1. Three Cases of Chorion Epithilioma

2. 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.(079) 27682572, Mobile;- 98252 95530 E mail:- nmpatel1932@wilnetonline.net

3. 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.

4. 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 D&C 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 First case report :-

6. Slide showing vaginal metastasis as shown by arrow

7. X-ray chest of the same patient showing multiple secondary metastasis in lungs, which were mistaken and treated as tuberculosis of lungs Secondary metastasis in lungs

8. Abdominal total hysterectomy with bilateral salpingo- ooperectomy was performed for this pt. This slide shows specimen after Operation.

9. The same specimen after cutting it open. Biopsy report confirmed it as chorion epithilioma

10. 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 Second case report:--

11. This specimen after operation of abdominal total hysterectomy with bil. Salpingo- -ooperectomy. A fungating growth is seen arising from funds of uterus

12. 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.

13. The next 2 cases I am reporting, were seen by me in my private hospital. 3 rd 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.

14. 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 sonologist’s diagnosis as a right one. You see in next few slides Steps of operation

15. Abdomen has been opened and you see the four bladed Crusener’s retractor in place and big tumor brought out of abdominal cavity. Hysterectomy is progress. Half the tumor is almost out.

16. Clamps were applied one after another and uterus is seen coming out of abdominal cavity. Almost 4/5 of the tumor is out Operation in progress.

17. 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.

18. 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.

19. 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.

20. The previous specimen seen bisected. Biopsy report confirmed it, as chorion epithilioma.

21. The biopsy report of chorion epithilioma was received from pathologist 7 days post operative. Pt. did well till that day. On 10 th 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..

22. 4th case of Chorion epithilioma

23. 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. Growth.

24. 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. Same specimen at a close up view. Biopsy report was Chorion epithelioma. Growth Lutin cyst