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Abstract: Staphyloma is a relatively common disease in gynecological clinics, and patients need to be treated by clearing surgery. If blood HCG is not checked regularly after benign staphyloma, it may cause invasive staphyloma. This patient, Ms. Zhang, was not regularly checked for blood HCG after clearance surgery for benign staphyloma, which eventually evolved into invasive staphyloma. Drugs were given for chemotherapy, and after 5 courses of consultation, the patient’s clinical biochemical indexes gradually returned to normal.
Basic information】Female, 42 years old
Type of disease】Invasive staphylococcal fetus
Hospital】Guangzhou Huadu District People’s Hospital
Date of consultation】January 2022
Treatment Plan】Chemotherapy (Actinomycin D for Injection)
Treatment period】5 courses of chemotherapy, 10 days in hospital for each of the first 3 courses, 21 days between the 2 courses. After the third course of treatment, the patient was discharged from the hospital for 1 month to recuperate and then consolidate 2 courses of treatment, each time hospitalized for 10 days, with an interval of 21 days between the two courses of treatment.
Treatment effect] The biochemical indexes returned to normal
I. Initial consultation
The patient came to our hospital with vaginal bleeding for half a month, 4 months after the gravida operation. The patient reported: 4 months ago, she was operated for benign staphyloma, and 2 months after the operation, her blood HCG dropped to normal, so she did not repeat the operation. She had a normal sexual life after surgery and used condoms during sex. In the last half month, irregular vaginal bleeding occurred without symptoms such as lower abdominal pain and dizziness, and a positive urine HCG test was performed at home, so she thought there was a preterm abortion and came to the clinic. The patient’s basal vital signs were measured. The patient’s temperature was 36.6°C, heart rate was 88 beats/min, respiratory rate was 20 breaths/min, blood pressure was 118/70 mmHg, general status was good, no anemic appearance, no abnormal cardiopulmonary auscultation, the whole abdomen was flat and no mass was palpated, and the liver and spleen were not palpated. The patient was later examined gynecologically and found to have a blood stained vulva, a patent vagina with dark red blood, a smooth vaginal wall with no purple-blue nodules, a pink cervical erosion of degree I, and a posterior uterus that was slightly larger than the normal uterus, but with normal uterine activity and no significant pressure pain. The patient had some enlargement of the ovaries bilaterally, with normal activity but no significant pressure pain. The results showed that the patient had a posterior uterus with a size of 8×8×7 cm, uneven echogenicity of the myometrium and enlarged ovaries on both sides, 4×4×4.5 cm on the left side and 5×4×4 cm on the right side, and the patient’s blood HCG was 8200 mIU/ml with normal blood count, which was initially determined to be invasive staphyloma. After explaining the situation to the patient and her family, she was admitted to hospital for treatment.
II. Treatment process
After the patient was admitted to the hospital, various tests were actively completed, including liver and kidney function tests, chest X-ray, electrocardiogram, coagulation time test, lipid test, biochemical test, etc. After that, chemotherapy was started with injectable actinomycin D. The patient tolerated it well for the first 3 days, and then developed nausea, vomiting, anorexia, dizziness, fatigue, hair loss, and other symptoms, and the reaction was relatively severe. On the fourth day of chemotherapy, the blood HCG dropped to 5300 mIU/ml. 10 days after treatment, the patient was allowed to be discharged from the hospital for recuperation, when the blood HCG was 1500 mIU/ml. 21 days later, the patient returned to the hospital for chemotherapy again, and the second course of chemotherapy was still administered with injectable actinomycin D for 10 days, and so on and so forth, for a total of three courses of chemotherapy. After three courses of treatment, the patient’s blood HCG dropped to normal, and no positive result of blood HCG appeared during the recuperation period at home. After 1 month of recuperation, 2 more courses of consolidation chemotherapy were administered, each hospitalized for 10 days, with an interval of 21 days between the 2 courses, and no rebound of blood HCG was observed afterwards.
III. Treatment effect
After a total of 5 courses of monotherapy, the patient had no vaginal bleeding, the uterus returned to normal size with uniform myometrial echogenicity and no abnormality in bilateral adnexal areas on ultrasound examination, and the blood HCG dropped to normal range. Subsequent follow-up showed no further positive blood HCG results, indicating that the chemotherapy was effective and that the patient was more sensitive to the drug actinomycin D for injection. However, due to the severe gastrointestinal reaction during chemotherapy, the patient’s gastrointestinal function declined during the rehabilitation phase of discharge, so the patient was relatively thin, but his mental status was still acceptable.
IV. Notes
We are glad that the patient’s condition was controlled after 5 courses of active treatment, and there was no subsequent recurrence, and the effect of medication was very good. However, the patient still needs to pay attention to the following points after discharge.
1, after discharge, early attention should be paid to adjust the diet, nutrition needs to be reasonable, but mainly a light diet, in order to improve the physical condition; daily life, should do a good job of contraception, you can use condoms for contraception, but need to pay attention to the treatment within two years can not be pregnant, after two years if the disease is stable, you can consider pregnancy, once pregnant, the disease is likely to relapse;.
2. Daily attention should be paid to observe physical changes, such as whether vaginal secretions are smelly and whether there is bloody discharge. If there is weakness, or enlargement of axillary, subclavian or mandibular lymph nodes, or enlargement of inguinal lymph nodes, the patient should seek medical attention without delay. Patients should go to the hospital for blood tests every half month and pay attention to the changes of blood HCG.
V. Personal insight
The patient in this article stopped paying attention to the blood HCG after the clearance surgery for benign staphyloma and neglected to check again, which led to the development of the disease and eventually evolved into invasive staphyloma. This shows that if a gravid fetus is present, after clearance surgery, the blood HCG level must be monitored regularly for a specified period of time, and one should not let down one’s guard just because the indicator is normal for a while. In clinical practice, regular blood HCG tests are required within two years of the staph clearance surgery, which enables us to detect abnormalities in a short period of time and to respond and treat them quickly, as the damage may be devastating once the disease progresses.