Puerperal choriocarcinoma

Beavington, L; Mossa, M.

doi:10.1136/bcr.09.2010.3320

Case Reports

2011

DOI: 10.1136/bcr.09.2010.3320

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Puerperal choriocarcinoma

L Beavington¹,

M. Mossa

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Cited by 2 publications

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“…Choriocarcinoma is generally observed within a year after pregnancy, but can also be rarely found in postmenopausal women a long latent period after previous pregnancies. 3,4 There are only a few case reports of metastatic choriocarcinoma as a cause of stroke, 2,5,6 and, to our knowledge, none have been reported among postmenopausal women. Hypercoagulability and marantic endocarditis are other common mechanisms of stroke in patients with cancer.…”

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Stroke Caused by a Pulmonary Vein Thrombosis Revealing a Metastatic Choriocarcinoma

et al. 2015

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A 57-year-old white woman, with history of hydatidiform mole 2 years earlier, was evaluated at our stroke center for the acute onset of intense cephalgia, vomiting, and aphasia. Recent medical history was significant for a vertebrobasilar transient ischemic attack 1 month earlier with a negative etiologic evaluation and negative vessel imaging and transesophageal echocardiography (TEE). A treatment by aspirin 160 mg was then started. On admission, neurological examination revealed a global aphasia and right homonymous hemianopsia. The National Institutes of Health Stroke Scale score was 8. She had no fever. Cardiovascular examination revealed a systolic murmur. Pulmonary auscultation was normal. A computed tomographic brain scan showed a left lobar temporal intracerebral hematoma with a subarachnoid hemorrhage in the ipsilateral sylvian fissure. Cerebral angiography and arteriography showed no vascular abnormality. Brain MRI showed a hemorrhagic infarction in the left middle cerebral artery territory and revealed several subacute infarctions in other vascular territories (Figure 1). Magnetic resonance angiography was normal. Coagulation tests involving fibrinogen, prothrombin time, activated partial thromboplastin time were normal. These multiple infarcts raised concern for a cardioembolic etiology to her stroke. The cardiac monitoring showed no arrhythmia. The transthoracic echocardiography showed an echogenic structure in the left atrium that was not clearly visualized ( Figure 2). TEE revealed a 3-cm thrombus in the left atrium extending into a pulmonary vein ( Figure 3, Movie I in the online-only Data Supplement). Anticoagulation by unfractionated heparin was started. Chest computed tomography and angiography confirmed the presence of the thrombus in the right inferior pulmonary vein contiguous to an invasive pulmonary mass of the right inferior lobe infiltrating the right inferior pulmonary vein (Figure 4). Abdominal and pelvic computed tomography were normal. Because the patient had a past medical history of hydatidiform mole, serum β-human chorionic gonadotrophin was measured. Its level was highly increased at 155.2 IU/L (normal β-human chorionic gonadotrophin level is <2 IU/L). Those investigations led to the diagnosis of a pulmonary metastasis of a choriocarcinoma.A transbronchial lung biopsy was performed, but the biopsy material was not specific. Because increased β-human chorionic gonadotrophin is a very sensitive and specific test for the diagnosis of choriocarcinoma, histopathologic proof of choriocarcinoma is not always required to initiate therapy.1 The patient was then transferred to the oncology department where combination chemotherapy (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) was initiated. One month later the patient was functionally independent (modified Rankin Scale=2) and her National Institutes of Health Stroke Scale score was 3. At 3 months, the control TEE showed a persistent thrombus in the left atrium and the MRI was stable. Anticoagulation treatment was...

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Stroke Caused by a Pulmonary Vein Thrombosis Revealing a Metastatic Choriocarcinoma

et al. 2015

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Three atypical presentations of choriocarcinoma, occurring during and shortly after a coexistent viable pregnancy

2021

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Gestational choriocarcinoma is a malignant tumour originating from the trophoblastic tissue that can arise during or after any type of pregnancy, but most of the time follows a molar pregnancy. Characteristic for this tumour is its rapid haematogenous spread to various organs, causing atypical presentations often attributable to metastatic disease. We review three cases that occurred during and shortly after a coexistent intrauterine pregnancy. The patient of Case 1 presented with neurological symptoms due to hypercalcaemia, in Case 2 there was initially suspicion of appendicitis and the third patient presented with acute respiratory insufficiency. This case series illustrates that, although highly effective chemotherapy is available, choriocarcinoma can be life-threatening and accurate diagnosis is challenging but critical.

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Puerperal choriocarcinoma

Cited by 2 publications

References 7 publications

Stroke Caused by a Pulmonary Vein Thrombosis Revealing a Metastatic Choriocarcinoma

Stroke Caused by a Pulmonary Vein Thrombosis Revealing a Metastatic Choriocarcinoma

Three atypical presentations of choriocarcinoma, occurring during and shortly after a coexistent viable pregnancy

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