Unusual Clinical Presentation of Disseminated Gestational Trophoblastic Neoplasia [19P

Abstract

INTRODUCTION: Gestational trophoblastic neoplasia (GTN) is comprised of malignant tumors characterized by an abnormal proliferation of trophoblastic tissue. Subtypes include invasive mole, choriocarcinoma, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. Clinical presentation of GTN varies based on location and extent of disease. Here we report the case of a patient who presented with atypical symptoms of GTN and was ultimately found to have massive disseminated tumor burden, greater than any prior reported case. METHODS: We report a case of a 35-year-old woman who presented with acute limb ischemia secondary to malignant obstruction of bilateral femoral arteries. She was found to have extensive intracranial, pulmonary, hepatic, splenic and cardiac metastasis two years after a first trimester spontaneous abortion. Her initial β-HCG was 1,228,233 IU/L. RESULTS: The patient was treated initially with whole brain radiation therapy (WBRT) for two weeks with concurrent weekly etoposide and cisplatin to address extensive metastatic disease in both the brain and liver. EMA-CO (etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine) was withheld initially due to concern for bleeding with concurrent radiation therapy. Upon completion of WBRT, the patient completed eleven cycles of EMA-CO She also successfully underwent bilateral lower extremity embolectomies. CONCLUSION: After completion of multi-agent chemotherapy and whole brain radiation therapy, the patient had total resolution of radiographic findings of metastatic disease and normalization of β-HCG. This case highlights the variable presentation of GTN and reiterates excellent response to treatment despite massive tumor burden.