High-risk Choriocarcinoma Research Articles

Endoscopic manifestations of jejunal choriocarcinoma.

Choriocarcinoma, a malignant tumor deriving from the trophoblastic tissue, is mostly associated with adverse pregnancy. Early metastasis is very common in patient with choriocarcinoma, but the cases of intestinal metastasis are definitely rare. Herein, we reported a case of jejunal choriocarcinoma revealed by endoscopy. Segmental resection of the jejunum as well as biopsy of liver nodules were performed. The patient was classified as super high-risk choriocarcinoma and received chemotherapy and surgical treatment. Unfortunately, the patient ultimately died of liver rupture.

Adjuvant chemotherapy of resistant high risk choriocarcinoma

Choriocarcinoma is a subtype of gestational trophoblastic disease. It is a very rare neoplasm, with incidence of about 1 case in 40.000 pregnancies. Gestational form of choriocarcinoma arises most commonly after abortion, while nongestational form develops from pluripotent germ cells. Choricarcinoma is highly malignant and highly chemosensitive type of tumor. A 43-year-old patient diagnosed with extra uterine pregnancy in September 2017 was treated with methotrexate with no response and had surgical removal of right Fallopian tube. Choriocarcinoma was diagnosed one and a half year after extra uterine pregnancy. Radiological imaging before treatment showed pulmonary and inguinal lymph node metastases and tumor invasion of the anterior uterine wall. Surgery was performed due to heavy bleeding and uterine wall invasion. As high risk patient she received chemotherapy. She was followed radiologically and her serum ?-HCG was monitored. Refractivity to the chemotherapy protocol during treatment was observed. Therapy response was achieved after administration of EMA-EP protocol modification i.e. three consecutive negative follow-up values of ?-HCG were obtained and radiological findings were disease free. One month after treatment patient had no signs of disease and ?-HCG level was normal.

Puerperal Choriocarcinoma After Normal Term Pregnancy: Surgery Role in Selected Cases

Choriocarcinoma is a malignant neoplasm that classically displays biphasic morphology (syncytiotrophoblasts, cytotrophoblasts and trophoblastic cells). The incidence after term pregnancy is unusual, being diagnosed in most of them because of symptoms due to metastases. We report a case of puerperal choriocarcinoma after a normal uncomplicated pregnancy. After the diagnosis, it was classified as FIGO Stage III malignant gestational trophoblastic neoplasia and high-risk choriocarcinoma. The patient began multiagent systemic chemotherapy biweekly (EMA-CO). Although her tumor marker was normalized after the 3rd cycle, the full-body scan showed a diminishing of the uterine mass but persistent lung metastases. The patient underwent an uncomplicated laparotomy hysterectomy and bilateral salpingectomy procedure. She completed 6 cycles of EMA-CO in total, after which lung lesions disappeared. She remains disease-free 12 months after diagnosis.

Choriocarcinoma with multiple lung, skull and skin metastases in a postmenopausal female: A case report.

Gestational trophoblastic disease with a primary extra-uterine nidus is rare, particularly during the postmenopausal period. The present report outlines a case of high-risk choriocarcinoma (International Federation of Gynecology and Obstetrics stage IV; World Health Organization score 13) in a 68-year-old female exhibiting neoplasm. The choriocarcinoma developed 20 years subsequent to the onset of menopause and 42 years following the patient's final pregnancy, and was associated with multiple metastases to the lungs, skull, neck, lymph nodes and skin. The patient was administered two courses of systemic chemotherapy with tegafur (800 mg) and actinomycin D (200 µg). Local chemotherapy was also administered to the scalp and left flank masses; the masses were injected first with methotrexate, and then with 5-fluorouracil. During chemotherapy, the patient's levels of β-human chorionic gonadotrophin (β-HCG) decreased from 3,171 IU/l to 1,763 IU/l, however by the conclusion of the courses of systemic and local chemotherapy, β-HCG levels had increased to 3,704 IU/l. The patient and their family subsequently elected to end treatment. The patient subsequently succumbed to infection, tumor consumption and organ insufficiency. This study describes the clinical and radiological features, as well as the treatment used for this rare type of choriocarcinoma.

Successful salvage of a relapsed high risk gestational trophoblastic neoplasia patient using capecitabine

Background Although most patients at high risk of Gestational Trophoblastic Neoplasia (GTN) respond to standard treatments, there is a group of patients that will die because of it. The use of new single or combination drugs in this population has become a priority. Case report We present the case of a relapsed high risk choriocarcinoma patient who did not respond to several chemotherapy treatments nor to PET guided salvage surgery. Because of treatment toxicity, the patient was started on Capecitabine, with which she achieved total remission, still present after 15 months of starting treatment. Conclusions The use of Capecitabine and the multidisciplinary management of this population should be taken into account for patients at high risk of relapsing to EP/EMA because of its efficacy and little toxicity.

Diagnostic and prognostic significance of circulating tumor suppressor gene p53 autoantibodies in patients with gestational trophoblastic tumors

Seventy-two patients with gestational trophoblastic tumors (GTTs) and 20 first-trimester healthy pregnant women (controls) participated in this study. According to the WHO scoring system, GTTs were subgrouped into 24 hydatiform mole spontaneous regression (HMSR), 18 postmolar high-risk (PMHR) and 16 low- and 14 high-risk cases of choriocarcinoma. Patients with choriocarcinoma were treated with hysterectomy and methotrexate chemotherapy, whereas molar pregnancy was managed by either oxytocin infusion followed by suction evacuation or by hysterectomy. Serum p53 autoantibodies were determined by enzyme-linked immunosorbant assay and serum hCGβ was determined by radioimmunoassay before and throughout the12 months after treatment. p53 autoantibodies were not detected in normal pregnancy and cases of HMSR but were detected in all cases of PMHR and choriocarcinoma. Concentrations of p53 autoantibodies were higher in choriocarcinoma than in PMHR cases. Serial measurements of p53 autoantibodies dropped to an undetectable level within 1 and 6 months after treatment in cases of PMHR and low-risk choriocarcinoma, respectively. Decreasing values of p53 autoantibodies in high-risk choriocarcinoma remained higher than the cut-off level of controls. There was a significant positive correlation between p53 autoantibodies and serum hCGβ concentration in GTTs. In conclusion, detection of p53 autoantibodies has a high potential for the differential diagnosis of GTTs and their serial measurements are clinically useful to monitor disease progression and to assess response to therapy in GTTs.

Herpes gestationis may present itself as a paraneoplastic syndrome of choriocarcinoma—a case report

Background Herpes gestationis (HG) is a rare, recurrent, pruritic, vesicobullous dermatosis occurring predominantly in pregnancy and seldom in early puerperium. Reports of the association of HG with choriocarcinoma are extremely rare and this case highlights such a possible link. Case This case focuses on the late postpartal manifestation of HG being associated with metastatic high-risk choriocarcinoma. Direct immunofluorescence was used to verify the diagnosis of HG. Symptomatic therapy with corticosteroids and antihistamines alleviated the pruritic symptoms associated with HG, but only the recurrent course of chemotherapy for the choriocarcinoma resulted in complete disappearance of all signs and symptoms of the HG. Conclusion The time course of this case highlights once again the possible association of HG as a paraneoplastic syndrome of choriocarcinoma.

Serum interleukin-2 and soluble interleukin-2 receptor in gestational trophoblastic diseases.

To investigate serum interleukin-2 (IL-2) and soluble interleukin-2 receptor (SIL-2) levels in gestational trophoblastic diseases (GTD). Sixty-six patients with GTDs and 23 first-trimester healthy pregnant women (controls) participated in this study. According to the World Health Organization scoring system, GTDs were subgrouped into the following groups: 30 hydatidiform mole spontaneous regression (HMSR), 12 postmolar gestational trophoblastic tumors of high risk (PMHR), 14 low-risk choriocarcinomas, and ten high-risk choriocarcinomas. Before treatment, a blood sample from each case was assayed for beta-hCG by radioimmunoassay, IL-2 by IRMA, and SIL-2R by enzyme-linked immunosorbent assay. Follow-up beta-hCG assays were carried out at weekly intervals after treatment for 3 months, then monthly for 1 year. Serum IL-2 levels in all subgroups of GTD were significantly lower than that of controls. Meanwhile, there were concomitant significant elevations of serum SIL-2R, showing mean rises of 3.86-fold, 3.9-fold, twofold, and 6.1-fold for cases of HMSR, PMHR, low-risk choriocarcinoma, and high-risk carcinoma, respectively. All cases of high-risk choriocarcinoma revealed abnormally high SIL-2R values. There was a significant positive correlation between serum beta-hCG and SIL-2R concentrations. The possible causes of IL-2 decreases and SIL-2R increases may indicate a defective immune response in GTDs. The high correlation between SIL-2R level and tumor burden suggests the use of serum SIL-2R assay for disease monitoring: SIL-2R is indirect marker of tumor activity, and it is useful in the differential diagnosis of GTD because a normal value of serum SIL-2R excludes high-risk cases of choriocarcinoma.