Coriocarcinoma metastásico a yeyuno. Reporte de tres casos

Abstract

Five per cent of patients presenting with choriocarcinoma develop small bowel metastasis. Tumors of the small bowel are rare and the metastases are generally from lung and breast carcinoma or from melanoma. Clinical presentation is vague and the majority of cases are autopsy findings. The main symptoms are related to the presence of abdominal tumor or hemorrhage, or bowel obstruction or perforation. We present the cases of three patients with small bowel metastasis from choriocarcinoma. A 24-year-old woman with bowel obstruction secondary to intussusception caused by a metastatic choriocarcinoma polypoid mass and two men, one 18 years old and the other 24 years old, with a history of testicular tumor, who presented with gastrointestinal bleeding due to small bowel metastasis from choriocarcinoma, 2 and 10 months after orchiectomy, respectively. Management was endoscopic in one case and surgical in the other two. Two patients died in the early postoperative period and one patient died during the first year of follow-up. Choriocarcinoma metastases are very rare and their main clinical manifestations are hemorrhage and bowel obstruction. Management can be either medical or surgical. The majority of patients with choriocarcinoma respond to chemotherapy but prognosis is worse for those patients presenting with small bowel metastasis.

Hemorragia gastrointestinal como primera manifestación de coriocarcinoma metastásico en un paciente masculino

“…La presentación agresiva, en conjunto con la detección tardía, de tumores gonadales en el hombre hacen que el pronóstico y la sobrevida sean desafortunados, e incluso que las manifestaciones extragonadales, como la hemorragia de tubo digestivo, sean el primer dato de alarma y que se sospechen muchas otras causas antes de imaginar que se trata de un coriocarcinoma metastásico. Martínez Ordaz, et al 14 explican que los coriocarcinomas son los tumores de células germinales con mayor formación neovascular, y que aun así la proliferación celular rápida condiciona una necrosis del propio tumor primario o metastásico, y eso explica la hemorragia como síntoma clínico en dos de sus tres casos reportados, que cabe señalar que se trataba de hombres de 24 y 19 años que, a semejanza de nuestro paciente de 19 años, presentaron hemorragia de tubo digestivo alto manifestada como evacuaciones melénicas como uno de sus síntomas más alarmantes. Es usual que el coriocarcinoma esté asociado a un adenocarcinoma desarrollado en otro sitio ajeno a las 15 , bien descrito anteriormente por Nguyen 10 en 1982, aunque esta forma de presentación es muy poco común, habiendo solo seis casos reportados de coriocarcinoma primario en el colon.…”

Gestational Trophoblastic Disease: Choriocarcinoma and Its Treatment

“…It consists of a GTN characterized by abnormal trophoblastic hyperplasia and anaplasia, absence of chorionic villi, hemorrhage and necrosis. Direct myometrial and vascular invasion may result in metastases in distant sites, most commonly in the vagina, pelvis, lungs, brain, kidney, liver, intestine, spleen, skin and fetus (LURAIN, 2010;MARTÍNEZ-ORDAZ et al, 2012;DHANDA et al, 2014;STEVES et al, 2015).…”

“…When CC occurs in men, although rare, its prognosis is even worse (MARTÍNEZ-ORDAZ et al, 2012;FANG-JIANG et al, 2014). Testicles are their main site, they are mixed and may involute after metastasis, leaving only a scar (MARTÍNEZ-ORDAZ et al, 2012).…”

“…When CC occurs in men, although rare, its prognosis is even worse (MARTÍNEZ-ORDAZ et al, 2012;FANG-JIANG et al, 2014). Testicles are their main site, they are mixed and may involute after metastasis, leaving only a scar (MARTÍNEZ-ORDAZ et al, 2012). Complete resection of the primary site and metastasis, followed by cycles of chemotherapy seem to have a better effect on remission (FANG JIANG et al, 2014).…”