors present a longitudinal follow-up of such a case. A 63-years old woman was diagnosed with epilepsy at the age of 19, and with progressive limb ataxia at the age of 36, which was initially thought to be caused by cerebellar atrophy, later probably by stiff person syndrome. At the age 59, her diabetes mellitus manifested with type 2 diabetic phenotype, but based on GAD positivity later was reclassified as type 1 diabetes. Only the last check-up discovered the celiac disease, retrospectively explaining the entire disease course and neurological symptoms. By presenting this case, the authors would like to draw attention to the fact that one should think of the possibility of celiac disease when cerebellar ataxia, progressive neurological symptoms and diabetes are present at the same time. An early diagnosis may help to delay the progression of disease and help better treatment.]

Clinical Neuroscience

[CLINICAL ANALYSIS OF PATIENTS WITH PERIPHERAL FACIAL PALSY]

ILNICZKY Sándor

[symptoms. In two thirds of the cases the cause is unknown, this is called “idiopathic peripheral facial palsy or Bell’s palsy”, but several different diseases have to be considered in the differential diagnosis. In this paper we reviewed the case histories of 110 patients treated for “peripheral facial palsy” in the Department of Neurology, Semmelweis University, Budapest in a five year period, 2000-2004. We studied the age, gender distribution, seasonal occurance, comorbidities, sidedness, symptoms, circumstances of referral to the hospital, the initial diagnoses and therapeutic options. We also discuss the probable causes and consequences of diagnostic failures. Results: the proportion of males and females was equal. There was no considerable difference between sexes regarding agedistribution. Of the 110 patients 106 was diagnosed with idiopathic Bell’s palsy, three cases with otic herpes zoster and one patient with Lyme disease. In our material, peripheral facial palsy was significantly more frequent in the cold period of late autumn, winter, and early spring. Diabetes mellitus and hypertension were more frequent than in the general population. 74% of the patients were admitted within two days from the onset of the symptoms. In 37% preliminary diagnosis was unavailable. In 15% cerebrovascular insult was the first, incorrect diagnosis, the correct diagnosis of “Bell’s palsy” was provided only in 16%. The probable causes of diagnostic failures may be the misleading symptoms and accompanying conditions. We examined the different therapies applied and reviewed the literature in this topic. We conclude that intravenous corticosteroid treatment in the early stage of the disease is the therapy of choice.]

Lege Artis Medicinae

[The clinical pathology of prostatic carcinoma]

KISS Ferenc

[On the basis of the actual state of art, the main tasks of clinical pathologists in the diagnostics of prostatic carcinoma may be summarized as follows: Recognition and differential diagnosis of prostatic adenocarcinoma. Estimation of tumour prognosis by means of a reliable histological grading system and establishing the pathological stage. Checking the efficacy of (hormonal) treatment relying upon histological features. An increasing effort to a better understanding and diagnosis of premalignant changes (dysplasia, prostatic intraepithelial neoplasia). In favour of individual characterization of a tumour, one should utilize the attainable modern investigative methods.]

Lege Artis Medicinae

[The differential diagnosis of pulmonary tuberculosis]

BÖSZÖRMÉNI Miklós

[Since the number of tuberculous patients is constantly decreasing, the diagnosis of pulmonary tuberculosis is a new challenge for physicians. That produces a lifethreatening danger specially for old tuberculous patients. Primary infection – since the clinical tuber culosis of children practically disappeared in Hungary - can be established mostly on young people with general symptoms, who's tuberculin-reaction shows hyperergy. The specific etiology of pleurisy can be determined by the exclusion of other etiologies on young tuberculin-positive people, but a thoracoscopic biopsy may be needed. Tuberculous bronchadenitis is a rarity, but must be differentiated from sarcoidosis or malignant mediastinal lymph nodes. In infiltrative lung diseases, primary and se condary pneumonias (caused in first line by lung cancer) and pulmonary infarctions are much more frequent, than tbc. The most difficult is the differential diagnosis of disseminated pulmonary diseases. The author warns against the too early application of aggressive diagnostic methods (BAL and especially lung biopsy by thoracotomy). He emphasizes in these situations the advantages of an antituberculous treatment without diagnosis (especially in old patients). In coin lesions the very specific transthoracic needle biopsy should be preferated. The author refers to the new researches objecting the rapid detection of BK in the sputum of paucibacillary patients, but is meaning, that the indirect ways of diagnosis mentioned in this paper would be necessary for a long time.]

Lege Artis Medicinae

[Diagnosis and management of irritable bowel syndrome]

ÚJSZÁSZY László, TÚRY Ferenc

[The basis for the diagnosis of irritable bowel syndrome is the evaluation of the patient's symptoms. The wide-ranging use of this diagnosis (irritable bowel syndrome, IBS) in the past was equivalent to the exclusion of different organic diseases. Today's use, as a „residual diagnosis" accompanies patients with severe clinical signs, psychiatric comorbidity and older age. Based on the Rome Consensus Criteria I and II, initiating the treatment based on dominant symptoms is an important part of the diagnosis. Diagnostic differentiation depend on the dominant symptoms, providing different strategies for cases having diarrhoea, obstipation or pain dominancy. ]