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Kim SU, Huh J, Kim DS, Huh CW. Recurrent cerebral hemorrhage with brain metastasis of choriocarcinoma presenting as initially absent and later identified as oncotic aneurysms: A case report and literature review. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Luu DT, Duc NM, My TTT, Giang TV, Bang LV, Lenh BV. An Extremely Rare Case of Splenic Rupture Secondary to Metastatic Gestational Choriocarcinoma. World J Oncol 2021; 12:39-43. [PMID: 33738005 PMCID: PMC7935620 DOI: 10.14740/wjon1356] [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: 01/12/2021] [Accepted: 02/01/2021] [Indexed: 11/11/2022] Open
Abstract
Gestational choriocarcinoma (GC) is an uncommon malignant tumor consisting of trophoblastic cells. The lungs, liver, and central nervous system are the most common metastatic sites for this disease. However, splenic metastasis is unusual and might result in spontaneous rupture. Symptoms associated with splenic rupture may be the first presentation of malignancy. A thorough medical history and examination are necessary to detect the primary lesion. Herein, we present a case of a 23-year-old female who had splenic rupture secondary to choriocarcinoma metastasis. Although the emergency condition had been solved, the patient died 1 month after due to brain metastasis. The goal of this article was to report a new case of spontaneous splenic rupture caused by choriocarcinoma metastasis and to review the existing literature on splenic metastases associated with GC, including the epidemiology and etiology.
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Affiliation(s)
- Doan Tien Luu
- Department of Radiology, Ha Noi Medical University Hospital, Ha Noi, Vietnam.,Department of Radiology, Ha Noi Medical University, Ha Noi, Vietnam.,These authors contributed equally as co-first authors
| | - Nguyen Minh Duc
- Department of Radiology, Ha Noi Medical University, Ha Noi, Vietnam.,Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.,Department of Radiology, Children's Hospital 2, Ho Chi Minh City, Vietnam.,These authors contributed equally as co-first authors
| | - Thieu-Thi Tra My
- Department of Radiology, Ha Noi Medical University, Ha Noi, Vietnam
| | - Tran-Van Giang
- Department of Radiology, Ha Noi Medical University, Ha Noi, Vietnam
| | - Luong Viet Bang
- Department of Pathology, Tam Anh General Hospital, Ha Noi, Vietnam
| | - Bui-Van Lenh
- Department of Radiology, Ha Noi Medical University Hospital, Ha Noi, Vietnam.,Department of Radiology, Ha Noi Medical University, Ha Noi, Vietnam
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Non-myxoma neoplastic cerebral aneurysms: A systematic review. J Clin Neurosci 2020; 82:200-206. [PMID: 33246908 DOI: 10.1016/j.jocn.2020.11.010] [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: 06/26/2020] [Revised: 10/07/2020] [Accepted: 11/01/2020] [Indexed: 11/24/2022]
Abstract
Neoplastic cerebral aneurysms (NCAs) are highly rare lesions characterized by invasion of cancerous cells within the wall of an artery leading to aneurysm formation. While NCAs caused by myxomas are well characterized in the clinical literature, rarer etiologies have also been reported and are typically associated worse clinical outcomes. We performed the first PRISMA-compliant systematic literature review of true, non-myxoma neoplastic cerebral aneurysms using the PubMed/MEDLINE, Embase, Scopus, and Google Scholar databases. Data of interest included age, sex, aneurysm size, number of aneurysms, aneurysm location, neoplasm type, aneurysm treatments, cancer treatments, risk of rupture, intracerebral hemorrhage prevalence, subarachnoid hemorrhage prevalence, and survival at 90 and 180 days. A total of 50 studies met our inclusion criteria. The mean age of the patient population was 37.4 years (SD: ±16.8) and had an overall female preponderance (39/50, 78%). Of these NCA cases, 29/50 (58.0%) were choriocarcinomas, 10/50 (20.0%) were related to lung cancer, and 11/50 (22.0%) had other origins of variable pathologies. 90-day survival rates were 60.0% (15/25) for choriocarcinomas, 28.6% (2/7) for the lung cancer group, and 14.3% (1/7) for the other origins group. 180-day survival rates were 52.0% (13/25) for the choriocarcinoma group, 14.3% (1/7) for the lung cancer group, and 0% (0/7) for the other origins group. Prognosis of NCA patients ultimately depends on the course of disease progression and cancer management. Further research is needed to better understand optimal treatment modalities for patients with NCAs.
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Wang D, Shu H, Zhang Q, Zhang H, Qing C, Wang H. Brain metastasis of choriocarcinoma presenting as multiple intracranial hematomas: A case report. Medicine (Baltimore) 2018; 97:e12275. [PMID: 30212964 PMCID: PMC6156003 DOI: 10.1097/md.0000000000012275] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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 Choriocarcinoma is the most malignant type of gestational trophoblastic neoplasia. Brain metastasis is the main cause of death and disability in choriocarc- inoma patients. Brain metastasis of choriocarcinoma easily invades the vessel wall to form microaneurysms, so we have reason to believe that multiple intracerebral hemorrhage is related to neoplastic intracranial microaneurysms. PATIENT CONCERNS We report a rare case of brain metastasis of choriocarcinoma that caused six hemorrhages in four lesions within 50 days and anterior cerebral artery aneurysm. DIAGNOSES We diagnosed multiple intracerebral hematoma, choriocarcinoma and intracranial aneurysms. INTERVENTIONS Evacuation of hematoma by craniotomy. OUTCOMES The patient finally asked to terminate the treatment and was discharged. One month later, the patient died of upper gastrointestinal bleeding. LESSONS more than 20 cases of oncotic aneurysm from choriocarcinoma have been reported in the English literature, but few had multiple hematomas. Therefore, this case is unique. Brain metastasis of choriocarcinoma should be considered when patients experience unexplained cerebral hemorrhage, especially repeated intracranial hemorrhage in women of childbearing age. Early and intensive treatment can help achieve a better prognosis and avoid a fatal outcome. Multiple intracranial hematomas are related to neoplastic intracranial microaneurysms.
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Affiliation(s)
- A M Cook
- Bristol Oncology Centre, England
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Smith R, Massey D. Splenic rupture due to metastatic disease: a rare complication. BMJ Case Rep 2017; 2017:bcr-2017-221336. [PMID: 28784910 DOI: 10.1136/bcr-2017-221336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report a case of splenic rupture in an 83-year-old woman presenting with symptoms concerning for upper gastrointestinal malignancy. CT imaging revealed marked gastric thickening and a 33×33 mm splenic metastasis, with subsequent gastroscopy demonstrating a large lesion at the gastro-oesophageal junction. While awaiting further investigation, the patient developed acute onset left upper quadrant pain, peritonism and hypovolaemic shock. Urgent CT imaging demonstrated a ruptured spleen with extensive haemoperitoneum, necessitating emergency splenectomy.
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Affiliation(s)
- Rachel Smith
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Dunecan Massey
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Hoffman HA, Toshkezi G, Fullmer JM, Hall W, Chin LS. Pitfalls in Diagnosis and Management of Testicular Choriocarcinoma Metastatic to the Brain: Report of 2 Cases and Review of Literature. World Neurosurg 2017; 106:536-542. [PMID: 28712904 DOI: 10.1016/j.wneu.2017.07.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 07/05/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Pure choriocarcinoma of the testes is a rare, aggressive germ cell tumor that can metastasize to the brain. Although its prognosis has improved with the development of cisplatin-based chemotherapy regimens, cerebral metastases are prone to hemorrhage and associated with high morbidity. Here, we present 2 cases of testicular choriocarcinoma with cerebral metastasis and discuss potential pitfalls in their diagnosis and management. We also review cases in the literature that feature these rare lesions. METHODS Medline was searched for all publications including the terms "testicular choriocarcinoma" and "cerebral metastasis" or "brain metastasis." Articles that included patients with tumors classified as a mix of choriocarcinoma and other germ cell tumor subtypes were excluded. RESULTS A total of 15 cases from the literature and our own 2 cases were included in the analysis. The mean age at presentation was 25.5 years. Neurologic symptoms accounted for the initial presentation of 9 patients (60%). Outcomes were predominantly poor, with 10 patients (67%) expiring shortly after their initial diagnosis. Three of these deaths were related to mass effect from metastasis-related hemorrhages. Two patients underwent emergent decompressive craniectomies, and both died from cerebral herniation. CONCLUSION The potentially catastrophic nature of choriocarcinoma-related cerebral hemorrhages underscores the need for prompt, accurate diagnosis and aggressive surgical management of these lesions. Their highly vascular nature and lack of findings on cerebral angiography may cause them to be confused with occult vascular malformations.
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Affiliation(s)
- Haydn A Hoffman
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York, USA.
| | - Gentian Toshkezi
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Joseph M Fullmer
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Walter Hall
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Lawrence S Chin
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York, USA
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Neoplastic cerebral aneurysm from metastatic tumor: a systematic review of clinical and treatment characteristics. Clin Neurol Neurosurg 2014; 128:107-11. [PMID: 25484302 DOI: 10.1016/j.clineuro.2014.11.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Revised: 10/30/2014] [Accepted: 11/16/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Neoplastic cerebral aneurysm (NCA) is a very rare event. The authors aimed to characterize the clinical and treatment details of this poorly defined entity. MATERIALS AND METHODS A computerized systematic literature search was performed in PubMed, Medline, Web of Science, Cochrane Library, Embase, Google Scholar, Science Direct and Scopus. Keywords used were as follows: "aneurysm"; "myxoma"; "choriocarcinoma"; "oncotic aneurysm"; "neoplastic aneurysm". Only reports with cerebral aneurysm resulting from metastatic tumor and contained adequate clinical information pertinent to the analysis were included. Clinical and treatment characteristics were analyzed. RESULTS Ninety-two studies reporting 96 cases of neoplastic cerebral aneurysm were identified. NCA from cardiac myxoma accounted for 60.4%, while NCA from choriocarcinoma and other tumors accounted for 26.1% and 13.5%, respectively. The rates of intracranial hemorrhages were 19.6% in NCA from myxoma, 100% in NCA from choriocarcinoma, and 84.6% in NCA from other tumors. 75.9% of NCA from myxoma were managed conservatively, 92% of NCA from choriocarcinoma were treated by surgery and/or chemotherapy, and 69.2% of NCA from other tumors were treated by surgery with or without chemotherapy. The mortality rates were 11.4% in NCA from myxoma, 60.9% in NCA from choriocarcinoma, and 92.3% in NCA from other tumors. According to a multiple logistic regression model, "pathology (P = 0.002)" is significantly correlated with outcome. CONCLUSIONS Neoplastic cerebral aneurysms are usually complicated with cardiac myxoma, choriocarcinoma and lung carcinoma. NCA from cardiac myxoma were probably multiple and rarely associated with intracranial hemorrhage, while the majority of NCA from choriocarcinoma and other tumors were single and presented with intracranial hemorrhage. The prognosis is quite good in NCA from cardiac myxoma, while NCA from malignant tumors were associated with poor outcome.
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Wang J, Wang R, Zhao J. Ruptured cerebral aneurysm from choriocarcinoma. J Clin Neurosci 2013; 20:1324-6. [DOI: 10.1016/j.jocn.2012.09.045] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 09/24/2012] [Accepted: 09/30/2012] [Indexed: 11/30/2022]
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Wanarak W, Songkiet S. Intracerebral hemorrhage cause by a ruptured oncotic aneurysm from choriocarcinoma metastasis. Asian J Neurosurg 2013; 8:48-50. [PMID: 23741263 PMCID: PMC3667461 DOI: 10.4103/1793-5482.110280] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Ruptured oncotic aneurysms from choriocarcioma metastasis are very rare. One rare case of metastatic cerebral choriocarcioma with an initial presentation of intracerebral hemorrhage is reported. A 25-year-old woman initially presented with sudden onset of alteration of consciousness. The computed tomography scan showed left parietal hematoma and CT angiography showed a small aneurysm of the left middle cerebral arteries territories. Her chest X-ray showed two lung masses. A craniectomy was performed to remove the hematoma and decompression following the aneurysm excision. After surgery the patient regained consciousness and had no neurological deficit. The pathology reported metastatic choriocarcioma and her beta – HCG was 73,656 units. After recovery she received chemotherapy with an etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine/oncovine (EMA-CO) regimen.
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Aubrey-Bassler FK, Sowers N. 613 cases of splenic rupture without risk factors or previously diagnosed disease: a systematic review. BMC Emerg Med 2012; 12:11. [PMID: 22889306 PMCID: PMC3532171 DOI: 10.1186/1471-227x-12-11] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 07/28/2012] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Rupture of the spleen in the absence of trauma or previously diagnosed disease is largely ignored in the emergency literature and is often not documented as such in journals from other fields. We have conducted a systematic review of the literature to highlight the surprisingly frequent occurrence of this phenomenon and to document the diversity of diseases that can present in this fashion. METHODS Systematic review of English and French language publications catalogued in Pubmed, Embase and CINAHL between 1950 and 2011. RESULTS We found 613 cases of splenic rupture meeting the criteria above, 327 of which occurred as the presenting complaint of an underlying disease and 112 of which occurred following a medical procedure. Rupture appeared to occur spontaneously in histologically normal (but not necessarily normal size) spleens in 35 cases and after minor trauma in 23 cases. Medications were implicated in 47 cases, a splenic or adjacent anatomical abnormality in 31 cases and pregnancy or its complications in 38 cases. The most common associated diseases were infectious (n = 143), haematologic (n = 84) and non-haematologic neoplasms (n = 48). Amyloidosis (n = 24), internal trauma such as cough or vomiting (n = 17) and rheumatologic diseases (n = 10) are less frequently reported. Colonoscopy (n = 87) was the procedure reported most frequently as a cause of rupture. The anatomic abnormalities associated with rupture include splenic cysts (n = 6), infarction (n = 6) and hamartomata (n = 5). Medications associated with rupture include anticoagulants (n = 21), thrombolytics (n = 13) and recombinant G-CSF (n = 10). Other causes or associations reported very infrequently include other endoscopy, pulmonary, cardiac or abdominal surgery, hysterectomy, peliosis, empyema, remote pancreato-renal transplant, thrombosed splenic vein, hemangiomata, pancreatic pseudocysts, splenic artery aneurysm, cholesterol embolism, splenic granuloma, congenital diaphragmatic hernia, rib exostosis, pancreatitis, Gaucher's disease, Wilson's disease, pheochromocytoma, afibrinogenemia and ruptured ectopic pregnancy. CONCLUSIONS Emergency physicians should be attuned to the fact that rupture of the spleen can occur in the absence of major trauma or previously diagnosed splenic disease. The occurrence of such a rupture is likely to be the manifesting complaint of an underlying disease. Furthermore, colonoscopy should be more widely documented as a cause of splenic rupture.
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Affiliation(s)
- F Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University of Newfoundland, Health Sciences Centre, St. John’s, Newfoundland and Labrador, St Johns, Canada
- Discipline of Emergency Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, St Johns, Canada
- Discipline of Family Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, St Johns, Canada
| | - Nicholas Sowers
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
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Zairi F, De Saint Denis T, Thines L, Bourgeois P, Lejeune JP. Ruptured cerebral oncotic aneurysm from choriocarcinoma: report of two cases and review of the literature. Acta Neurochir (Wien) 2011; 153:353-7. [PMID: 21057824 DOI: 10.1007/s00701-010-0863-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 10/27/2010] [Indexed: 10/18/2022]
Abstract
The study design involved case reports and review of the literature. Oncotic aneurysm from choriocarcinoma is an extremely rare event that should be known by all neurosurgeons and suspected in women of childbearing age. The purpose of this article is to report the authors' experience and to provide insight on clinical presentation and radiological signs to aware the reader to this entity and then to prevent misdiagnosis. The authors report two cases of ruptured oncotic aneurysm treated at their institution in 2010. A review of the literature was performed to discuss the pathogenesis and the role of the neurosurgeon. Chemotherapy is the treatment of choice making surgery necessary only for patients with large intracerebral haematoma that represents an immediate threat.
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Chang IB, Cho BM, Park SH, Yoon DY, Oh SM. Metastatic choriocarcinoma with multiple neoplastic intracranial microaneurysms. J Neurosurg 2008; 108:1014-7. [DOI: 10.3171/jns/2008/108/5/1014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓The authors report on a case of a metastatic choriocarcinoma that mimicked systemic necrotizing vasculitis on a cerebral angiogram. A 35-year-old woman presented with right hemiplegia and a drowsy mental state. A computed tomography (CT) scan revealed an intracerebral hemorrhage in the left frontal region. A cerebral angiogram showed multiple microaneurysms arising from the bilateral anterior cerebral arteries and middle cerebral arteries, and the renal angiogram showed multiple microaneurysms arising from the left distal renal artery. A chest CT scan revealed multiple metastatic lesions in the left lower lung field. The hematoma and microaneurysms were surgically removed. Choriocarcinoma was diagnosed after histological examination. Despite receiving postoperative chemotherapy, the patient died 1 month after the operation.
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Affiliation(s)
| | | | | | - Dae Young Yoon
- 2Radiology, Hallym University, College of Medicine, Seoul, Korea
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Patients with presenting unusual manifestations with gestational trophoblastic neoplasm: case series and review of literatures. Arch Gynecol Obstet 2007; 277:465-70. [DOI: 10.1007/s00404-007-0469-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Accepted: 09/10/2007] [Indexed: 10/22/2022]
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Huang CY, Chen CA, Hsieh CY, Cheng WF. Intracerebral hemorrhage as initial presentation of gestational choriocarcinoma: a case report and literature review. Int J Gynecol Cancer 2007; 17:1166-71. [PMID: 17425677 DOI: 10.1111/j.1525-1438.2007.00934.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Choriocarcinoma is the most malignant tumor of gestational trophoblastic neoplasia. It grows rapidly and metastasizes to the lung, liver, and, less frequently, to the brain. One rare case of metastatic cerebral choriocarcinoma with initial presentation of intracerebral hemorrhage is reported. A 40-year-old woman initially presented sudden onset of headache. Intracerebral hemorrhage resulting from ruptured pseudoaneurysm was suspected. Emergent surgery with excision of the pseudoaneurysms was performed. Metastatic choriocarcinoma was accidentally found with positive immunohistochemical staining of cytokeratin and β subunit of human chorionic gonadotropin (β-HCG). Choriocarcinoma with brain metastases was diagnosed. She then received chemotherapy with regimen of etoposide, methotrexate, actinomycin-D, cyclophosphamide, and vincristine (EMACO). Elevated serum β-HCG (30.3 mIU/mL) and new pulmonary lesions were noted by computed tomography 4 months after completion of EMACO. Salvage chemotherapy with etoposide, methotrexate, actinomycin-D, etoposide, and cisplatin (EMAEP) regimen was given. Seven months later after completion of EMAEP, two new pulmonary lesions were detected by positron emission tomography (PET) scan. So she received video-assisted thoracoscopic surgery with tumor excision. Pathologic report confirmed the diagnosis of lung metastases. The patient recovered well. She is free of disease for 12 months. The diagnosis of metastatic cerebral choriocarcinoma was only made by histopathology after craniotomy. Metastatic choriocarcinoma should be always in the differential diagnosis for women at childbearing age presenting with unexplained stroke-like symptoms. In addition, PET scan may be valuable in detecting occult metastatic lesions of choriocarcinoma.
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Affiliation(s)
- C-Y Huang
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan
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Smart P, Cullinan M, Crosthwaite G. Spontaneous splenic rupture secondary to metastatic gastric carcinoma: case report and review. ANZ J Surg 2002; 72:153-5. [PMID: 12074069 DOI: 10.1046/j.1445-2197.2002.02323.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Philip Smart
- Department of Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia.
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Abstract
OBJECTIVE The clinicopathologic features of splenic metastases have seldom been investigated. The aim of this study was to evaluate the clinical and pathological impact of splenic metastases. CASE MATERIAL We reviewed the clinical/autopsy records and pathologic features of 92 Chinese patients (58 men, 34 women) with secondary nonlymphoid splenic tumors recorded during a 25-year period. RESULTS The incidence of splenic secondary tumors at autopsy was 0. 6% and at splenectomy, 1.1%. The lesions were often seen in elderly patients (mean age, 60 years). Seven (8%) of the splenic lesions were symptomatic. The symptomatic splenic lesions, as compared with asymptomatic lesions, were bigger and were found more often in women and younger patients. Two patients experienced spontaneous splenic rupture because of metastatic carcinoma. Eighty-seven (95%) of the secondary splenic tumors were carcinomas. Lung was the most common primary tumor site (21%), followed by the stomach (16%), pancreas (12%), liver (9%), and colon (9%). Rarely reported sources of primary tumor, such as esophageal carcinomas, nasopharyngeal carcinoma, and choriocarcinoma, were also found. Splenic metastases could be identified macroscopically in 74 (80%) of our patients. Grossly, splenic metastases involved the splenic capsule (n = 8) or were solitary (n = 31), multiple (n = 30), or diffuse (n = 8) lesions in the splenic parenchyma. Isolated splenic metastases were noted in 5.3% of the metastases found at autopsy. Many of the metastatic lesions in the spleen were identified shortly after primary tumors were detected (mean latent period, 6.7 months). The time from diagnosis of the primary tumor to metastasis to the spleen was more than 2 years in 14 patients. CONCLUSIONS Splenic metastases are uncommon. A variety of clinical and pathologic patterns were noted in our series.
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Affiliation(s)
- K Y Lam
- Department of Pathology, Queen Mary Hospital, Hong Kong
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Nongestational trophoblastic disease of the ovary diagnosed by DNA polymorphism analysis: A case of prolonged survival by intensive surgical and chemotherapies. Placenta 1999. [DOI: 10.1016/s0143-4004(99)80013-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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