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Kashtiara A, Schoonjans C, Van Looveren C, Jordens N, Van Peer F, Herthogs M, Deman F, Van Rompuy AS. Pneumothorax caused by metastatic gestational trophoblastic neoplasia: a case report. Acta Chir Belg 2024; 124:50-53. [PMID: 36355799 DOI: 10.1080/00015458.2022.2146844] [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: 10/23/2022] [Accepted: 11/05/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Gestational trophoblastic neoplasia (GTN) is a group of malignant neoplasms that arise from abnormal proliferation of trophoblastic tissue. The metastatic spread rate is depended on the histopathological type, with pulmonary metastases being the most common (80%) in patients with metastases. Pneumothorax as a primary manifestation is extremely rare. We hereby discuss a unique case of spontaneous hemi-pneumothorax due to metastatic GTN in a 30-weeks pregnant woman. CASE PRESENTATION A 25-year-old woman - G2 P0 A1 - was admitted to our maternal intensive care department with atypical respiratory symptoms. A chest x-ray revealed a large right sided pneumothorax. The patient underwent an urgent percutaneous chest tube. Since halting of the suction resulted in residual pneumothorax, a video-assisted thoracoscopic surgery (VATS) with wig resection of a bullous lesion was performed followed by chemical pleurodesis. Histopathological examination identified the lesion as a gestational trophoblastic metastasis with some features of choriocarcinoma. After primary section Caesarea adjuvant chemotherapy (MTX) was instigated with rapid decline of serum HCG values. Six months after surgery she was doing well with no biochemical or radiographic evidence of recurrent metastasis. CONCLUSION Lung metastases are common in patients with metastatic GTN; however, pneumothorax is an extremely rare complication. We report a case of pneumothorax in a 30-week pregnant woman caused by pulmonary spread of GTN from a previous miscarriage. This case illustrates that in patients with pneumothorax and a history of miscarriage, metastatic GTN should be considered as a possible cause.
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Affiliation(s)
- Ardavan Kashtiara
- Department of Thoracic and Vascular Surgery, GZA Hospitals, Antwerp, Belgium
| | - Carmen Schoonjans
- Department of Thoracic and Vascular Surgery, GZA Hospitals, Antwerp, Belgium
| | | | - Nathalie Jordens
- Department of Obstetrics and Gynecology, GZA Hospitals, Antwerp, Belgium
| | - Fleur Van Peer
- Department of Obstetrics and Gynecology, GZA Hospitals, Antwerp, Belgium
| | | | - Frederik Deman
- Department of Pathology, GZA Hospitals, Antwerp, Belgium
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Pahwa S, Sharma A, Kamboj M, Gupta G, Pasricha S. Metastatic choriocarcinoma of the kidney in the absence of existing primary uterine tumor: A rare presentation. J Cancer Res Ther 2023; 19:819-822. [PMID: 37470618 DOI: 10.4103/jcrt.jcrt_1880_20] [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] [Indexed: 07/21/2023]
Abstract
Gestational choriocarcinomas are malignant neoplasms generally arising in the uterus in women of childbearing age. These are aggressive tumors with a high incidence of metastasis to vascular organs such as the lung, liver, and brain. Renal metastasis is extremely rare with low incidence rate and very few cases have been reported in literature. Hereby, we report a rare case of metastatic choriocarcinoma to the kidney in a 29-year-old female 10 years after resection of a hydatidiform mole. The histopathological diagnosis was made on a nephrectomy specimen. Pelvic and abdominal scan did not show any abnormal radiological findings. She was started on first-line chemotherapy and showed a complete response. In conclusion, gestational or primary nongestational choriocarcinomas should always be considered as a differential diagnosis in young females of reproductive age group presenting with flank abdominal pain, unexplained hematuria, and atypical renal tumor histology.
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Affiliation(s)
- Saloni Pahwa
- Department of Pathology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Anila Sharma
- Department of Pathology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Meenakshi Kamboj
- Department of Pathology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Gurudutt Gupta
- Department of Pathology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Sunil Pasricha
- Department of Pathology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
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Pham T, Lapid D, Schmeler KM, Rauh-Hain JA, Leon MG. Retroperitoneal Hematoma as an Atypical Presentation of Choriocarcinoma: A Case Report. Case Rep Oncol 2023; 16:1274-1279. [PMID: 37928866 PMCID: PMC10622162 DOI: 10.1159/000534036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/01/2023] [Indexed: 11/07/2023] Open
Abstract
A 38-year-old female with an etonogestrel implant in place and history of previous ectopic pregnancy presented with acute abdominal pain and vaginal bleeding. She was found to have a beta-hCG of >12,000 mIU/mL and free fluid noted on a focused assessment with sonography in trauma exam. She underwent an emergent diagnostic laparoscopy due to the suspicion of a ruptured ectopic pregnancy. Findings at the time of surgery included a normal-appearing uterus and left fallopian tube, a surgically absent right fallopian tube and large volume hemoperitoneum with a rapidly expanding left retroperitoneal hematoma. A postoperative computerized tomography (CT) angiogram suggested active bleeding from a pseudoaneurysm of the left renal artery which was successfully embolized by interventional radiology. Biopsy confirmed gestational trophoblastic neoplasia (GTN) after metastases to the brain. In this report, we describe the details of this case of GTN with an atypical presentation.
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Affiliation(s)
- Truce Pham
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, Houston, TX, USA
| | - Danica Lapid
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, Houston, TX, USA
| | - Kathleen M. Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - J. Alejandro Rauh-Hain
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mateo G. Leon
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, Houston, TX, USA
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Jareemit N, Benjapibal M. Gestational Trophoblastic Neoplasia with Gum Metastasis: A Case Study and Literature Review. Case Rep Oncol 2020; 13:485-490. [PMID: 32508621 PMCID: PMC7250376 DOI: 10.1159/000506329] [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: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 11/19/2022] Open
Abstract
Gestational trophoblastic neoplasia (GTN) is an uncommon group of pregnancy-related malignancies. Delayed diagnosis is a prognostic factor for worse outcome. GTN is even harder to diagnose if the site of metastasis is uncommon. The reported case is a 27-year-old G<sub>2</sub>P<sub>1</sub>A<sub>1</sub> woman who presented to our center with acute transient generalized tonic-clonic seizure. She had developed hemoptysis for the 2 preceding weeks, which had been treated as pneumonia. She had then noticed multiple gum lesions and vaginal spotting 1 week before her presentation. Her serum β-human chorionic gonadotropin level was 77,474 IU/L without evidence of pregnancy. She was diagnosed with GTN with lung, brain, and gum metastases. The patient was staged as IV with a World Health Organization prognostic score of 14. Etoposide, methotrexate, actinomycin D alternating with cyclophosphamide, and vincristine weekly (EMACO) were given. The gum lesions disappeared after 2 cycles of the multiagent chemotherapy, and complete remission was achieved after 8 cycles. This case study will increase awareness of uncommon metastatic sites of GTN. Any associated vaginal bleeding should be considered a clue to metastatic GTN.
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Affiliation(s)
| | - Mongkol Benjapibal
- *Assoc. Prof. Mongkol Benjapibal, MD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700 (Thailand),
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Althwanay AM, AlMaradheef RA, Althwanay RM, Awadalla AS, Abdelhameed AAN. Choriocarcinoma presenting as skin lesions and back pain. Hematol Oncol Stem Cell Ther 2019; 13:48-50. [PMID: 31899161 DOI: 10.1016/j.hemonc.2019.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 11/02/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
| | | | | | - Awadia Salman Awadalla
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Arwa Abdelhameed Nabhan Abdelhameed
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; Department of Internal Medicine, King Fahad Hospital of the University, Alkhobar, Saudi Arabia
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Yousefi Z, Mottaghi M, Rezaei A, Ghasemian S. Abnormal Presentation of Choriocarcinoma and Literature Review. IRANIAN JOURNAL OF CANCER PREVENTION 2016; 9:e4389. [PMID: 27482332 PMCID: PMC4951767 DOI: 10.17795/ijcp-4389] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 03/15/2016] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Gestational trophoblastic neoplasms have highly been malignant potential, which usually occurred in child-bearing age women. Unusual feature of this malignancy would be rare, it was important to take in mind the possibility of GTN in different manifestation. Based on the above mentioned, the aim of this presentation would be the management and outcome of a case series of choriocarcinoma patients with abnormal manifestation. CASE PRESENTATION We have presented four patients, first who initially manifestation with signs of septic shock, the second case with severe gastrointestinal hemorrhage, the third case with postpartum infection and the forth case was a postmenopausal bleeding patient. CONCLUSIONS In case of metastatic choriocarcinoma with precise history, accurate diagnosis and appropriate treatment have led us to curable results.
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Affiliation(s)
- Zohreh Yousefi
- Department of Obstetrics and Gynecology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Mansorhe Mottaghi
- Department of Obstetrics and Gynecology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | | | - Sedighe Ghasemian
- Department of Obstetrics and Gynecology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
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Gestational Choriocarcinoma Presenting with Lacrimal Gland Metastasis: A First Reported Case. Case Rep Obstet Gynecol 2015; 2015:879538. [PMID: 26075121 PMCID: PMC4446461 DOI: 10.1155/2015/879538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/27/2015] [Accepted: 04/27/2015] [Indexed: 11/30/2022] Open
Abstract
Background. Gestational choriocarcinoma (GC) is a recognized clinicopathological subtype of gestational trophoblastic neoplasia that usually metastasizes hematogenously to highly vascular organs like the lung, liver, and brain. However, orbital metastasis to the choroid and lacrimal gland is a rare occurrence. Case Presentation. A 21-year-old female presented with headache and left orbital swelling one year after resection of a complete hydatidiform mole followed by adjuvant methotrexate chemotherapy. A metastatic imaging screening revealed multiple metastases in the lungs, brain, and adrenal gland, in addition to the choroid and lacrimal gland. Based on her modified WHO risk factors scoring she was started on chemotherapy and whole brain radiotherapy, which resulted in a complete response. At two-year follow-up, serum b-HCG level was with normal limits; imaging surveillance was uneventful. Conclusion. We present the first case of lacrimal gland metastasis in a young girl from GC relapse.
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Retroperitoneal nongestational choriocarcinoma in a 25-year-old woman. Obstet Gynecol Sci 2014; 57:544-8. [PMID: 25469347 PMCID: PMC4245352 DOI: 10.5468/ogs.2014.57.6.544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 06/05/2014] [Accepted: 06/05/2014] [Indexed: 11/08/2022] Open
Abstract
Choriocarcinoma is a highly invasive and metastatic neoplasm which arises in women of reproductive age. It can be either gestational or nongestational in origin, but the latter form is very rare. Choriocarcinoma is characterized by the production of human chorionic gonadotropin. It can metastasize to distant organs such as lung, brain, liver, kidney, and vagina in the early stages of disease, but retroperitoneal metastasis is extremely rare. Treatment options include surgical intervention and chemotherapy. We present the case of a 25-year-old nulliparous woman who presented to our department with a retroperitoneal mass and negative urine human chorionic gonadotropin test, who was immunohistopathologically diagnosed with nongestational choriocarcinoma. The patient responded well to surgery and multi-drug chemotherapy.
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Bruner DI, Pritchard AM, Clarke J. Uterine rupture due to invasive metastatic gestational trophoblastic neoplasm. West J Emerg Med 2013; 14:444-7. [PMID: 24106538 PMCID: PMC3789904 DOI: 10.5811/westjem.2013.4.15868] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 04/09/2013] [Accepted: 04/11/2013] [Indexed: 11/11/2022] Open
Abstract
While complete molar pregnancies are rare, they are wrought with a host of potential complications to include invasive gestational trophoblastic neoplasia. Persistent gestational trophoblastic disease following molar pregnancy is a potentially fatal complication that must be recognized early and treated aggressively for both immediate and long-term recovery. We present the case of a 21-year-old woman with abdominal pain and presyncope 1 month after a molar pregnancy with a subsequent uterine rupture due to invasive gestational trophoblastic neoplasm. We will discuss the complications of molar pregnancies including the risks and management of invasive, metastatic gestational trophoblastic neoplasia.
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Affiliation(s)
- David I Bruner
- Naval Medical Center Portsmouth, Emergency Medicine Program, Portsmouth, Virginia
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