Metastatic choriocarcinoma presenting and treated during viable pregnancy: a case report

Abstract

We present a 25-year-old Caucasian woman in her first pregnancy (conceived on clomiphene) who had an uncomplicated course until 19 weeks of pregnancy. She has given written permission for the case to be reported. Booking blood tests in 2003 showed her to be blood group A positive and negative for hepatitis B virus and HIV. A nuchal translucency scan was low risk and confirmed the gestational age. She had a past history of ileo-caecal resection for Crohn's disease 4 years earlier.Between 19 and 23 weeks of gestation she had recurrent episodes of abdominal pain and vaginal bleeding warranting admission and a 2-unit blood transfusion. At 22 weeks an ultrasound scan showed normal fetal anatomy and a normal posterior, not low, placenta. However, it showed an 8.5-cm complex cystic mass on the anterior uterine wall. This was felt likely to represent a blood clot because it had not been present on the routine anomaly scan at 20 weeks. She remained an inpatient as she continued to have intermittent vaginal bleeding.After 6 days she complained of breathlessness and pleuritic chest pain. An ECG showed sinus tachycardia and a chest X-ray showed multiple rounded opacities throughout both lungs, measuring up to 2 cm in diameter, suggestive of metastases. A subsequent computed tomography pulmonary angiogram showed no evidence of embolic disease but confirmed multiple lesions highly suggestive of metastases. Renal, liver and thyroid function were normal and a quantitative b-human chorionic gonadotrophin (bhCG) measurement was 115 000 IU/l. Clinical examination of the breasts and skin revealed no abnormality and there were no palpable lymph nodes in the neck, groin and axilla.

Primary rectal choriocarcinoma associated with rectal adenocarcinoma in a woman with a history of ulcerative colitis: Case report

“…Although initial treatment was accompanied with β-hCG level reduction patients passed away in less than 2 years of initial treatment in Ragam et al [ 13 ] and Pezzuto et al [ 14 ] subjects. However, Bircher et al [ 15 ] case was alive and could gave birth to another child 7 years later of termination of treatments.…”

“…EMA/CO: etoposide, methotrexate and dactinomycin alternating with cyclophosphamide and vincristine. First author of the study age gender presentation IBD type Tumor location Metastatic sites IHC study positive for Treatment Ragam et al [ 13 ] 46 male fever and bloody diarrhea UC Rectosigmod Liver and Kidney βhCG, CK 7, p63, CD10, and CD30 Chemotherapy with bleomycin, etoposide and cisplatin Pezzuto et al [ 14 ] 47 male abdominal pain and melena Crohn’s disease Cecum Lung and Brain β-hCG CK-pool, CK-19 and Vimentin Total colectomy with lymph-nodes dissection Bircher et al [ 15 ] 25 Female Abdominal pain and vaginal bleeding Crohn’s disease Not found Lung Not performed Chemothera py started with methotrexate and folinic acid and continued with EMA/CO …”

Choriocarcinoma on Live Pregnancy: Case Study

“…There are no recommendations on hCG concentration monitoring to diagnose choriocarcinoma on live pregnancy [3]. The disease is in question if there is abnormal vaginal bleeding and/or bleeding at metastatic sites, together with respiratory symptoms, neural/spinal signs, high beta-hCG concentration in blood, low serum HPL and snow storm image in placental sonography [6,[8][9]. Genetic and histopathologic testing will help to determine the diagnosis.…”

Metastatic Choriocarcinoma Presenting in a Gravid Woman

“…This is the 18th reported case of antepartum choriocarcinoma resulting in both maternal and neonatal survival [2,3,4,5,6,7,10,11]. Primary pulmonary choriocarcinoma is extremely rare and associated with an overall poor prognosis [14].…”

“…In a review of the literature in 1999, Steigrad et al [2] identified 36 reported cases of choriocarcinoma with intrauterine pregnancy. Subsequently, 8 additional cases have been reported [3,4,5,6,7,8,9,10]. In addition, 1 case of tubal choriocarcinoma with concurrent intrauterine pregnancy has been reported [11].…”