1
|
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.
Collapse
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
| |
Collapse
|
2
|
De Lucia DR, Castaldo A, D'Agostino V, Ascione R, Pesce I, Coppola L, Catelli A, Radice L. Metastatic choriocarcinoma with hemorrhagic complications and spontaneous ovarian hyperstimulation syndrome: A case report. Radiol Case Rep 2021; 16:3868-3874. [PMID: 34703509 PMCID: PMC8526915 DOI: 10.1016/j.radcr.2021.09.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/10/2021] [Accepted: 09/15/2021] [Indexed: 01/15/2023] Open
Abstract
Gestational choriocarcinoma is a malignant trophoblastic tumor arising from any gestational event, even with a long latency period, generally in the reproductive female. It is associated with a high level of beta-human chorionic gonadotropin. Its primary site is usually the uterus but not all patients have a detectable lesion in this site. Regression of the primary tumor after it has metastasized is not uncommon, and one-third of cases manifest as complications of metastatic disease. In this report we present an uncommon case of gestational choriocarcinoma with lung, liver and jejunal metastases at the time of diagnosis without evidence of pelvic disease, in 34-year-old woman. The main points of interest of our case were the development of the ovarian hyperstimulation syndrome with massive multicystic ovarian enlargement induced by high level of beta-human chorionic gonadotropin and the bleeding of jejunal and liver metastases, due to the high vascularity of the tumor tissue, a condition known as "Choriocarcinoma Syndrome". We will focus on the radiological findings of metastases, bleeding complications and ovarian hyperstimulation syndrome.
Collapse
Key Words
- CE-CT, Contrast Enhancement Computed Tomography
- Choriocarcinoma syndrome
- FSH, Follicle Stimulating Hormone
- Gestational choriocarcinoma
- HU, Hounsfield Unit
- Hemorrhagic metastases
- Hypervascular metastases
- LH, Luteinizing Hormone
- MIP, Maximum Intensity Projection
- MPR, Multiplanar Reconstruction
- MRI, Magnetic Resonance Imaging
- OHSS, Ovarian Hyperstimulation Syndrome
- Ovarian hyperstimulation syndrome
- TSH, Thyroid Stimulating Hormone
- US, Ultrasonography
- b-hCG, Beta Human Chorionic Gonadotropin
Collapse
Affiliation(s)
- Davide Raffaele De Lucia
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples 80131, Italy
| | - Anna Castaldo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples 80131, Italy
| | - Valerio D'Agostino
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples 80131, Italy
| | - Raffaele Ascione
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples 80131, Italy
| | - Ilaria Pesce
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples 80131, Italy
| | - Luigi Coppola
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples 80131, Italy
| | - Antonio Catelli
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples 80131, Italy
| | - Leonardo Radice
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Pansini, 5, Naples 80131, Italy
| |
Collapse
|
3
|
Nishino K, Yamamoto E, Ikeda Y, Niimi K, Yamamoto T, Kajiyama H. A poor prognostic metastatic nongestational choriocarcinoma of the ovary: a case report and the literature review. J Ovarian Res 2021; 14:56. [PMID: 33888146 PMCID: PMC8063363 DOI: 10.1186/s13048-021-00810-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/13/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Pure ovarian choriocarcinoma can be gestational or nongestational in origin. Nongestational pure ovarian choriocarcinoma is extremely rare and the prognosis is thought to be worse than that of the gestational type in patients with metastatic disease. We present a case of metastatic pure ovarian choriocarcinoma with poor prognosis in which the origin was identified as nongestational by DNA short tandem repeat (STR) analysis. CASE PRESENTATION A nulliparous woman in her thirties with metastatic choriocarcinoma was referred to our hospital after initial treatment proved unsuccessful. Two months earlier, she had undergone brain tumor resection and histological examination confirmed choriocarcinoma. Serum human chorionic gonadotropin (hCG) concentration at initial diagnosis was 5030 IU/L. Two cycles of a combination chemotherapy regimen of methotrexate, etoposide, and actinomycin-D (MEA therapy), which is commonly used for gestational choriocarcinoma, was administered. However, the disease could not be controlled. Imaging modalities at presentation revealed tumor present in the left ovary and left lung, but not in the uterus, which led us think that the choriocarcinoma was nongestational. Bleomycin, etoposide, and cisplatin (BEP therapy) which is commonly used for nongestational choriocarcinoma (malignant germ cell tumor) and surgical resection of the uterus, bilateral ovaries, and an affected part of the left lung led to the nadir level of hCG, but the tumor relapsed and levels of hCG again increased. To investigate the origin of choriocarcinoma, we performed DNA STR analysis of tumor cells and oral mucosal cells. Analysis revealed the origin of the choriocarcinoma as nongestational, as the genotype of tumor cells entirely corresponded with that of oral mucosal cells. BEP therapy and chemotherapy regimens administered for nongestational choriocarcinoma and gestational choriocarcinoma proved ineffective, and the patient died 21 months after diagnosis of metastatic choriocarcinoma. CONCLUSION Metastaic nongestational pure choriocarcinoma of ovary is an extremely rare and an aggressive disease, frequently resulting in poor outcome.
Collapse
Affiliation(s)
- Kimihiro Nishino
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan.
| | - Eiko Yamamoto
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan.,Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiki Ikeda
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - Kaoru Niimi
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - Toshimichi Yamamoto
- Department of Legal Medicine and Bioethics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| |
Collapse
|
4
|
Basida B, Zalavadiya N, Khicher S, York R. Haemoptysis in third trimester-sole manifestation of stage IV gestational choriocarcinoma. BMJ Case Rep 2021; 14:14/4/e241870. [PMID: 33875512 PMCID: PMC8057579 DOI: 10.1136/bcr-2021-241870] [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: 11/04/2022] Open
Abstract
Gestational choriocarcinoma is a rare neoplasm of pregnancy that is often undiagnosed until the advanced stage manifests with metastatic complications. Herein, we present a case of a 22-year-old young woman with metastatic gestational choriocarcinoma with unidentified primary origin, who presented with haemoptysis as a chief problem in her third trimester. The case emphasises on the rarity of this neoplasm in a viable pregnancy. Prompt diagnosis and treatment is the key for good maternal and fetal prognosis.
Collapse
Affiliation(s)
- Brinda Basida
- Department of Internal Medicine, Sinai Grace Hospital, Detroit, Michigan, USA
| | - Nirav Zalavadiya
- Department of Internal Medicine, Sinai Grace Hospital, Detroit, Michigan, USA
| | - Suman Khicher
- Department of Rheumatology, Detroit Medical Center, Detroit, Michigan, USA
| | - Russel York
- Department of Rheumatology, Detroit Medical Center, Detroit, Michigan, USA
| |
Collapse
|
5
|
He Y, Bhoopathy V, Habashy D, Adams S, McCombie SP, Arianayagam M. Spontaneous bleeding from an unusual renal mass: A case of gestational choriocarcinoma related to previous pregnancy over a decade earlier. Urol Case Rep 2021; 37:101614. [PMID: 33842209 PMCID: PMC8020421 DOI: 10.1016/j.eucr.2021.101614] [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: 01/22/2021] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 10/27/2022] Open
Abstract
Gestational choriocarcinoma is an uncommon trophoblastic malignancy, occurring in females after pregnancy, which is rarely encountered by urologists. It can be rapidly progressive, however metastases to other organs can occur after a prolonged latency period. We describe a rare case of solitary metastatic gestational choriocarcinoma presenting with spontaneous bleeding from a renal mass, over a decade after the associated pregnancy with a presumed sub-clinical primary tumour. This case demonstrates the importance of recognising gestational choriocarcinoma as a potential differential diagnosis of spontaneous bleeding renal mass in females of child-bearing age as a urologist given the often-aggressive nature of the disease.
Collapse
Affiliation(s)
- Yilu He
- Nepean Urology Research Group, Nepean Hospital, Kingswood, NSW, Australia
| | - Varun Bhoopathy
- Nepean Urology Research Group, Nepean Hospital, Kingswood, NSW, Australia
| | - David Habashy
- Nepean Urology Research Group, Nepean Hospital, PO Box 63, Penrith, NSW, 2751, Australia
| | - Stuart Adams
- NSW Health Pathology, Nepean Hospital, Penrith, NSW, 2751, Australia
| | - Steve P McCombie
- Nepean Urology Research Group, Nepean Hospital, Kingswood, NSW, Australia.,Fiona Stanley Hospital, Murdoch, WA, Australia.,University of Western Australia, Crawley, WA, Australia
| | - Mohan Arianayagam
- Nepean Urology Research Group, Nepean Hospital, Kingswood, NSW, Australia
| |
Collapse
|
6
|
Yin S, Qin J, Zhou Q, Zhu C, Li Y, Wu D, Shen Z, Guo Y, Zhou Y, Nashan B. Sequential metastasis to the liver and pancreas 4 years after gestational trophoblastic neoplasia: a case report. J Int Med Res 2020; 48:300060520966807. [PMID: 33131363 PMCID: PMC7653300 DOI: 10.1177/0300060520966807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 09/21/2020] [Indexed: 11/15/2022] Open
Abstract
This case report describes a 43-year-old female initially diagnosed with gestational trophoblastic neoplasia that then experienced metastasis to the liver and then subsequently to the pancreas nearly 4 years after the primary diagnosis. After resection of the body and tail of the pancreas, the postoperative histopathological examination confirmed a placental site trophoblastic tumour that had developed after several cycles of chemotherapy for the original primary tumour and the liver metastases. This type of sequential recurrence of gestational trophoblastic neoplasia in the primary site or metastatic sites, such as the liver or pancreas, can be cured by a comprehensive treatment strategy involving surgery and/or salvage chemotherapy and continuous follow-up over a long period, especially for patients with a high-risk status.
Collapse
Affiliation(s)
- Shuai Yin
- Department of Hepatobiliary and Transplantation Surgery, The
First Affiliated Hospital of USTC, Division of Life Sciences and Medicine,
University of Science and Technology of China, Hefei, Anhui Province,
China
- Laboratory of Transplantation Immunology, University of Science
and Technology of China, Hefei, Anhui Province, China
| | - Jiwei Qin
- Department of Hepatobiliary and Transplantation Surgery, The
First Affiliated Hospital of USTC, Division of Life Sciences and Medicine,
University of Science and Technology of China, Hefei, Anhui Province,
China
- Laboratory of Transplantation Immunology, University of Science
and Technology of China, Hefei, Anhui Province, China
| | - Qingqing Zhou
- Department of Obstetrics and Gynaecology, Anhui Medical
University, Anhui Provincial Hospital, Hefei, Anhui Province, China
| | - Chenchen Zhu
- Department of Obstetrics and Gynaecology, Anhui Medical
University, Anhui Provincial Hospital, Hefei, Anhui Province, China
| | - Yuebo Li
- Department of Obstetrics and Gynaecology, The First Affiliated
Hospital of USTC, Division of Life Sciences and Medicine, University of Science
and Technology of China, Hefei, Anhui Province, China
| | - Dabao Wu
- Department of Obstetrics and Gynaecology, The First Affiliated
Hospital of USTC, Division of Life Sciences and Medicine, University of Science
and Technology of China, Hefei, Anhui Province, China
| | - Zhen Shen
- Department of Obstetrics and Gynaecology, The First Affiliated
Hospital of USTC, Division of Life Sciences and Medicine, University of Science
and Technology of China, Hefei, Anhui Province, China
| | - Yafei Guo
- Department of Hepatobiliary and Transplantation Surgery, The
First Affiliated Hospital of USTC, Division of Life Sciences and Medicine,
University of Science and Technology of China, Hefei, Anhui Province,
China
- Laboratory of Transplantation Immunology, University of Science
and Technology of China, Hefei, Anhui Province, China
| | - Ying Zhou
- Department of Obstetrics and Gynaecology, The First Affiliated
Hospital of USTC, Division of Life Sciences and Medicine, University of Science
and Technology of China, Hefei, Anhui Province, China
| | - Björn Nashan
- Department of Hepatobiliary and Transplantation Surgery, The
First Affiliated Hospital of USTC, Division of Life Sciences and Medicine,
University of Science and Technology of China, Hefei, Anhui Province,
China
- Laboratory of Transplantation Immunology, University of Science
and Technology of China, Hefei, Anhui Province, China
| |
Collapse
|
7
|
Parajuli P, Poudyal S, Chapagain S, Luitel BR, Chalise PR, Sharma UK. Gestational choriocarcinoma presenting with bilateral kidney and lung metastases with unknown primary: An uncommon clinical scenario. Urol Case Rep 2020; 33:101433. [PMID: 33102126 PMCID: PMC7574294 DOI: 10.1016/j.eucr.2020.101433] [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: 08/27/2020] [Accepted: 09/27/2020] [Indexed: 11/16/2022] Open
Abstract
Gestational choriocarcinoma with kidney and lung metastases with delayed presentation after term pregnancy is rare event and not described frequently in literature. We describe a rare case of 24-year-old female with hematuria after 3 years of term delivery. Management includes chemotherapy and even renal embolization in case of life threatening hematuria.
Collapse
Affiliation(s)
- Purushottam Parajuli
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgung, Kathmandu, 44600, Nepal
| | - Sujeet Poudyal
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgung, Kathmandu, 44600, Nepal
| | - Suman Chapagain
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgung, Kathmandu, 44600, Nepal
| | - Bhoj Raj Luitel
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgung, Kathmandu, 44600, Nepal
| | - Pawan Raj Chalise
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgung, Kathmandu, 44600, Nepal
| | - Uttam Kumar Sharma
- Department of Urology and Kidney Transplant Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgung, Kathmandu, 44600, Nepal
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|