Misdiagnosis of intramural ectopic pregnancy and invasive gestational trophoblastic disease on ultrasound: A challenging case at Tu Du Hospital in Vietnam in COVID-19 pandemic peak and mini-review of literature.

Differentiation between intramural ectopic pregnancy and molar ectopic pregnancy is very difficult because of their exceptional rarity. Herein, we present a misdiagnosed case of intramural pregnancy and invasive trophoblastic disease on ultrasound. A 45-year-old female patient was admitted to our tertiary referral hospital due to abdominal pain and unusual ultrasonography findings. Initially, a diagnosis of intramural ectopic pregnancy was identified based on transvaginal color Doppler ultrasonography, 3-dimensional ultrasound, and serial serum beta-human chorionic gonadotropin, thus the patient underwent laparotomy with hysterectomy. However, the histopathological endpoint showed an invasive trophoblastic disease. Clinically, this pathology should be included in the differential diagnosis of intramural ectopic pregnancy since an imaging scan remains quite unclear.

Long-term survival in multiresistant metastatic choriocarcinoma after pembrolizumab treatment: A case report.

•Checkpoint inhibitor therapy affecting PD-L1 as treatment for advanced solid tumors.•Success in trial pembrolizumab therapy in multiresistant metastatic choriocarcinoma.•Long-term remission after pembrolizumab therapy in multiresistant choriocarcinoma.•Only six reported cases, one with comparable follow-up and outcome.

Core 2 ß1,6-N-acetylglucosaminyltransferases accelerate the escape of choriocarcinoma from natural killer cell immunity.

Hyperglycosylated human chorionic gonadotropin (H-hCG) is secreted from choriocarcinoma and contains a core2 O-glycan formed by core2 ß1,6-N-acetylglucosaminyl transferase (C2GnT). Choriocarcinoma is considered immunogenic as it is gestational and contains paternal chromosomal components. Here we examined the function of C2GnT in the evasion of choriocarcinoma cells from natural killer (NK) cell-mediating killing. We determined that C2GnT is highly expressed in malignant gestational trophoblastic neoplasms. C2GnT KO downregulates core2 O-glycan expression in choriocarcinoma cells, which are more efficiently killed by NK cells than control cells. C2GnT KO cell containing tumor necrosis factor-related apoptosis inducing ligand have lower viability than control cells. Additionally, poly-N-acetyllactosamine in core2 branched oligosaccharides on MHC class I-related chain A (MICA) and mucin1 (MUC1) is significantly reduced in C2GnT KO cells. Meanwhile, the cumulative survival rate of nude mice inoculated with C2GnT KO tumors was higher than that of the control group. These findings suggest that choriocarcinoma cells may escape NK cell-mediated killing via glycosylation of MICA and MUC1.

Prevalence of gestational trophoblastic disease in ectopic pregnancy.

OBJECTIVE: To describe the prevalence of gestational trophoblastic disease in ectopic pregnancy. STUDY DESIGN: Medical records of 105 patients from January 2007 to October 2009. We excluded of the study 5 cases (one case where the answer of the biopsy was not clear; 4 others with diagnosis of adhnexial mass where the pregnancy test had resulted positive but the answer of biopsy have been resulted ruptured ovary cyst and pyosalpingitis). So definitely the size of the sample was 100 patients. RESULTS: 79 patients with EP underwent surgery due to a (diagnosis of EP with hem peritoneum and enraptured ectopic pregnancy) and in 18 of them the answer of the biopsy was GTD. 4 of 75 cases admitted in our hospital with diagnosis of EP, (pregnancy test was used instead of estimation of the level of ß-hCG because our hospital couldn't offer estimation of the level of ß-hCG during 24 hours) have been not confirmed diagnosis of EP by biopsy, but ruptured ovary cyst with hem peritoneum, pyosalpingitis.31 cases with EP (enraptured EP) underwent medical treatment with methotroxate. In 10 cases last management was failed and surgical intervention was institutionalized and histological analysis revealed GTD in 6 of them (partial mole). ß-hCG level was detected in 31 cases with enraptured fallopian pregnancy; in all cases where treatment with methotroxate has been failed and GTD was confirmed, the level of ß-hCG was > 10.234 mUI/ml. 21 cases with enraptured fallopian pregnancy were successfully treated, and at this point we never learned the answer of biopsy. We registered one case with cervical pregnancy and one cornual (interstitial portion) pregnancy. CONCLUSION: we found 18 cases of GTD in EP /11.500 deliveries (1,56 per 1,000 deliveries), prevalence of the GTD in EP was about 18%.