Uterine artery embolization as treatment for life-threatening haemorrhage from a cervical choriocarcinoma: a case report.Eur J Obstet Gynecol Reprod Biol. 2008;141:87-88. [PMID: 18649986 DOI: 10.1016/j.ejogrb.2008.05.008]

Identification and treatment of primary cervical gestational trophoblastic neoplasia: a retrospective study of 13 patients and literature review

Background

Primary cervical gestational trophoblastic neoplasias (GTNs) are extremely rare ectopic GTNs. Such lesions are difficult to diagnose clinically because of their rarity, with abnormal vaginal bleeding of a non-specific cause being the most common symptom. To that end, this retrospective study aimed to identify the clinical characteristics of cervical GTN and to explore diagnostic and therapeutic strategies.

Results

Thirteen patients diagnosed with primary cervical GTN at the Department of Gynecology, Peking Union Medical College Hospital, Beijing, China, between June 1, 1988 and May 31, 2020 were included in the study. All patients had irregular vaginal bleeding, including six who presented with massive bleeding. Seven patients (53.8%) were initially misdiagnosed with a cervical pregnancy. All patients received chemotherapy; 11 (84.6%) also underwent hysterectomy because of chemoresistant lesions or uncontrolled bleeding. All patients achieved complete remission; however, two women (15.4%) experienced a relapse during the median follow-up period of 35 months. A comprehensive review of English-language literature published between 1980 and 2020 identified 22 case reports encompassing 27 patients. The definitive diagnosis was achieved via pathology in 26 of them (96.3%), and hysterectomy was performed in 21 (77.8%).

Conclusions

Owing to its rarity and nonspecific symptoms, the diagnosis of primary cervical GTN is challenging and often relies on pathology. The combination of chemotherapy and hysterectomy is the main therapeutic strategy for this disease.

Choriocarcinoma misdiagnosed as cerebral hemangioma: A case report

BACKGROUND

Choriocarcinoma is a subtype of gestational trophoblastic disease, gestational trophoblastic neoplasia. Patients with brain metastasis are rare and information on the optimal treatment and patient outcome is limited. In order to improve the prognosis of this disease, accurate and timely treatments are very important for the patient of brain metastasis by choriocarcinoma.

CASE SUMMARY

A 17-year-old unmarried girl was misdiagnosed with a cerebral hemangioma with intracranial hemorrhage in a local hospital after presentation with severe head pain. She underwent craniotomy three times for treatment. The pathological results of posterior intracranial hematoma showed choriocarcinoma, and the patient was diagnosed as choriocarcinoma (21 points in stage IV). After uterine artery embolization, etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine chemotherapy for 7 cycles, and whole brain radiotherapy, the patient achieved remission. She has been followed for 2 years with no signs of tumor recurrence.

CONCLUSION

For female patients of childbearing age with an intracranial hematoma, the possibility of brain metastasis by choriocarcinoma should be considered. It is necessary to obtain a detailed history, including menstruation, beginning age of first sex, contraception, etc. The level of β-human chorionic gonadotropin should be tested at the beginning, and a stratified treatment should be administered according to the International Federation of Gynecology and Obstetrics staging and World Health Organization prognostic scoring systems.

Successful treatment of multisite hemorrhage by several methods in brain metastasis of choriocarcinoma: A case report

RATIONALE

Brain metastasis of choriocarcinoma is a highly malignant gestational trophoblastic neoplasia (GTN) and has a notoriously poor prognosis. Hemorrhagic choriocarcinoma lesions may lead to life-threatening conditions also. Treatment of brain metastases of choriocarcinoma with hemorrhage in multiple sites is very difficult in clinical practices. A patient has been successfully treated in our hospital, which provides as clinical references for this difficulty in treating brain metastases of choriocarcinoma with hemorrhage in multiple sites.

PATIENT CONCERNS

A 28-year-old patient with gravida 2, para 0 was admitted in our hospital for amenorrhea, vaginal bleeding, and lower abdominal pain.

DIAGNOSES

The patient was diagnosed as choriocarcinoma FIGO stage IV and the score of the Prognostic Scoring Index modified by the WHO was 15.

INTERVENTIONS

The patient received multiagent chemotherapy (EMACO regimen) soon after the diagnosis of choriocarcinoma with brain metastasis. During the therapy, the patient was given 3 different methods of treatment for metastatic site hemorrhage. An emergency surgery was performed to control massive bleeding from the metastatic lesions of broad ligament. Blood transfusions were given to treat acute left pulmonary hemorrhage. Uterine artery embolization (UAE) was performed to treat increased uterine bleeding.

OUTCOMES

The patient achieved remission after 9 cycles of chemotherapy. She has been followed up for 14 months with no signs of tumor recurrence.

LESSONS

The diagnosis of choriocarcinoma may be difficult, especially in the setting with the limit of medical resources. The application of various diagnostic techniques such as x-ray, computed tomography, and magnetic resonance imaging is helpful for evaluating the patient's condition.

Bleeding from gestational trophoblastic neoplasia: embolotherapy efficacy and tumour response to chemotherapy

AIM

To evaluate retrospectively the impact of selective arterial embolisation (SAE) on the prognosis of patients with gestational trophoblastic neoplasia (GTN).

MATERIALS AND METHODS

A retrospective analysis of the records of all patients with GTN between January 2005 and January 2015 was performed. Forty-one patients (mean age, 28.9 ± 7.6 years) with massive vaginal haemorrhage from GTN (including 27 cases of choriocarcinoma and 14 cases of invasive mole) were treated with SAE. The complications, control of haemorrhage, and outcome of chemotherapy were reviewed retrospectively.

RESULTS

SAE successfully controlled the haemorrhage for 38 patients (92.7%). All patients with successful SAE received systemic chemotherapy without recurrent massive bleeding during the period of chemotherapy. The average number of chemotherapy cycles was 9.8 for every patient. Complete remission (CR) was achieved in 34 patients (89.5%), two patients had partial remission, and two patients died. Two patients with CR required repeated embolisation for recurrence of massive bleeding 30 and 47 months after the first embolisation procedure due to uterine arteriovenous malformation (AVM).

CONCLUSIONS

SAE can effectively control haemorrhage from GTN and these patients had good response to systemic chemotherapy following successful SAE. Uterine bleeding may recur due to uterine AVMs, even following complete embolisation and CR of GTN.

Causes and palliation of transfusion-associated vaginal bleeding in patients with metastatic cancer

PURPOSE

The current study was undertaken (1) to capture a clinically relevant, systematically collected series of patients with metastatic cancer and transfusion-associated vaginal bleeding and (2) to provide insight into how best to palliate this bleeding.

METHODS/RESULTS

As part of a single-institution review, 46 patients with metastatic cancer and transfusion-associated vaginal bleeding were identified. In a minority, 14 (30%), the cancer itself was directly responsible for the bleeding, and under these circumstances, gynecological cancer was the most frequent cause. In 13 patients (28%), more than 1 palliative intervention was attempted. Of all the interventions, a hysterectomy was performed most frequently and was successful in 11 patients. The use of ablation or embolization procedures was rarely tried but successful in 4 patients. However, 2 patients died of vaginal bleeding, despite multiple palliative procedures to control bleeding, including tumor embolization in one.

CONCLUSIONS

Transfusion-associated vaginal bleeding in patients with metastatic cancer can arise from nonmalignant causes and often assumes an uneventful course but can, at times, be serious and difficult to control.