Abstract
Introduction: Choriocarcinoma (CCA) is a malignant pregnancy-related tumor that originates from cytotrophoblast and syncytiotrophoblast cells without villi. CCA is the most metastatic form among gestational trophoblastic neoplasia and the diagnosis is often in advanted stage. Patient concerns: In this report, we present a rare case of CCA with lung metastasis after term pregnancy in a 41-year-old woman at 45 days after the birth of a healthy baby and discuss management of residual metastasis after completing treatment. Diagnosis: The diagnosis of CCA can be based on the following criteria: a human chorionic gonadotropin (hCG) plateau for at least 4 values over 3 weeks, an hCG increase of 10% or greater for at least 3 values over 2 weeks, hCG persistence for 6 months or more after molar pregnancy evacuation, histopathologic diagnosis of choriocarcinoma and presence of metastatic disease. Intervention and outcomes: High risk patients must be treated with multiagent chemotherapy (EMA-CO schedule). The complete remission rates ranges from 69% to 86%. Conclusion: Residual lesions after chemotherapy are often the result of necrosis or fibrosis. In our clinical practice will avoid the risks deriving from excessive anticancer treatment in these patients, while favoring a strict follow-up strategy to monitor disease behavior in time.
Highlights
Choriocarcinoma (CCA) is a malignant pregnancy-related tumor that originates from cytotrophoblast and syncytiotrophoblast cells without villi
We present a rare case of CCA with lung metastasis after term pregnancy in a 41-year-old woman at 45 days after the birth of a healthy baby and discuss management of residual metastasis after completing treatment
The treatment of choice for gestational CCA depends on the combined anatomic Federation of Gynecology and Obstetrics (FIGO) staging and modified WHO risk-factor scoring system, which attribute the risk a patient has of developing chemoresistance[7]
Summary
Choriocarcinoma (CCA) is a malignant pregnancy-related tumor that originates from cytotrophoblast and syncytiotrophoblast cells without villi. Patient concerns: In this report, we present a rare case of CCA with lung metastasis after term pregnancy in a 41-year-old woman at 45 days after the birth of a healthy baby and discuss management of residual metastasis after completing treatment. We present a rare case of CCA with lung metastasis after term pregnancy in a 41-year-old woman at 45 days after the birth of a healthy baby and discuss management of residual metastasis after completing treatment. In March 2019, the CT scan showed a partial response (PR) to treatment (reduction of lung lesions); normal hCG levels (3 mIU/ mL) were observed. Chemotherapy was stopped and a short-term follow-up was begun, with the patient undergoing a CT scan and assessment of hCG blood levels every 3 months. At the latest follow-up, in February 2020, the CT scan detected a further size reduction of pulmonary lesions (Figs. 1B, C) (maximum diameter 2 mm), while blood hCG value was 1 mIU/mL
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