A case of jejunal choriocarcinoma detected by capsule endoscopy and double-balloon endoscopy

Endoscopic manifestations of jejunal choriocarcinoma

Choriocarcinoma, a malignant tumor deriving from the trophoblastic tissue, is mostly associated with adverse pregnancy. Early metastasis is very common in patient with choriocarcinoma, but the cases of intestinal metastasis are definitely rare. Herein, we reported a case of jejunal choriocarcinoma revealed by endoscopy. Segmental resection of the jejunum as well as biopsy of liver nodules were performed. The patient was classified as super high-risk choriocarcinoma and received chemotherapy and surgical treatment. Unfortunately, the patient ultimately died of liver rupture.

Metastatic choriocarcinoma as initial presentation of small bowel perforation in absence of primary uterine lesion: a case report

BACKGROUND

Choriocarcinoma is a highly malignant tumor of gestational trophoblastic neoplasia that characteristically spreads via the bloodstream. Small bowel metastasis is very rare, and a small number of cases of choriocarcinoma metastasis to small bowel have been reported.

METHODS

We report a case of a 40-year-old woman presenting with acute abdominal pain and vaginal bleeding due to small bowel perforation secondary to jejunal metastasis. In our case, metastatic choriocarcinoma was present in the small bowel, lung, and liver, but no primary lesion was apparent.

RESULTS

After resection and anastomosis of the perforated small bowel, chemotherapy was performed. The patient began chemotherapy with etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMA-CO) for 9 cycles. When the 4th cycle of chemotherapy was finished, β-human chorionic gonadotropin (hCG) level was normalized and follow-up computed tomography scans showed regression of the liver metastasis and small bowel lesion and significantly decreased lung metastasis. After 9 cycles of chemotherapy were completed, the patient showed complete response.

CONCLUSIONS

If patients have high β-hCG of unknown origin and suspected panperitonitis, which are suspicious of choriocarcinoma metastasis to small bowel, the pathologic findings are important. It is essential to confirm the histopathologic diagnosis postoperatively. Choriocarcinoma can spread to various organs and show aggressive manifestations. Therefore, we should be aware of possible metastatic sites and remain alert to its diagnosis.