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Braga A, Paiva G, Alevato R, Saldanha P, Elias KM, Horowitz NS, Berkowitz RS. Treatment of High-Risk Gestational Trophoblastic Neoplasia. Hematol Oncol Clin North Am 2024:S0889-8588(24)00108-4. [PMID: 39322460 DOI: 10.1016/j.hoc.2024.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
High-risk gestational trophoblastic neoplasia encompasses patients with high volumes of disease or diffuse metastatic involvement who are unlikely to achieve remission with single-agent chemotherapy. Etoposide-based multi-drug regimens form the core of high-risk therapy. Second-line therapy includes platinum-based regimens. Increasingly, third-line therapy uses immunotherapy. Surgical intervention may be required to resect foci of resistant disease or manage complications. Treatment should continue until the hCG is less that the reference range for normal, followed by at least 3 cycles of consolidation therapy. At least 2 years of hCG surveillance are advisable for most patients requiring multiagent therapy to encompass 95% of relapses.
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Affiliation(s)
- Antonio Braga
- Postgraduate Program in Medical Sciences, Faculty of Medicine, Fluminense Federal University, Rua Ataíde Parreiras, 100, Bairro de Fátima, Niterói, RJ, 24070-090, Rio de Janeiro, Brazil; Rio de Janeiro Trophoblastic Disease Center, Maternity School of Rio de Janeiro Federal University, Rua Laranjeiras, 180, Laranjeiras, Rio de Janeiro, RJ, 22240-003, Brazil; Postgraduate Program in Applied Health Sciences, Vassouras University, Av. Expedicionário Osvaldo de Almeida Ramos, 250, Bloco 03, 2 andar, Centro, Vassouras, RJ, 27700-000, Brazil.
| | - Gabriela Paiva
- Postgraduate Program in Medical Sciences, Faculty of Medicine, Fluminense Federal University, Rua Ataíde Parreiras, 100, Bairro de Fátima, Niterói, RJ, 24070-090, Rio de Janeiro, Brazil
| | - Raphael Alevato
- Postgraduate Program in Medical Sciences, Faculty of Medicine, Fluminense Federal University, Rua Ataíde Parreiras, 100, Bairro de Fátima, Niterói, RJ, 24070-090, Rio de Janeiro, Brazil
| | - Penélope Saldanha
- Rio de Janeiro Trophoblastic Disease Center, Maternity School of Rio de Janeiro Federal University, Rua Laranjeiras, 180, Laranjeiras, Rio de Janeiro, RJ, 22240-003, Brazil
| | - Kevin M Elias
- New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Neil S Horowitz
- New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Ross S Berkowitz
- New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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Coopmans L, Larsson A, Joneborg U, Lok C, van Trommel N. Surgical Management of Gestational Trophoblastic Disease. Gynecol Obstet Invest 2023; 89:214-229. [PMID: 37788661 DOI: 10.1159/000534065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 09/04/2023] [Indexed: 10/05/2023]
Abstract
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 was 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 or placental site trophoblastic tumor) 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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Affiliation(s)
- Leonoor Coopmans
- Gynecological Oncology, Center for Gynecological Oncology Amsterdam, Netherlands Cancer Institute, Amsterdam, The Netherlands,
| | - Agnes Larsson
- Department of Gynecologic Cancer Surgery, Karolinska University Hospital and Department of Women's and Children's Health Karolinska Institutet, Stockholm, Sweden
| | - Ulrika Joneborg
- Department of Gynecologic Cancer Surgery, Karolinska University Hospital and Department of Women's and Children's Health Karolinska Institutet, Stockholm, Sweden
| | - Christianne Lok
- Gynecological Oncology, Center for Gynecological Oncology Amsterdam, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Nienke van Trommel
- Gynecological Oncology, Center for Gynecological Oncology Amsterdam, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Jaz K, Miedziarek C, Piasek E, Florek A, Nowak-Markwitz E, Zaborowski MP. Choriocarcinoma complicated with intra-abdominal and intrapleural hemorrhage in pregnancy - case report. Front Oncol 2023; 13:1198553. [PMID: 37664020 PMCID: PMC10469698 DOI: 10.3389/fonc.2023.1198553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/21/2023] [Indexed: 09/05/2023] Open
Abstract
Background Choriocarcinoma is a rare neoplasm, exceptionally uncommon during an ongoing pregnancy. The disease often has a metastatic character, causing severe symptoms from various anatomic sites like the lungs, central nervous system, vagina, pelvis, or liver. Due to the condition's rarity, evidence on how to treat the choriocarcinoma originating during pregnancy remains scarce. Case presentation Here, we present a case of a patient who developed choriocarcinoma before the 29th week of gestation. The neoplasm had a metastatic character, resulting in hemorrhage complicated by a hypovolemic shock. The patient underwent an emergency cesarean section and several surgeries to stop the massive hemorrhage. The treatment of the choriocarcinoma included chemotherapy with methotrexate followed by an EMA-CO regimen. The patient had a complete response to the therapy. The neonate suffered from complications related to prematurity. Conclusion Metastatic choriocarcinoma can be a diagnostic and therapeutic challenge during ongoing pregnancy. Treatment of the disease can be associated with severe complications, but a complete response to chemotherapy is possible with a favorable long-term prognosis.
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Affiliation(s)
- Kamila Jaz
- Department of Gynecology, Obstetrics and Gynecologic Oncology, Division of Gynecologic Oncology, Poznan University of Medical Sciences, Poznań, Poland
| | - Cezary Miedziarek
- Department of Gynecology, Obstetrics and Gynecologic Oncology, Division of Gynecologic Oncology, Poznan University of Medical Sciences, Poznań, Poland
| | - Ewa Piasek
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
| | - Artur Florek
- First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
| | - Ewa Nowak-Markwitz
- Department of Gynecology, Obstetrics and Gynecologic Oncology, Division of Gynecologic Oncology, Poznan University of Medical Sciences, Poznań, Poland
| | - Mikołaj Piotr Zaborowski
- Department of Gynecology, Obstetrics and Gynecologic Oncology, Division of Gynecologic Oncology, Poznan University of Medical Sciences, Poznań, Poland
- Institute of Bioorganic Chemistry, Polish Academy of Sciences, Poznań, Poland
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Filho LHCP, Silva TA, Beal PR, Buonfiglio VB, Sadi MV. Spontaneous rupture of a retroperitoneal lymph node metastasis causing massive hemorrhage in a patient with advanced mixed germ cell tumor. Urol Case Rep 2022; 45:102180. [PMID: 35968525 PMCID: PMC9372596 DOI: 10.1016/j.eucr.2022.102180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/28/2022] [Accepted: 07/31/2022] [Indexed: 11/30/2022] Open
Abstract
Retroperitoneal hemorrhage is a rare and life-threatening clinical presentation that may occur in patients with advanced germ cell tumors, typically after chemotherapy. Rapid clinical suspicion is crucial to offer the best treatment. Surgery is usually recommended but dismal complications may occur. We report on a man with metastatic testicular cancer presenting with massive spontaneous retroperitoneal hemorrhage that had not received previous systemic treatment and was managed without surgical treatment, with good clinical outcome.
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Affiliation(s)
| | - Tiago Aparecido Silva
- Corresponding author. Department of Surgery, Division of Urology Federal University of São Paulo Rua Botucatu, 740 – Vila Clementino, Zip Code 04023062, São Paulo, SP, Brazil.
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Braga A, Elias KM, Horowitz NS, Berkowitz RS. Treatment of high-risk gestational trophoblastic neoplasia and chemoresistance/relapsed disease. Best Pract Res Clin Obstet Gynaecol 2021; 74:81-96. [PMID: 33622563 DOI: 10.1016/j.bpobgyn.2021.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/05/2020] [Accepted: 01/08/2021] [Indexed: 01/01/2023]
Abstract
High-risk gestational trophoblastic neoplasia (GTN) has an increased risk of developing chemoresistance to single-agent chemotherapy; therefore, the primary treatment should be a multiagent etoposide-based regimen, preferably EMA/CO. After remission (normalization of human chorionic gonadotropin - hCG), at least three consolidation courses of EMA-CO are needed to reduce the risk of relapse. Chemoresistance is diagnosed during treatment if hCG levels plateau/increase, in two consecutive values over a two-week period. When this occurs after remission, in the absence of a new pregnancy, there is a relapse. In both cases, after re-assessment of the extent of disease, EMA-EP is the most common chemotherapy choice. Even in these cases, remission rates are high. After remission is achieved, hCG should be measured monthly for a year. Pregnancy can be allowed after 12 months from remission. The follow-up of these patients in referral centers minimizes the chance of death from this disease and should be encouraged.
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Affiliation(s)
- Antonio Braga
- Rio de Janeiro Trophoblastic Disease Center (Maternity School of Rio de Janeiro Federal University and Antonio Pedro University Hospital of Fluminense Federal University), Brazil; Postgraduate Program in Perinatal Health, Faculty of Medicine, Rio de Janeiro, RJ, Brazil; Postgraduate Program in Medical Sciences, Fluminense Federal University, Niterói, RJ, Brazil.
| | - Kevin M Elias
- New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Neil S Horowitz
- New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ross S Berkowitz
- New England Trophoblastic Disease Center, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Abstract
This article addresses the role of surgery in the management of gynecologic cancers with liver metastases. The authors review the short-term and long-term outcomes of aggressive resection through retrospective and randomized studies. Although the data supporting aggressive resection of liver metastasis are largely retrospective and case based, the randomized control data to address neoadjuvant versus chemotherapy have been widely criticized. Residual disease remains an important predictor for survival in ovarian cancer. If a patient cannot achieve near optimal cytoreduction, radical cytoreductive procedures, such as hepatic resection, should be considered for palliation only.
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Affiliation(s)
- Kiran H Clair
- Division of Gynecologic Oncology, University of California, 333 City Boulevard West, Suite 1400, Orange, CA 92868, USA.
| | - Juliet Wolford
- Division of Gynecologic Oncology, University of California, 333 City Boulevard West, Suite 1400, Orange, CA 92868, USA
| | - Jason A Zell
- Division of Hematology/Oncology, Department of Medicine, University of California, 333 City Boulevard West, Suite 1400, Orange, CA 92868, USA
| | - Robert E Bristow
- Department of Obstetrics and Gynecology, University of California, 333 City Boulevard West, Suite 1400, Orange, CA 92868, USA
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Lok C, Frijstein M, van Trommel N. Clinical presentation and diagnosis of Gestational Trophoblastic Disease. Best Pract Res Clin Obstet Gynaecol 2020; 74:42-52. [PMID: 33422446 DOI: 10.1016/j.bpobgyn.2020.12.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/05/2020] [Accepted: 12/01/2020] [Indexed: 12/14/2022]
Abstract
Gestational trophoblastic disease (GTD) is a heterogeneous group of pregnancy-related disorders characterized by abnormal proliferation of trophoblastic tissue. It encompasses the premalignant partial and complete hydatidiform mole but also the malignant invasive mole, choriocarcinoma, placental-site trophoblastic tumor, and epithelioid trophoblastic tumor. The clinical presentation changed to earlier detection after the introduction of first trimester ultrasounds. Patients are often asymptomatic, but vaginal bleeding continues to be the most common presenting symptom. Other symptoms can develop in the case of metastatic disease. Ultrasound, serum human chorionic gonadotrophin, and sometimes additional imaging such as CT, MRI, or PET can confirm the diagnosis and stage of disease. Familiarity with the pathogenesis, classification, imaging features, and treatment of GTD facilitates diagnosis and appropriate management.
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Affiliation(s)
- Christianne Lok
- Department of Gynaecologic Oncology, Center of Gynecologic Oncology Amsterdam, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands.
| | - Minke Frijstein
- Department of Gynaecologic Oncology, Center of Gynecologic Oncology Amsterdam, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands.
| | - Nienke van Trommel
- Department of Gynaecologic Oncology, Center of Gynecologic Oncology Amsterdam, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands.
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Unusual Presentation of Gestational Trophoblastic Disease with Isolated Liver Metastases, Skipping Lungs: Case Report and Review of the Literature. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2018. [DOI: 10.1007/s40944-018-0210-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Ren Z, Yu L, Xie M, Liang Y, Zhu F, Huang R, Zhang Z, Fu C. Successful treatment of multisite hemorrhage by several methods in brain metastasis of choriocarcinoma: A case report. Medicine (Baltimore) 2018; 97:e10794. [PMID: 29794762 PMCID: PMC6392619 DOI: 10.1097/md.0000000000010794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
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.
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Affiliation(s)
- Zhen Ren
- Department of Obstetrics and Gynecology, the Second Xiangya Hospital
| | - Li Yu
- Department of Obstetrics and Gynecology, the Second Xiangya Hospital
| | - Mengnv Xie
- Department of Obstetrics and Gynecology, the Second Xiangya Hospital
| | - Yiyi Liang
- Department of Anesthesia, Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Fang Zhu
- Department of Obstetrics and Gynecology, the Second Xiangya Hospital
| | - Rui Huang
- Department of Obstetrics and Gynecology, the Second Xiangya Hospital
| | - Zhibang Zhang
- Department of Obstetrics and Gynecology, the Second Xiangya Hospital
| | - Chun Fu
- Department of Obstetrics and Gynecology, the Second Xiangya Hospital
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Fatema N, Arora NV, Al Abri FM, Khan YMT. Pancreatic and Hepatic Metastasis of an Undiagnosed Choriocarcinoma: An Exceptional Cause of Haemoperitoneum in Young Women - Report of a Rare Case. Case Rep Oncol 2016; 9:633-638. [PMID: 27920694 PMCID: PMC5118864 DOI: 10.1159/000449462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 08/29/2016] [Indexed: 12/27/2022] Open
Abstract
Haemoperitoneum in women of reproductive age usually suggests either ruptured ectopic pregnancy or ruptured ovarian cysts. Metastatic choriocarcinoma is considered the least common cause of haemoperitoneum in women of childbearing age. We report a rare case of pancreatic and hepatic metastasis of choriocarcinoma in a young, 30-year-old female who had delivered 10 months prior at term gestation with no previous history of gestational trophoblastic disease or molar pregnancy. She had a short history of fever and pain in the right hypochondrium, with findings of hypovolaemic shock due to intraperitoneal haemorrhage. Unfortunately, the patient expired with massive uncontrolled bleeding from liver metastasis despite 2 emergency laparotomies within 12 h. This case report is an apt reminder to clinicians to include metastatic choriocarcinoma on the list of differential diagnoses for haemoperitoneum with a positive pregnancy test in women of reproductive age to diagnose early and to avoid life-threatening consequences.
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Affiliation(s)
- Nishat Fatema
- Department of Obstetrics and Gynaecology, Ibri Regional Hospital, Ibri, Sultanate of Oman
| | - Neeru Vinod Arora
- Department of Obstetrics and Gynaecology, Ibri Regional Hospital, Ibri, Sultanate of Oman
| | - Fatma Majid Al Abri
- Department of Obstetrics and Gynaecology, Ibri Regional Hospital, Ibri, Sultanate of Oman
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11
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Arteriovenous Fistula Embolization in Suspected Parauterine Choriocarcinoma. Case Rep Obstet Gynecol 2016; 2016:6353471. [PMID: 27403360 PMCID: PMC4923520 DOI: 10.1155/2016/6353471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/27/2016] [Accepted: 05/31/2016] [Indexed: 11/17/2022] Open
Abstract
This is a case of choriocarcinoma that did not regress after chemotherapy treatment. A 30-year-old female patient (gravida 2, para 2), presented to our ER with stroke and persistent mild pelvic pain 2 months after a Caesarean section. Computed tomography (CT) revealed an ischemic left hemicerebellar region and a hypervascular mass in the pelvic region. This mass was not present on routine fetal ultrasound during pregnancy. The lesion was treated by chemotherapy after closure of a foramen ovale and insertion of an inferior vena cava (IVC) filter. After that, 2 courses of EMACO (Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide, and Vincristine) chemotherapy regimen were given. Posttreatment CT showed the hypervascular mass without any changes. Arteriography showed the arteriovenous fistulae that were embolized successfully with plugs, coils, and glue. Embolization was considered due to the risk of acute hemorrhagic life-threatening complications. Eight chemotherapy courses were added after embolization. Treatment by endovascular approach and reduction of the hypervascular mass can be a valuable adjunct to chemotherapy treatment of choriocarcinoma.
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12
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Endovascular management of postpartum hemorrhage of placental origin. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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13
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Feng F, Xiang Y. Surgical management of chemotherapy-resistant gestational trophoblastic neoplasia. Expert Rev Anticancer Ther 2014; 10:71-80. [DOI: 10.1586/era.09.169] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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14
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Mousa AY, Abu-Halimah S, Alhalbouni S, Hass SM, Yang C, Gill G, AbuRahma AF, Bates M. Amyloidosis and spontaneous hepatic bleeding, transcatheter therapy for hepatic parenchymal bleeding with massive intraperitoneal hemorrhage: a case report and review of the literature. Vascular 2013; 22:356-60. [PMID: 23929426 DOI: 10.1177/1708538113492725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Hepatic hemorrhage can be devastating, especially in patients with underlying hepatic pathology. This is a case report of a 50-year-old man who presented to the emergency room with Stage 3 shock as evidenced by a systolic blood pressure of 90 mmHg, a heart rate of 125 beats per minute, respiration of 32, with delayed capillary refill and agitation. At this time, he was found to have a massive spontaneous intra-abdominal hemorrhage with an advanced stage of amyloidosis with multiple organ malfunctions. The initial diagnosis was based on an abdominal computed tomography scan and the patient was taken expeditiously to a hybrid angiography suite for a celiac angiogram. An intraoperative diagnosis of extravasation from amyloid related vasculopathy was made based on the angiographic appearance of hepatic circulation. Coil embolization of the feeding branch of the bleeder was achieved using the interlock coil system and a completion angiogram was done showing complete cessation of active bleeding. The postoperative phase was uneventful and the patient was discharged home on postoperative day three. His postoperative visit at five months later was unremarkable.
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Affiliation(s)
- Albeir Y Mousa
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, USA
| | - Shadi Abu-Halimah
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, USA
| | - Saadi Alhalbouni
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, USA
| | - Stephen M Hass
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, USA
| | - Calvin Yang
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, USA
| | - Gurpreet Gill
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, USA
| | - Ali F AbuRahma
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, USA
| | - Mark Bates
- Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, USA
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Lybol C, Centen DW, Thomas CMG, ten Kate-Booij MJ, Verheijen RHM, Sweep FCGJ, Ottevanger PB, Massuger LFAG. Fatal cases of gestational trophoblastic neoplasia over four decades in the Netherlands: a retrospective cohort study. BJOG 2012; 119:1465-72. [DOI: 10.1111/j.1471-0528.2012.03480.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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16
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Tse K, Ngan HY. Gestational trophoblastic disease. Best Pract Res Clin Obstet Gynaecol 2012; 26:357-70. [DOI: 10.1016/j.bpobgyn.2011.11.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 11/29/2011] [Indexed: 10/14/2022]
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17
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Desai KR, Chen RI. Endovascular therapy for palliative care of cancer patients. Semin Intervent Radiol 2011; 24:382-90. [PMID: 21326590 DOI: 10.1055/s-2007-992326] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Interventional radiology procedures often play an integral role in the diagnosis and treatment of patients with cancer. In the latter stages of cancer treatment, palliative care therapies may be sought for improvement in the quality of remaining life for oncology patients. Increased awareness among interventionalists and referring oncologists regarding minimally invasive treatments for palliation is desirable to provide additional options for patients. In particular, endovascular therapies can provide control of symptoms and complications related to incurable malignancies.
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Affiliation(s)
- Kush R Desai
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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18
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Tatokoro M, Kawakami S, Sakura M, Kobayashi T, Kihara K, Akamatsu H. Successful management of life-threatening choriocarcinoma syndrome with rupture of pulmonary metastatic foci causing hemorrhagic shock. Int J Urol 2008; 15:263-4. [PMID: 18304226 DOI: 10.1111/j.1442-2042.2007.01979.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We report a case of a man with testicular cancer metastatic to the lung and retroperitoneal lymph node, with significant elevation of serum levels of human chorionic gonadotropin, 534,000 mIU/mL. Just after the initiation of chemotherapy, life-threatening hemothorax occurred and hemorrhagic shock ensued. The pulmonary tumor had broken off, and lower lobectomy was carried out. Pathologic examination of the specimen revealed choriocarcinoma and yolk sac tumor. Through multimodal treatments he achieved complete remission. To our knowledge, this is the first case report of choriocarcinoma syndrome with life-threatening hemorrhage caused by rupture of pulmonary metastases, resulting in complete remission through multimodal treatments.
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Affiliation(s)
- Manabu Tatokoro
- Department of Urology, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Regis C, Taieb S, Lesoin A, Baranzelli MC, Blehaut T, Leblanc E. Présentation inhabituelle d'un choriocarcinome gestationnel. ACTA ACUST UNITED AC 2006; 34:716-9. [PMID: 16971152 DOI: 10.1016/j.gyobfe.2006.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Accepted: 05/02/2006] [Indexed: 10/24/2022]
Abstract
Gestational choriocarcinoma is a rare malignant tumour with a strong metastatic potential. We report a case of a 31-year-old patient with a gestational trophoblastic tumor revealed by renal and pulmonary metastases, one year after a normal pregnancy. The diagnosis was established by the pathologist on the radical nephrectomy specimen. The evolution was quickly favorable after adequate treatment using multiagent chemotherapy. This case highlights the polymorphic aspects of the gestational choriocarcinoma and stresses the importance of a betaHCG assessment anytime abnormal symptoms occur in the outcome of a pregnancy.
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Affiliation(s)
- C Regis
- Service de cancérologie gynécologique, centre de lutte contre le cancer (CLCC) Oscar-Lambret, BP 307, 3, rue Frédéric-Combemale, 59020 Lille cedex, France
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