James P. Hennessy

Hodgkin's disease in pregnancy

Abstract Thirty-five cases of pregnancy associated with Hodgkins disease have been reviewed with regard to incidence, treatment, and prognosis. The literature has been briefly reviewed. Interruption of pregnancy is not indicated on the basis of evidence presented in our series. Pregnancy had no effect on the incidence of exacerbations nor did it adversely affect survival time.

Invasive hydatidiform mole

Abstract This is a case of invasive mole treated by complete hysterectomy and removal of the remaining appendages. Although on the patients first. admission to the hospital, the possibility of a hydatidiform mole was considered, the primary cause of her admission to the hospital was abdominal pain on the left side and the presence of a progressively enlarging mass. Since removal of both ovaries would probably be followed by miscarriage, religious considerations precluded further interference. After spontaneous expulsion of the mole, curettage, and exploration of the uterus, bleeding ceased and the patient was discharged from the hospital. When she was readmitted suffering from jaundice, enlargement of the uterus, and vaginal bleeding, the picture was one of suspicious malignancy, probably chorionepithelioma. After the clearing of the jaundice and the negative x-rays of chest and long bones, the markedly positive 1 riedman test and continued intermittent vaginal bleeding made a total hysterectomy with removal of the tubes appear the operation of choice, because a chorionepithelioma could not be discounted. The final diagnosis is not easy. Two outstanding pathologists have examined the specimen carefully and feel that such invasiveness as can be found is definitely limited and not characteristic of a true epithelioma. Although the patients course in the beginning was suspicious of malignancy, fortunately it turned out to be clinically benign. Since it appears that there are various histologic or clinical grades of chorionic malignancy, rather than designate them all as chorionepithelioma, we must try to distinguish between them. Also, every patient harboring a hydatidiform mole should be individualized. Management of these cases consists in the diagnosis and removal of malignant chorionic tissue while it remains localized in the pelvis and the avoiding of unnecessary surgery during the childbearing age because of the possibility that malignant chorionic tissue might be present. We must approach the problem very carefully, studying the clinical picture of each case, making a careful study of the microscopic traits of tissue that were removed or expelled, and making careful hormone studies. With critical evaluation of all factors, it will usually be possible to arrive at a more precise individual diagnosis.