Unusual case of massive lower gastrointestinal bleeding in a young woman

Toh, Bin Chet; Chew, Min Hoe; Tan, Benita Kiat Tee

doi:10.1111/ans.15310

Cited by 2 publications

(4 citation statements)

References 2 publications

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“…Intestinal metastases from choriocarcinoma are rare, occurring in only approximately 5% of patients with choriocarcinoma; lower gastrointestinal metastases are even rarer, but intestinal metastases often predict a poor prognosis [ 8 , 9 ]. This disease was first described by Sears JB et al in 1933, and only 27 cases have been reported to date in the English literature (partially shown in Table 2 [ 5 , 10 – 19 ]). In the early reported cases, limitations in the understanding of gestational trophoblastic neoplasms and ancillary examination techniques precluded a definitive diagnosis in most cases.…”

Section: Discussionmentioning

confidence: 99%

“…Whole-abdomen CT is most commonly used to assess the presence of intestinal lesions, which may present as thickening of the intestinal wall or a soft tissue shadow in the intestine, but previous case reports did not describe the presence of lymph node enlargement. The lesion appears as a markedly enhanced nodular shadow on mesenteric vascular CTA, and a large amount of contrast leakage suggests the presence of active bleeding [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, for patients with severe anemia and extremely unstable vital signs, the surgical extent can be greatly limited, and recovery from surgery may delay the administration of chemotherapy and lead to progression of the remaining metastatic lesions. Toh BC et al performed selective coil vascular embolization of the mid jejunal branches of the superior mesenteric artery to achieve hemostasis in a patient with an actively bleeding jejunal lesion, and a late review did not reveal rebleeding of the intestinal lesion or intestinal ischemia [ 10 ]. Given the high sensitivity of choriocarcinoma to chemotherapy, Anisha Ramessur et al administered a low-dose EP chemotherapy regimen (etoposide 100 mg/m 2 and cisplatin 20 mg/m 2 ) to reduce bleeding and side effects due to chemotherapeutic drug metabolism in patients with intestinal metastases from choriocarcinoma, causing intussusception and bleeding from intestinal lesions.…”

Section: Discussionmentioning

confidence: 99%

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Intestinal metastasis from choriocarcinoma: a case series and literature review

Wang

Zhu

et al. 2022

World J Surg Onc

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Background Gestational choriocarcinoma is a rare trophoblastic tumor that spreads mainly to the lung, liver, and central nervous system. Fewer than 5% of patients present with metastasis to the gastrointestinal system and have a poor prognosis Case presentation We describe four cases of patients with intestinal metastasis from choriocarcinoma who visited the First Affiliated Hospital of Zhejiang University School of Medicine and the First People’s Hospital of Hangzhou between April 2012 and October 2019. Four patients presented with gastrointestinal symptoms or developed gastrointestinal symptoms during treatment for choriocarcinoma. Three patients had these intestinal lesions surgically removed, and the postoperative pathology results suggested choriocarcinoma. All patients received multiple chemotherapy regimens during treatment for suboptimal human chorionic gonadotropin (hCG) levels; one patient died 22 months after a definitive diagnosis was made, and the other three patients are still undergoing regular follow-up. Conclusion Given the low incidence of intestinal metastases from choriocarcinoma, the metastatic route of intestinal metastases from choriocarcinoma remains to be elucidated, and diagnosis mainly depends on pathology findings. An effective treatment has not been determined, and surgical excision with chemotherapy is generally accepted.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Intestinal metastasis from choriocarcinoma: a case series and literature review

Wang

Zhu

et al. 2022

World J Surg Onc

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“…The authors concluded that in GTN patients with life-threatening hemorrhagic complications, embolization is a safe and quick procedure [96]. A case of successful embolization of hemorrhaging gastrointestinal metastases has been described by Toh et al [97], while McDonald et al [98] published a case report of pulmonary metastases with bleeding arteriovenous malformation treated with embolization. The use of advanced interventional radiology techniques has also been described in treating chemotherapy-resistant disease in a few selected patients [53].…”

Section: Embolizationmentioning

confidence: 99%

Surgical Management of Gestational Trophoblastic Disease

Coopmans,

Larsson,

Joneborg

et al. 2023

Gynecol Obstet Invest

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Background Gestational Trophoblastic Disease (GTD) is a rare pregnancy related condition consisting of premalignant and malignant forms arising from proliferation of trophoblastic cells. The malignant forms are collectively referred to as Gestational Trophoblastic Neoplasia (GTN) and are highly sensitive to chemotherapy. However, surgical procedures remain indispensable in the diagnosis and treatment of GTD. Objectives The aim of this review is to summarize surgical interventions in the treatment of GTD and GTN. We reviewed indications, efficacy, possible complications and oncological outcomes of surgery. Methods Three searches were performed in the databases of PubMed, Embase and the Cochrane Library to create an up-to-date overview of existing literature on the following subjects: 1. The role of primary hysterectomy in GTD and GTN 2. The role of second curettage in GTD and GTN 3. Fertility sparing surgery in GTN 4. Surgical management of metastases. Included articles originated from the time period 1952-2022. Articles written in English, Spanish and French were included. Outcomes Thirty-eight articles were found and selected. Surgical evacuation through suction curettage is most used and advised in the treatment of GTD. A second curettage could be beneficial in patients with low hCG levels and low FIGO scores. In women who have completed their families, primary hysterectomy might be considered as the risk of subsequent GTN is lower than after suction curettage. In case of the rare forms of GTN (Epithelioid Trophoblastic Tumor (ETT) or Placental Site Trophoblastic Tumor (PSTT)) surgical tumor resection remains the most important step in treatment. Data on fertility sparing surgery in GTN are scarce and this treatment should be considered experimental. Conclusion and Outlook Surgery remains an important part of treatment of GTD and is sometimes indispensable to achieve curation. Further collection of evidence is needed to determine treatment steps.

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Unusual case of massive lower gastrointestinal bleeding in a young woman

Cited by 2 publications

References 2 publications

Intestinal metastasis from choriocarcinoma: a case series and literature review

Intestinal metastasis from choriocarcinoma: a case series and literature review

Surgical Management of Gestational Trophoblastic Disease

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