Choriocarcinoma in a 73-year-old woman: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Choriocarcinoma is a highly malignant tumor of trophoblastic origin. Most cases present within one year of the antecedent pregnancy (molar or non-molar). However, very rarely, choriocarcinoma can develop from germ cells or from dedifferentiation of endometrial carcinoma into choriocarcinoma. This article concerns a case of choriocarcinoma developing 38 years after the patient's last pregnancy and 23 years after menopause.</p> <p>Case presentation</p> <p>A 73-year-old African-American woman presented with a three-week history of vaginal bleeding. A vaginal mass was seen on pelvic examination. Ultrasonography showed a thickened complex endometrial echo. Her β-human chorionic gonadotrophin level was found to be elevated (2,704,040 mIU/mL). Vaginal and uterine biopsies were suggestive of choriocarcinoma. Immunohistochemistry tests were positive for β-human chorionic gonadotrophin as well as cytokeratin and negative for octamer binding transcription factor 3/4 and α-fetoprotein, supporting the diagnosis of choriocarcinoma. A combination of etoposide, methotrexate, and dactinomycin, followed by cyclophosphamide and vincristine (the so-called EMA/CO regimen) was initiated. After seven cycles of chemotherapy, her β-human chorionic gonadotrophin level dropped below 5 mIU/mL. Our patient is being followed up at our oncology institute.</p> <p>Conclusions</p> <p>We report an extremely rare case of choriocarcinoma arising 23 years after menopause. A postmenopausal woman presenting with vaginal bleed from a mass and β-human chorionic gonadotrophin elevation should be evaluated by immunohistochemical analysis to rule out the possibilities of a germ cell origin of the tumor or dedifferentiation of an epithelial tumor. Absence of octamer binding transcription factor 3/4, α-fetoprotein and CD-30 staining helps in exclusion of most germ cell tumors. DNA polymorphism studies can be used to differentiate between gestational and non-gestational tumor origin. These require fresh tissue samples and are time consuming. Finally, the effective first-line therapy for β-human chorionic gonadotrophin-producing high-risk gestational as well as non-gestational trophoblastic tumors is combination chemotherapy (the EMA/CO regimen). Therefore, treatment should be commenced when a potential diagnosis of metastatic trophoblastic tumor is being considered.</p

Morphological evaluation of steatosis in monolayer cultures (MDCK cells) after treatment with gentamicin and valproic acid

An attempt was made to develop a method for the morphological and morphometric evaluation of fat inclusions in monolayer cell cultures. For this purpose we used electron microscopy (SEM and TEM) and Sudan black staining methods followed by morphometric evaluation techniques. MDCK (Madin-Darby-caninekidney) cells were treated with valproic acid (VPA; 10, 100, 1000 pglml medium for 22 hrs) and gentamicin (1, 10,50 pglml for 60 min). Sudan black staining revealed a dose-dependent increase in fat deposits after application of the two substances. SEM inspection showed differences in the size and distribution of the fat inclusions. TEM findings only partly allowed us to differentiate clearly between VPA- and gentamicin-induced fat inclusions

Comparison of Fully Coupled Modeling and Experiments for Electromagnetic Forming Processes in Finitely Strained Solids

International audienceIn fracture and fragmentation research the technique of electromagnetic forming, which uses electromagnetic (Lorentz) body forces to shape metallic parts, is finding significant use due to the high velocity, high strain rate loading it can impart without contact on workpieces. The same process is also becoming increasingly relevant formanufacturing processes in sheet metal forming, where this technique offers several advantages: speed, repeatability, non-contact loading, reduced springback and considerable ductility increase in several metals. Current modeling techniques for these coupled electromagnetic and thermomechanical processes are not based on coupled variational principles that can simultaneously account for electromagnetic and mechanical effects. Typically, separate solutions to the electromagnetic (Maxwell) and motion (Newton) equations are combined in staggered or lock-step methods, sequentially solving the mechanical and electromagnetic problems. To address this issue, Thomas and Triantafyllidis (J Mech Phys Solids 57:1391-1416, 2009) have recently introduced a fully coupled Lagrangian (reference configuration) variational principle, involving the magnetic field potential and the displacement field as independent variables. The corresponding Euler-Lagrange equations areMaxwell's and Newton's equations in the reference configuration under the eddy current approximation. This novel approach is used here to simulate free expansion experiments of AA6063-T6 aluminum tubes. A viscoplastic constitutive model, developed independently by the authors (Thomas et al. Acta Mater 55:2863-2873, 2007) for necking experiments in tubes of the same aluminum alloy, is used in the simulations. The measured electric currents and tube deformation--the latter obtained by Photon Doppler Velocimetry--show reasonably good agreement with the corresponding simulations, which are obtained using a variational integration numerical scheme that results in an efficient staggered solution algorithm