Infantile choriocarcinoma treated with chemotherapy alone

Abstract

The case to be discussed is a 3-week-old boy who presented with two 10 min left-sided focal seizures. Examination revealed pallor, hepatomegaly, mild hypotonia, and the presence of three 0.5-1 cm, purplish, nontender cutaneous lesions, on the left side of the neck, the right thigh and the right shoulder. Blood count showed Hb 9.7 g/dl; total white cell count, differential white cell count, and platelet counts were normal. Other baseline biochemistry investigations were normal. Neuroblastoma or acute leukaemia were considered possible diagnoses and excision biopsy of the left subcutaneous neck mass was performed. Radiologic imaging was required to determine the extent of the disease.Dr. Johnson. Mr. Munro, can you describe what you found at surgery?The left neck mass was subcutaneous, firm, mobile, 1 cm in diameter, and appeared haemorrhagic. It was easily excised and sent fresh to pathology.Dr. Johnson. May we now hear the radiologic findings?Ultrasonographic examination demonstrated multiple small echogenic nodules in the brain. A similar appearance was shown on ultrasound of the neck mass. Four large echogenic cavitating nodules were seen in the liver. A. Graham Wilkinson, FRCR (Paediatric Radiologist)Magnetic resonance imaging (MRI) of the brain showed multiple lesions less than 1 cm in diameter throughout the brain. These were of low signal on T1-and high signal on T2-weighted images with prominent surrounding oedema and dense central enhancement following the injection of gadolinium (Fig. 1). Abdominal MRI confirmed the presence of four cavitating hepatic lesions, the largest of which measured 7.5 cm in diameter. Dense enhancement of the rim of these lesions was seen (Fig. 2). Abdominal computed tomography (CT) showed

Treatment of infantile choriocarcinoma of the liver

“…β‐hCG levels are expected to fall exponentially during treatment. It has been recommended to administer two further courses of chemotherapy once normal levels have been achieved 6. Despite the rapid fall in β‐hCG levels, its endocrinologic effects of precocious puberty and advanced bone age, may persist long after the tumor has been treated 2.…”

“…Despite its highly malignant nature, this tumor is extremely chemosensitive 5. However, as there are no established protocols, the treatments have usually been based on germ cell tumor protocols 6. Our experience with the diagnosis and successful management of a critically ill infant with choriocarcinoma is detailed below.…”

Infantile Choriocarcinoma of the Liver: Case Report and Review of the Literature

“…A history of hemoptysis, hematemesis, melena, or hematuria was also often obtained. These infants were acutely ill [13]. Signs and symptoms of precocious puberty could also be present, related to the elevated levels of B-HCG.…”

“…Most of the infantile cases diagnosed during life have died either before treatment started or despite treatment. There are six case reports of infants who have survived [13].…”

Solitary infantile choriocarcinoma of the liver: MRI findings

“…The decline in serial serum b-HCG levels can be used to monitor treatment response. The tumour is usually highly susceptible to chemotherapy [10].…”