The value of the Aschheim-Zondek reaction in the diagnosis and prognosis of chorionepithelioma

Abstract

CHORIONEPITHELIOMA is a relatively rare disease, usually presenting diagnostic difficulties until unmistakable symptoms of metastasis, either local or distant, appear. ·when the condition develops before the expulsion of the products of conception, as in the case reported by Schmitz wherein renal hematuria due to metastasis preceded termination of pregnancy by three months, a definite diagnosis is impossible without microscopic examination of the metastatic tissue. Even the usual case of chorionepithelioma, characterized in its early stage by abnormal uterine bleeding a month or two after the expulsion of the products of conception, is difficult to diagnose by microscopic examination of uterine scrapings, because the chorionic epithelium is normally a proliferative and invasive tissue showing a tendency to persist and penetrate to a considerable depth into the uterine musculature. '.i'his is especially marked when the syncytial covering proliferates for no accountable reason and forms polypoid processes which invade the surrounding tissue and lodge in the uterine and even in distant veins (SchmorP). The layer of Langhans is also prone to proliferate in the course of normal or mole pregnancy, break through the surrounding syncytial covering and invade the uterine musculature. The inadequacy of uterine curettage in the diagnosis of chorionepithelioma is clearly illustrated by the two case histories, herein recorded. Though the absence of fragments of chorionic villi and the presence of anaplasia in trophoblastic tissue recovered a month or two after termination of pregnancy are strongly suggestive of chorionepithelioma, a definite diagnosis cannot be made on the strength of these findings alone because they do not show the extent of invasion and necrosis of the myometrium. In reporting these two cases of chorionepithelioma, the authors hope to emphasize by contrast the value of the Aschheim-Zondek test in the early diagnosis and prognosis of chorionepithelioma and to stress the irreparable damage that may result from intrauterine application of radium in suspected cases through masking pelvic symptoms which