Diagnosis Of Choriocarcinoma Research Articles

A rare case of a gestational and metastatic choriocarcinoma

Gestational choriocarcinoma is a malignant and rare trophoblastic tumor. It belongs to the group of gestational trophoblastic diseases (GTD) whose common denominator is hypersecretion of the gonadotrophic chorionic hormone. It is a highly malignant tumor made from the juxtaposition of cytotrophoblast and syncytiotrophoblast cells with complete disappearance of chorionic villi. It is most often metastatic and is followed in most cases by a hydatiform mole, but may also occur after spontaneous abortion or normal pregnancy. We present a case of a 50-year-old Moroccan patient, G2P2, admitted to the gynecological emergency department for vaginal bleeding and dyspnea. Speculum examination showed an invasive vaginal lesion. Thoracic-abdominal-pelvic CT showed bilateral pulmonary nodules and cystic lesions in the uterus and vagina. Through a vaginal biopsy, the diagnosis of choriocarcinoma was confirmed. Taking into account the usually very chemo-sensitive character of these diseases, EMA-CO type chemotherapy (Etoposide, Methotrexate and Actinomycin D alternating at weekly intervals with Vincristine and Cyclophosphamide) has been introduced. The patient received 8 cycles of EMA-CO including 2 cycles after normalization of β-hCG. The evolution was very favorable and regular controle was scheduled.

Gestational choriocarcinoma of the cervix – a case report

Cervical primary choriocarcinoma is an extremely rare condition that should be considered in the differential diagnosis of a cervical abnormal bleeding, especially due to intense vasculature, mainly in young women. We present the case of a 31-year-old Caucasian patient, para 2, presenting a cervical well vascularised tumor in the uterine cervix, causing vaginal bleeding that occurred after an evacuated uterine curettage and hemostatically for incomplete abortion. The diagnosis of suspected cervical pregnancy was established based on the imaging aspect: the transvaginal ultrasound showed a parenchymal mass protruding into the cervical canal with intense peripheral vascular network. For differential diagnosis, serum β-hCG dosing was recommended, which had a value of 2110 mUI/ml. The histopathological results correlated with elevated levels of β-hCG suggested the diagnosis of choriocarcinoma. Full interaxial hysterectomy was performed. Choriocarcinoma has a very good prognosis, even in advanced stages, because it is a very chemosensitive tumor.

Gestational Trophoblastic Disease

Gestational trophoblastic disease (GTD) represents a group of disorders that derive from placental trophoblastic tissue, including hydatidiform moles, postmolar gestational trophoblastic neoplasia (GTN), and gestational choriocarcinoma. GTN is the most curable gynecologic malignancy and tends to be more common after a complete molar pregnancy than a partial mole. Human chorionic gonadotropin (β-hCG) represents a marker for GTD and should be followed for 6 months after molar pregnancy evacuation to rule out the development of postmolar GTN. GTN is defined by a plateaued, rising, or prolonged elevated β-hCG value after molar evacuation; histologic diagnosis of choriocarcinoma, invasive mole, placental site trophoblastic tumor, or epithelioid trophoblastic tumor; or identification of metastasis after molar pregnancy evacuation. Classification for GTN as low (score ≤ 6) or high risk (score > 7) is based on the World Health Organization prognostic score. This scoring system helps select treatment, which usually entails actinomycin D or methotrexate for low-risk disease and EMA/CO (etoposide, methotrexate, actinomycin D/cyclophosphamide, vincristine) for high-risk disease. These regimens can achieve cure rates approaching 100% and over 90% for low- and high-risk disease, respectively. This review contains 5 figures, 8 tables and 49 references Key words: choriocarcinoma, gestational trophoblastic disease, gestational trophoblastic neoplasia, human chorionic gonadotropin, hydatidiform mole, invasive mole

Multiple Metastases Gestational Choriocarcinoma - A Case Report

Abstract Introduction. Gestational choriocarcinoma (GC) is a malignant condition that develops form trophoblastic cells originating from a previous pregnancy, eutopic or ectopic. Metastatic choriocarcinoma is often diagnosed in the absence of a primary uterine or ovarian tumor, presumably because the latter has undergone complete necrosis. GC rapidly metastasizes spreading to lungs, brain, bones, bone marrow, liver, and other organs, but responds well to chemotherapy. Material and methods. We present the case of a 25-year-old woman with critical evolution after being diagnosed with choriocarcinoma following a complete hydatidiform mole pregnancy. Even though the patient initially received proper treatment, due to poor follow-up compliance, the condition led to invasive metastases. When it spread to the musculoskeletal system and other organs, doctors were able to link symptoms to the choriocarcinoma diagnosis and chemotherapy was initiated. Unfortunately, the patient succumbed due to intracranial hemorrhage. Discussions. GC is a highly and fast invasive malignancy, with rapidly growing tumors. It is often associated with hemorrhage, ischemic necrosis, and secondary inflammation. Often, by the time the tumor is discovered, X-rays of the chest and bones already show metastatic lesions. Chemotherapy success depends on early detection and diagnosis of tumors after pregnancy. Conclusions. Even though the initial diagnosis and treatment should have led to a favorable outcome, the patient’s poor compliance was followed by rapid progression of the disease and, finally, exitus.

Multiple Metastases Gestational Choriocarcinoma - A Case Report

Abstract Introduction. Gestational choriocarcinoma (GC) is a malignant condition that develops from trophoblastic cells originating from a previous pregnancy, eutopic or ectopic. Metastatic choriocarcinoma is often diagnosed in the absence of a primary uterine or ovarian tumor, presumably because the latter has undergone complete necrosis. GC rapidly metastasizes spreading to lungs, brain, bones, bone marrow, liver, and other organs, but responds well to chemotherapy. Material and methods. We presented the case of a 25-year-old woman with critical evolution after being diagnosed with choriocarcinoma following a complete hydatidiform mole pregnancy. Even though the patient initially received proper treatment, due to poor follow-up compliance, the condition led to invasive metastases. When it spread to the musculoskeletal system and other organs, doctors were able to link symptoms to the choriocarcinoma diagnosis and chemotherapy was initiated. Unfortunately, the patient succumbed due to intracranial hemorrhage. Discussions. GC is a highly and fast invasive malignancy, with rapidly growing tumors. It is often associated with hemorrhage, ischemic necrosis, and secondary inflammation. Often, by the time the tumor is discovered, X-rays of the chest and bones have already shown metastatic lesions. Chemotherapy success depends on the early detection and diagnosis of tumors after pregnancy. Conclusions. Even though the initial diagnosis and treatment should have led to a favorable outcome, the patient’s poor compliance was followed by rapid progression of the disease and, finally, exitus.

Is chemotherapy always necessary for patients with nonmetastatic gestational trophoblastic neoplasia with histopathological diagnosis of choriocarcinoma?

ObjectiveTo evaluate expectant management versus immediate chemotherapy following pathological diagnosis of gestational choriocarcinoma (GCC) in patients with nonmetastatic disease. MethodsMulticenter retrospective cohort that included patients with histological diagnosis of GCC with nonmetastatic disease followed at one of thirteen Brazilian referral centers for gestational trophoblastic disease from January 2000 to December 2016. ResultsAmong 3191 patients with gestational trophoblastic neoplasia, 199 patients with nonmetastatic GCC were identified. Chemotherapy was initiated immediately in 152 (76.4%) patients per FIGO 2000 guideline, while 47 (23.6%) were managed expectantly. Both groups presented with similar characteristics and outcomes. All patients (n=12) who had normal human chorionic gonadotropin (hCG) in the first 2–3weeks of expectant management achieved complete sustained remission with no chemotherapy. Only 44.7% (21 patients) of patients who were expectantly managed needed to receive chemotherapy due to plateauing or rising hCG level in the first 2–3weeks of follow up. The outcome of patients receiving chemotherapy after initial expectant management was similar to those who received chemotherapy immediately after the diagnosis in terms of need for multi-agent chemotherapy or number of cycles of chemotherapy. There was no case of relapse or death in either group. Logistic regression analysis showed that age≥40years and hCG≥92,428IU/L at GCC diagnosis were risk factors for needing chemotherapy after initial expectant management of nonmetastatic GCC. ConclusionIn order to avoid exposing patients unnecessarily to chemotherapy, close surveillance of women with pathological diagnosis of nonmetastatic GCC seems to be a safe practice, particularly for those who have a normal hCG at the time of diagnosis. If confirmed by other studies, the FIGO guidelines may need to be revised.

Acute Respiratory Failure Months After Delivery: A Case of Choriocarcinoma With Lung Metastasis

SESSION TITLE: Lung Cancer 1 SESSION TYPE: Affiliate Case Report Slide PRESENTED ON: Monday, October 30, 2017 at 03:15 PM - 04:15 PM INTRODUCTION: Choriocarcinoma is an invasive, highly vascular gestational trophoblastic neoplasm, the lung is the most common metastasis site 80% [1], Respiratory failure requiring mechanical ventilation is associated with high mortality rates with few case reports of survival [2],we present a case of choriocarcinoma with metastasis to the lung that survived mechanical ventilation with a favorable outcome. CASE PRESENTATION: A 26 years old female presented with hemoptysis and acute hypoxic respiratory failure two months after delivery, she had persistent vaginal bleeding despite undergoing Dilatation and curettage (D&C) prior to presentation, Vitals on admission were significant for hypoxia ( 87% ) on room air , tachypnea ( 24 ), tachycardia (120 ) and stable blood pressure, physical exam was remarkable for crackles in bilateral lung fields , initial lab work was pertinent for a beta-HCG level of 12286 mIU/ml , CXR showed bilateral nodular opacities (image 1),Chest CT scan revealed innumerable bilateral pulmonary nodules consistent with a metastatic process (image 2), additionally abdominal and pelvic CT scan was remarkable for an enlarged uterus, review of the pathology from prior D&C showed a cluster of atypical trophoblastic cells consistent with choriocarcinoma, chemotherapy regimen (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine ) was initiated,respiratory status deteriorated requiring intubation and mechanical ventilation, initial P/F ratio of 70, bedside bronchoscopy with BAL was consistent with diffuse alveolar hemorrhage(DAH),ARDS was managed with lung protective strategies with gradual improvement,patient was extubated after 7 days,she was subsequently discharged without supplemental oxygen. DISCUSSION: Choriocarcinoma is an aggressive vascular tumor that is potentially curable with chemotherapy[3], DAH and ARDS were associated with the initiation of chemotherapy, the management of ARDS was crucial to overcoming this initial phase while patient responded to treatment. CONCLUSIONS: Prompt diagnosis of choriocarcinoma with the management of the associated ARDS secondary to DAH are key factors to improve outcomes. Reference #1: Berkowitz, et al., Current management of gestational trophoblastic diseases. Gynecol Oncol, 2009.112(3): p.654-62. Reference #2: Vaccarello, L., et al.,Respiratory failure from metastatic choriocarcinoma: a survivor of mechanical ventilation. Gynecol Oncol,1997.67(1): p. 111-4. Reference #3: Lurain, J.R., Treatment of gestational trophoblastic tumors.Curr Treat Options Oncol, 2002. 3(2):p.113-24. DISCLOSURE: The following authors have nothing to disclose: Wisam Naji No Product/Research Disclosure Information

Case Report: Multiple hemorrhagic metastases to the brain from primary lung choriocarcinoma.

Herein we report a very rare entity of multiple hemorrhagic metastases to the brain from a primary lung choriocarcinoma in a young woman. The patient presented with recent onset of progressive headache, decreased level of consciousness and multiple episodes of vomiting. CT of the head revealed multiple hemorrhagic lesions within the brain. The patient's serum B-human chorionic gonadotrophin was increased. A chest X-ray revealed a right lung mass. The patient urgently underwent operative excision of the lesion in the posterior fossa, so as to prevent impending tonsillar herniation. The histology from the lesion provided the diagnosis of choriocarcinoma. After surgery, ultrasonography of the abdomen and pelvis was normal, and a chest CT revealed an enhanced and highly vascular right apical lung lesion, suggestive of lung primary choriocarcinoma, with regard to the clinical background. The patient was then started on chemotherapy, following which her serum B-HCG level decreased rapidly. This case highlights the importance of keeping this entity in the differential diagnosis of hemorrhagic lesions in any patients of a child bearing age. Early diagnosis and rapid initiation of multimodal therapy is prudent for ensuring a good outcome from an otherwise rapidly metastasizing and highly vascular lesion.

Prognosis of gestational choriocarcinoma diagnosed incidentally during laparoscopy for a presumed cornual pregnancy: a report of five cases.

The clinical presentations of gestational choriocarcinoma vary markedly, and a misdiagnosis could be made in atypical patients if simply relying on clinical features. Laparoscopic resection of uterine mass lesion is rarely used in gestational choriocarcinoma diagnosis because of the fear of heavy blood loss and distant metastasis. Five patients who were preoperatively diagnosed as having cornual pregnancy underwent laparoscopic resection of mass lesion and then proved to have gestational choriocarcinoma based on pathological examinations. Chemotherapy was started within two days after surgery, and the rate of complete remission was 100%. The mean follow-up time was 29.8±19.1 months, and no patient showed signs of relapse. Laparoscopic resection of uterine mass followed by timely postoperative chemotherapy may be an effective and safe way to obtain pathologic results in patients with suspected gestational choriocarcinoma.

Choriocarcinoma with Rupture of Uterus During Lactational Amenorrhea

Gestational trophoblastic neoplastia presenting as rupture uterus during lactionak amennorhea are a very rare occurence and we here report one such case. A lactating 19-year-old with previous LSCS was referred to us as a case of acute abdomen with hemoperitoneum with ruptured ectopic with an Hb of 3.5 gm/dl with gross hemoperitoneum and UPT negative. Patient was explored under general anesthesia, and gross hemoperitoneum of 2 l with 700 gm blood clot was found. Both fallopian tubes were normal with bilateral large ovarian cysts and a perforated uterus at the fundus with a cauliflower-like exophytic friable growth oozing from the site. Diagnosis of choriocarcinoma was made, and subtotal hysterectomy with left salpingo-oophorectomy and right ovarian tissue reconstruction was done. BHCG was traced to be 2.8 lacs, and post-op metastasis to lungs and peritoneum was found on CT scans. With final histopathology of choriocarcinoma, patient has already received two cycles of EMA-CO regimen and is on close follow-up. A high index of suspicion, prompt diagnosis and expertise management is required for such cases.

Choriocarcinoma of unknown origin with multiple organ metastasis and cerebral hemorrhage: A case report and literature review.

A 26-year-old man was admitted to Beijing Friendship Hospital, Capital Medical University (Beijing, China) with a 4-day history of headache, moderate fever and numbness in the right upper limb. Prior to this, the patient had been diagnosed with cerebral hemorrhage by computed tomography (CT) scan upon visiting a local hospital. Chest X-ray revealed multiple lesions in the lungs. Following referral, no abnormalities were found elsewhere, including in the testes, during a physical examination. Additional examination of other tumor biomarkers was unremarkable, and the initial suspicion of parasitic infection was ruled out. Tests revealed extremely high levels of β-human chorionic gonadotropin (>200,000 mIU/ml). In addition, CT scans showed multiple metastases in the head, lungs, liver and kidneys. An ultrasound-guided Tru-Cut biopsy of the liver was performed in order to form a definitive diagnosis. Although the patient was treated with mannitol to reduce intracranial pressure, and with cefoperazone sodium and sulbactam sodium to fight infection, the patient succumbed to a cerebral hernia on the fourth day of hospitalization. Following this, the ultrasound-guided Tru-Cut liver biopsy result was received, which suggested a diagnosis of choriocarcinoma.

Postmolar choriocarcinoma: An independent risk factor for chemotherapy resistance in low-risk gestational trophoblastic neoplasia

ObjectiveTo evaluate the effect of a clinicopathologic diagnosis of choriocarcinoma (CCA) on clinical characteristics, extent of disease, and response to chemotherapy in low-risk gestational trophoblastic neoplasia (GTN). MethodsWe reviewed the records of 678 patients with low-risk GTN (FIGO stage I and stages IIIII, score<7) treated from 1962 to 2009. Patient and disease characteristics, treatment course, as well as clinical response and survival were analyzed retrospectively. Patients with a clinicopathologic diagnosis of CCA were compared to those with a clinical diagnosis of postmolar GTN. ResultsOf 678 women with low-risk GTN, 129 (19.0%) had a clinicopathologic diagnosis of CCA. Patients with CCA had higher parity (median 1 vs. 0, p=0.003), more pretreatment human chorionic gonadotropin (hCG) levels at >100,000mIU/mL (12.7% vs. 5.9%, p=0.009), longer duration of disease (19.6 vs. 9.9weeks, p<0.001), and higher FIGO scores (median 2 vs. 1, p<0.001) compared with those with other histology; however, patients with CCA and postmolar GTN presented with similar stage of disease (stage I, 83.1% vs 88.2%, p=0.126). Although there was no difference in survival between groups, increased resistance to first-line methotrexate chemotherapy was significantly associated with a diagnosis of postmolar CCA (OR 2.67, p=0.007)), pretreatment hCG level at >10,000mIU/mL (OR 2.62, p=0.002), and higher FIGO score (3–4: OR 2.02, p=0.027; 5–6: OR 5.56, p<0.001) on multivariate analysis. ConclusionsClinicopathologic diagnosis of postmolar CCA in patients with low-risk GTN is associated with higher pretreatment hCG levels, higher FIGO scores, and increased resistance to first-line single-agent methotrexate chemotherapy.

Third-Trimester Intraplacental Choriocarcinoma Presenting With Respiratory Failure and Hyperthyroidism

ABSTRACT Objective: Choriocarcinoma is an aggressive disease typically identified after a molar pregnancy. Diagnosis with a co-existing pregnancy is extremely rare. Only 35 cases have been reported from 1907 to 1995. We report a case of choriocarcinoma diagnosed during the third trimester of an intra-uterine pregnancy presenting with respiratory failure and biochemical hyperthyroidism. Methods: This is a case report of an intraplacental choriocarcinoma during the third trimester of pregnancy. We included a review of literature highlighting the rarity of this disease, diagnostic challenges, and treatment options. Results: A 34-year-old woman, 31 weeks pregnant, presented with dyspnea and hemoptysis for 2 weeks. Imaging showed bilateral pulmonary infiltrates, suggestive of pneumonia. Thyroid function tests checked due to tachycardia revealed hyperthyroidism, with thyroid-stimulating hormone of 0.02 μIU/mL (normal range, 0.5 to 4.5 μIU/mL) and free thyroxine of 4.8 ng/dL (normal range, 0.7 to 1.8 ng/dL). Serum human chorionic gonadotropin was elevated, at 1,433,740 mIU/mL. Respiratory failure ensued, requiring ventilatory support. Emergent cesarean section was done due to worsening clinical status. Histopathologic findings of the placenta were diagnostic of intraplacental choriocarcinoma. Chemotherapy was given; however, the patient developed acute cerebral hemorrhage and she eventually expired. Conclusion: Diagnosis of choriocarcinoma co-existing with intra-uterine pregnancy can be difficult, as initial symptoms can be mistaken for other diseases, such as pneumonia in this case. Biochemical hyperthyroidism during the third trimester in a patient with no history of thyroid disease is rare, and choriocarcinoma should be considered. A timely diagnosis is imperative, as early intervention with chemotherapy can be curative and potentially life-saving. Abbreviations: FIGO = International Federation of Gynecology and Obstetrics GTN = gestational throphoblastic neoplasia hCG = human chorionic gonadotropin T4 = free thyroxine TSH = thyroid-stimulating hormone WHO = World Health Organization

FIGO stage IV gestational choriocarcinoma misdiagnosed as pulmonary tuberculosis: A case report.

Choriocarcinoma is a rare, highly malignant neoplasm, which may occur during or following any type of pregnancy. This tumor often demonstrates rapid hematogenous spread to multiple organs, and is associated with high human chorionic gonadotropin (HCG) levels and a good response to chemotherapy. In the present study, the case of a 29-year-old female with distant metastatic choriocarcinoma [International Federation of Gynecology and Obstetrics (FIGO) stage IV; World Health Organization score, 15], who was misdiagnosed with pulmonary tuberculosis at a local hospital is presented. The major failure in the diagnosis of this case was that the patient's serum β-HCG levels were ignored initially. However, the patient received combined treatment with systematic multi-agent chemotherapy, whole-brain radiation therapy and gross total resection of the brain lesion at West China Second Hospital, and achieved complete remission. In conclusion, the accurate and prompt diagnosis of choriocarcinoma is crucial for a good outcome. Furthermore, in young female patients exhibiting symptoms such as pulmonary bleeding or neurological disturbances following a hydatidiform mole or a normal pregnancy, even in the absence of abnormal uterine bleeding, serum β-HCG levels must be analyzed and a diagnosis of choriocarcinoma must be considered.

A Case of Choriocarcinoma Initially Diagnosed as an Ectopic Pregnancy With a Concomitant Invasive Squamous Cell Cervical Cancer [199

INTRODUCTION: We report a case of choriocarcinoma that was initially diagnosed as an ectopic pregnancy with a concomitant invasive squamous cell cervical cancer. CASE PRESENTATION: A 35-year-old woman, gravida 4 para 3, presented to an outside hospital with vaginal bleeding and pelvic pain. Diagnosed with ectopic pregnancy, the patient was brought to the operating room. Examination under anesthesia revealed a fungating cervical mass. A biopsy was obtained, but dilatation and curettage was deemed too dangerous. The patient was empirically treated with methotrexate. The gynecology team at Einstein was contacted when the cervical biopsy returned as poorly differentiated invasive squamous cell carcinoma of the cervix. The patient was taken to the operating room by a gynecologic oncologist for a staging procedure, further cervical biopsy, and a failed attempt at dilatation and curettage. Pathology showed invasive poorly differentiated carcinoma with focal areas of squamous differentiation, extensive ulceration, necrosis, and hemorrhage. The patient began chemotherapy with plans for radiation therapy. The β human chorionic gonadotropin (β-hCG) levels continued to plateau. The case was brought to the tumor board and the potential for a choriocarcinoma was then raised. The slides were reviewed and restained. With this information the diagnosis of choriocarcinoma was made. The chemotherapy was adjusted and the β-hCG began to fall. DISCUSSION: The case demonstrates the importance of trending β-hCG levels in the absence of a pathology report confirming products of conception. This case also demonstrates the importance of interdisciplinary discussion and review of cases to provide quality care.

The Diagnosis of Choriocarcinoma in Molar Pregnancies: A Revised Approach in Clinical Testing

BackgroundHydatidiform moles occur in approximately 1 in 1,500 pregnancies; however, early miscarriages or spontaneous abortions may not be correctly identified as molar pregnancies due to poor differentiation of chorionic villi.MethodsThe current clinical testing algorithm used for the detection of hydatidiform moles uses a combination of morphological analysis and p57 immunostaining followed by ploidy testing to establish a diagnosis of either a complete or partial molar pregnancy. We review here 198 referrals for fluorescence in situ hybridization (FISH) ploidy testing, where the initial diagnosis based on morphology is compared to the final diagnosis based on a combination of morphology, FISH and p57 immunohistochemical (IHC) staining.ResultsApproximately 40% of cases were determined to be genetically abnormal, but only 28.8% of cases were diagnosed as molar pregnancies. The underestimation of complete molar pregnancies and those with androgenetic inheritance was also found to be likely using conventional diagnostic methods, as atypical p57 staining was observed in approximately 10% of cases.ConclusionsOur findings suggest that a revised approach to testing products of conception is necessary, with cases screened according to their clinical history in order to distinguish molar pregnancy referrals from hydropic pregnancies.

Respiratory symptoms as an initial presentation of choriocarcinoma

Chronic dyspnea, chest pain, cough, and hemoptysis for more than 2 weeks often indicate a diagnosis of infective etiology of the respiratory tract in a tropical country. However, in a young reproductive female, these complaints with an episode of hemoptysis may rarely be the presenting symptomatology of pulmonary metastasis of choriocarcinoma. A young female of reproductive age group presented with hemoptysis, cough, and breathlessness. Chest X-ray revealed bilateral lower lobe opacities. Fine-needle aspiration cytology of the lung lesions depicted choriocarcinoma metastasis. Ultrasonography and magnetic resonance imaging revealed endomyometrial mass lesion suggestive of invasive gestational trophoblastic disease. β hCG levels were high. Dilatation and curettage and histopathological analysis of the mass confirmed the diagnosis of choriocarcinoma. This young female who presented with respiratory complaints was finally diagnosed to be a case of choriocarcinoma with lung metastasis. Therefore, choriocarcinoma metastasis must be considered as a differential diagnosis in a female of childbearing age presenting with respiratory complaints and hemoptysis.

Acute Clinical Presentation of Metastatic Testicular Choriocarcinoma: A Case Report and Brief Review of Literature

We present an unusual case of a 23-year-old Hispanic male with no past medical history, who presented with 2 days history of diffuse abdominal pain. CT scan showed widely bleeding metastatic lesions in the retroperitoneum, lungs and liver causing large hemothorax and hemoperitoneum. He developed acute symptomatic anemia and needed interventional radiology-guided embolization of hepatic artery in addition with an urgent chest tube to relieve the symptoms along with transfusion. Subsequent exam found a true choriocarcinoma of the right testis. Following chemotherapy, the patient’s lesions shrunk and his anemia improved. A review of literature shows that testicular choriocarcinoma is a rare aggressive malignancy which metastasizes hematogenously and bleeds extensively due to their high vascularity. They can present with acute symptoms and signs that often lead patients to seek emergency care. Acute bleeding manifestation could be also the first presentation often leading to the final diagnosis of choriocarcinoma like in this case. J Med Cases. 2014;5(12):639-642 doi: http://dx.doi.org/10.14740/jmc1943w

Acute Clinical Presentation of Metastatic Testicular Choriocarcinoma: A Case Report and Brief Review of Literature

We present an unusual case of a 23-year-old Hispanic male with no past medical history, who presented with 2 days history of diffuse abdominal pain. CT scan showed widely bleeding metastatic lesions in the retroperitoneum, lungs and liver causing large hemothorax and hemoperitoneum. He developed acute symptomatic anemia and needed interventional radiology-guided embolization of hepatic artery in addition with an urgent chest tube to relieve the symptoms along with transfusion. Subsequent exam found a true choriocarcinoma of the right testis. Following chemotherapy, the patient’s lesions shrunk and his anemia improved. A review of literature shows that testicular choriocarcinoma is a rare aggressive malignancy which metastasizes hematogenously and bleeds extensively due to their high vascularity. They can present with acute symptoms and signs that often lead patients to seek emergency care. Acute bleeding manifestation could be also the first presentation often leading to the final diagnosis of choriocarcinoma like in this case. J Med Cases. 2014;5(12):639-642 doi: https://doi.org/10.14740/jmc1943w

Changes in clinical presentation of postterm choriocarcinoma at the New England Trophoblastic Disease Center in recent years

ObjectiveTo review the last 15year experience of choriocarcinoma following a term gestation at the New England Trophoblastic Disease Center (NETDC) and compare these results to earlier data to determine any changes in the clinical presentation and outcome of this disease. MethodsWomen with postterm choriocarcinoma from 1996 through 2011 followed by the NETDC were identified by diagnosis codes. Twenty charts were identified and reviewed. These data were then compared to published results from the NETDC of 44 women from 1964 to 1996. ResultsTime from antecedent pregnancy to diagnosis of choriocarcinoma was significantly longer in the current series, 46.1 vs. 19.7weeks (p=0.03). Despite this change, patient outcomes remained comparable, with similar overall mortality rates (13% vs. 10%, p=NS). However, patient presentation was notably different. In the early series, five (11%) infants suffered hydrops or stillbirth, while in the recent series there were no adverse infant outcomes (p=0.08). Six women in the current series presented in the absence of symptoms suspicious for choriocarcinoma (either by an incidental positive pregnancy test without other symptoms or by placental pathology), compared to one woman in the prior series (30% vs. 2%, p=0.001). ConclusionsIn recent years postterm choriocarcinoma is being diagnosed or referred later after the antecedent pregnancy at our regional referral center. Recent patients more commonly have no other symptoms than a question of pregnancy and are less likely diagnosed due to the presence of fetal hydrops or stillbirth. Despite later diagnoses, survival with postterm choriocarcinoma continues to be high.