Kidney involvement in a patient affected by placental site trophoblastic tumor.
We report a 42-year-old woman who presents a few days after a spontaneous incomplete abortion at the ninth week of pregnancy with hypertension and nephrotic syndrome. Curettage findings and increased values for the β subunit of human chorionic gonadotrophin were suspicious for a trophoblastic disease. A uterine placental site trophoblastic tumor was diagnosed 2 months later after hysterectomy and treated successfully using chemotherapy. Kidney biopsy showed features consistent with an unusual form of thrombotic microangiopathy characterized by the presence of large thrombus-like structures occluding the capillary lumina and smaller aggregates in the mesangium and along glomerular basement membranes. These deposits were positive for immunoglobulin M, C4, C1q, κ and λ light chains, and fibrinogen. Electron microscopy showed fibrin deposits located primarily in the subendothelial space. The differential diagnosis of this presentation included pre-eclamptic nephropathy, Waldenström disease, lupus anticoagulant glomerulonephritis, systemic lupus erythematosus, and cryoglobulinemic glomerulonephritis. We review the pathogenic mechanisms involved in this case.
Department of Biomedical Sciences and Human Oncology, University of Torino, Torino, Italy.
Gianna
G
Mazzucco
Loredana
L
Colla
Guido
G
Monga
D000022:Abortion, Spontaneous; D000328:Adult; D001706:Biopsy; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D005921:Glomerulonephritis / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007044:Hysterectomy; D007678:Kidney Glomerulus / Q000648:ultrastructure*; D008854:Microscopy, Electron; D011247:Pregnancy; D057049:Thrombotic Microangiopathies / Q000150:complications* / Q000175:diagnosis; D018245:Trophoblastic Tumor, Placental Site / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D014594:Uterine Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery