Role of thoracotomy in pulmonary metastases from gestational choriocarcinoma

Saitoh, Kazunori; Harada, Kunihiko; Nakayama, Hiroshi; Terauchi, Akiko; Nagano, Takashi; Inoue, Kenji

doi:10.1016/s0022-5223(19)37468-9

Cited by 10 publications

(2 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Most authorities agree that the procedure should be limited to patients whose lung tumor has failed to respond to multiple courses of combination chemotherapy. It is also essential to be certain that the lesion removed is the only focus of residual disease (12)(13)(14). Tumor in other locations, including multiple lung metastases, makes this surgery inappropriate.…”

Section: Discussionmentioning

confidence: 99%

The role of surgery in the management of gestational trophoblastic disease

Jones¹,

Wolchok²,

Lewis³

1996

Int J Gynecol Cancer

View full text Add to dashboard Cite

Jones WB, Wolchok J, Lewis JL Jr. The role of surgery in the management of gestational trophoblastic disease. Int J Gynecol Cancer 1996; 6: 261-266.Between November 1967 and December 1994, 242 patients with gestational trophoblastic disease (GTD) were treated with chemotherapy by the Gynecology Service of Memorial Hospital. Eighty-seven of the patients (35.9%) underwent at least one major operation during the course of their illness. Twenty-six patients underwent two major operations, and in five patients, three major operations were performed, for a total of 118 procedures. The most frequent procedures were: hysterectomy, 56 (47.4%); hysterotomy, 15 (12.7%); thoracotomy, 13 (11%); and craniotomy, 5 (4.2%). Twenty-nine additional procedures ranging in complexity from oophorectomy to segmental liver resection were also performed. Twenty-nine operations (24.5%) were considered to be beyond the scope of most gynecologic surgeons. The overall complete remission rate for 242 patients was 90.4%. The rate for patients who underwent a major surgical procedure was 79.3% compared to 96.7% for patients whose treatment was with chemotherapy alone.The data demonstrate that the integration of surgery in the management of GTD patients often requires a multidisciplinary approach that in many cases can best be achieved at specialized treatment centers.

show abstract

Section: Discussionmentioning

confidence: 99%

The role of surgery in the management of gestational trophoblastic disease

Jones¹,

Wolchok²,

Lewis³

1996

Int J Gynecol Cancer

View full text Add to dashboard Cite

show abstract

“…Two reports in this Journal have recommended resection of isolated pulmonary metastases in choriocarcinoma; however, this tumor behaves differently from PSTT. 4,5 Unlike choriocarcinoma, PSTT is not usually sensitive to chemotherapy, and despite a few reports showing a significant response to chemotherapy, treatment of PSTT is centered around complete resection if possible. [6][7][8]…”

Section: Cpcmentioning

confidence: 99%

Clinical-pathologic conference in general thoracic surgery: metastatic placental site trophoblastic tumor

Patterson

2004

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

A 35-year-old woman came to an outside hospital 37 weeks' pregnant and reporting shortness of breath. A chest radiograph performed in the emergency department revealed a right pneumothorax. A 12F catheter was placed to drain the pneumothorax. Subsequently, a persistent air leak developed, and the patient was transferred to the obstetric service at our hospital. Three days after admission, she had an uncomplicated vaginal delivery. However, she continued to have a persistent air leak from her chest tube. Several days later, the air leak ceased but a recurrent pneumothorax developed. This required the placement of a larger chest tube, which once again revealed a persistent air leak.The only significant procedures in the patient's surgical history were a cesarean section and a cholecystectomy. She had a 10 pack-year smoking history and no history of a previous pneumothorax. After the air leak was tracked for 1 week after delivery, the patient was taken for a video-assisted thoracoscopy. A video-assisted thoracoscopic resection of a right lower lobe bleb and mechanical pleurodesis were performed. The patient tolerated the procedure well and was discharged to home on the fourth postoperative day after her chest tube was removed. The case is being presented because of interesting findings in the resected specimen.Dr Patterson: She had had no imaging other than just a chest radiograph? Dr Force: She had a computed tomographic (CT) scan as well. Dr Gierada: On the chest radiograph taken when she was transferred here, you can faintly see the pneumothorax catheter, and there was still a very small right apical pneumothorax. A follow-up radiograph 3 days later showed almost a complete collapse of her right lung (Figure 1). The following day, the lung had come up partly in the morning, and a few hours later it was up almost completely. No obvious lesions were seen in the lungs on images obtained without a pneumothorax present. A CT scan obtained later that same day showed the pneumothorax, and in the right lung base there was a cystic lesion with what looked like perhaps some thin septations with a little thickening of the septations or some vessels running along them. A very thin-walled inferior portion was adhered to it, so that it looked like a thin bleb (Figure 2). This is an unusual location for a bleb as a cause of spontaneous

show abstract

Thoracotomy in the management of gestational choriocarcinoma. A clinicopathologic study

Jones

Romain

Erlandson

et al. 1993

Cancer

View full text Add to dashboard Cite

Background. Pulmonary metastases occur frequently in patients with gestational choriocarcinoma and most of these patients achieve remission with chemotherapy alone. Thus, the indications for surgical intervention are limited, but in appropriately selected patients, resection of a chemotherapy‐resistant lung lesion can be curative. Methods. Nine patients with choriocarcinoma metastatic to the lung underwent 11 thoracotomies. The procedure was done in two patients for diagnosis and in seven to remove a resistant focus of tumor in the lung. The excised resistant tumors in six patients were studied histopathoiogically, immunohistochemically, and by electron microscopic examination (one patient). Results. Six (66.6%) patients achieved complete remission for periods ranging from 3 months to 18 years, and three patients died of their disease. The residual lung nodules in these patients with chemotherapy‐resistant tumors were characterized by the presence of large mononucleated tumor cells that showed features intermediate between those of cytotrophoblasts and syncytiotrophoblasts but lacking ultrastructural and immunohistochemical features of the intermediate trophoblasts seen in placental site tumors. Conclusions. A major role for operative treatment of chemotherapy‐resistant choriocarcinoma in the lung is suggested by the observation that some of the resistant tumors contain a unique variant of trophoblastic cells that show a decreased sensitivity to chemotherapy but are amenable to surgical resection.

show abstract

Role of thoracotomy in pulmonary metastases from gestational choriocarcinoma

Cited by 10 publications

References 19 publications

The role of surgery in the management of gestational trophoblastic disease

The role of surgery in the management of gestational trophoblastic disease

Clinical-pathologic conference in general thoracic surgery: metastatic placental site trophoblastic tumor

Thoracotomy in the management of gestational choriocarcinoma. A clinicopathologic study

Contact Info

Product

Resources

About