Metastatic Choriocarcinoma Presenting Research Articles

Severe thyrotoxicosis as initial presentation of gastric choriocarcinoma: a case report

BackgroundExtragonadal choriocarcinoma is rare and can be associated with hyperthyroidism when producing very high levels of human chorionic gonadotropin.Case presentationA 62-year-old Hispanic female presented with a 3-week history of shortness of breath, palpitations, extreme weakness, new-onset hot flashes, and right flank pain. Her physical examination was remarkable for tachycardia, hepatomegaly, hyperreflexia, and tremor; goiter was absent. Laboratory studies revealed increased lactate dehydrogenase, alkaline phosphatase, suppressed thyroid stimulating hormone, very elevated T4, and absent thyroid stimulating immunoglobulin. 18F-fluorodeoxyglucose positron emission tomography-computed tomography exhibited hepatomegaly with multiple large fluorodeoxyglucose-avid liver masses and a focus of fluorodeoxyglucose avidity in the stomach with no structural correlate. A thyroid scan (99mTcO4−) showed diffusely increased tracer uptake. She was started on propranolol and methimazole. Upon stabilization of severe thyrotoxicosis, upper endoscopy was performed, showing a ~ 5 cm bleeding lesion in the greater stomach curvature body; biopsy was consistent with choriocarcinoma; beta-human chorionic gonadotropin hormone was 2,408,171 mIU/mL. The patient received methotrexate followed by etoposide and cisplatin. Methimazole was titrated down, and upon liver failure the medication was stopped. The thyrotoxicosis was effectively controlled with antithyroid drug and concurrent chemotherapy. At ~ 1.5 months after initial diagnosis, the patient died due to bleeding/acute liver failure with coagulation defects followed by multiple organ failure.ConclusionsSevere thyrotoxicosis can represent an unusual initial presentation of metastatic choriocarcinoma in the setting of extreme elevation of beta-human chorionic gonadotropin. Primary gastric choriocarcinoma is an aggressive malignancy with very poor outcomes. The co-occurrence of severe thyrotoxicosis with advanced primary gastric choriocarcinoma and imminent liver failure complicates management options.

Metastatic choriocarcinoma presenting as intracranial hemorrhage and intussusception

Extrauterine choriocarcinoma is a rare entity. The criteria used for its diagnosis are as follows: (1) Absence of disease in the uterine cavity, (2) pathologic confirmation of diagnosis, (3) exclusion of molar pregnancy, and (4) absence of a coexistent intrauterine pregnancy. Delay in the diagnosis can be attributed to its nongynecologic manifestations such as bleeding from any organ system, unexplained systemic symptoms, and metastatic foci from an unknown primary malignancy. This is an unusual case of 27-year-old G3P3 (3-0-0-3) who underwent emergency left parietal craniotomy excision due to increased intracranial pressure symptoms secondary to left parietal tumor. Histopathology revealed metastatic adenocarcinoma. About a month later, she underwent exploratory laparotomy for acute abdominal symptoms secondary to a jejunal mass. Jejuno-jejunal resection anastomosis was done and histopathology revealed choriocarcinoma.

Pulmonary metastatic choriocarcinoma presenting as hemodynamically unstable patient with hemothorax

Pulmonary metastatic choriocarcinoma presenting as hemodynamically unstable patient with hemothorax

Choriocarcinoma with cerebral metastasis presenting as a stroke-like lesion

Choriocarcinoma is a very aggressive malignant variant of gestational trophoblastic disease characterized by malignant proliferation of trophoblastic tissues and absence of chorionic villi. We present a rare case of metastatic choriocarcinoma presenting with a stroke-like lesion. A 40-year old multiparous woman that presented with bleeding per vaginam, right-sided facial nerve palsy and hemiparesis following eight weeks of amenorrhea. Serum β-hCG was elevated and urine pregnancy test was positive in neat and in serial dilution. She was managed as a case of metastatic choriocarcinoma and had five courses of the EMA-CO drug regimen. She made rapid neurological recovery and was discharged in good condition. We conclude that metastatic choriocarcinoma may present in bizarre forms. It should be suspected in any woman presenting with abnormal vaginal bleeding, unusual systemic physical features and raised serum β-hCG. We conclude that combination chemotherapy is usually effective even in metastatic choriocarcinoma.

Ruptured cerebral aneurysm from choriocarcinoma

Gestational trophoblastic diseases include hydatidiform moles, invasive moles, choriocarcinoma, placental-site trophoblastic tumours and miscellaneous trophoblastic lesions. Choriocarcinoma is a rare disease that arises from the trophoblastic epithelium of the placenta at the beginning of pregnancy. Among the confirmed cases, 45% occur after molar pregnancy, 25% after normal pregnancy, 25% after an abortion and 5% after ectopic pregnancy. This tumour is usually diagnosed based on its histopathologic appearance and a high level of serum beta-human chorionic gonadotropin (β-HCG). Choriocarcinoma exhibits a good response to chemotherapy and radiation. However, it is also known for its tendency to spread rapidly to multiple organs, including the lungs, liver and brain. As one of the worst prognostic factors, brain metastasis complicates 3–28% of gestational choriocarcinoma cases. Increased β-HCG levels and a low serum cerebrospinal fluid β-HCG level can be strongly suggestive of intracranial choriocarcinoma, even in the absence of histopathologically proven disease. Reviewing the literature, there were 23 cases of intracerebral haemorrhage from an oncotic aneurysm as an initial presentation of choriocarcinoma. We report a further case of intracerebral haematoma secondary to oncotic aneurysm as the first presentation of metastatic choriocarcinoma with normal serum β-HCG.

Unsuspected metastatic choriocarcinoma presenting as unexplained severe anaemia

Unsuspected metastatic choriocarcinoma presenting as unexplained severe anaemia

Metastatic gestational trophoblastic tumor presenting as spontaneous kidney rupture: Treatment with embolization

Choriocarcinoma is a rapidly growing tumor that characteristically outgrows its blood supply. We report a rare case of metastatic choriocarcinoma presenting with acute right flank pain due to kidney rupture secondary to renal metastasis. The renal metastasis was embolised to stanch blood for control of hemorrhage. A brief review of the imaging features and therapeutic options for the ruptured renal metastases is discussed along with the case.

Metastatic choriocarcinoma presenting and treated during viable pregnancy: a case report

Please cite this paper as: Bircher C, Smith R, Seckl M, Brown D, Short D, Rees H, McCarthy A, Nirmal D. Metastatic choriocarcinoma presenting and treated during viable pregnancy: a case report. BJOG 2011;118:1672–1675.

Unusual clinical and radiological presentation of metastatic choriocarcinoma to the brain and long-term remission following emergency craniotomy and adjuvant EMA-CO chemotherapy: Response to the Letter

Unusual clinical and radiological presentation of metastatic choriocarcinoma to the brain and long-term remission following emergency craniotomy and adjuvant EMA-CO chemotherapy: Response to the Letter

Splenic rupture: a rare presentation of metastatic choriocarcinoma

Splenic rupture: a rare presentation of metastatic choriocarcinoma

Unusual clinical and radiological presentation of metastatic choriocarcinoma to the brain and long-term remission following emergency craniotomy and adjuvant EMA-CO chemotherapy

Choriocarcinoma is the most malignant tumor of gestational trophoblast origin. Metastasis to brain is considered a poor prognostic indicator. Recent advances in adjuvant radiotherapy and chemotherapy have led to an excellent outcome of these patients. Craniotomy is indicated in selected cases with cerebral metastases. The authors report an interesting case of an aggressive choriocarcinoma with multiple metastases to the brain and viscera. The patient had radiological evidence of new lesions occurring almost every week while on the initial treatment and yet had a complete long-term remission with EMA-CO therapy. The interesting presentation, radiology and adjuvant therapies are discussed.

Metastatic gestational trophoblastic tumour presenting as spontaneous subcapsular renal haematoma

We describe a rare case of metastatic choriocarcinoma, which presented with acute left loin pain due to a subcapsular haematoma secondary to a bleeding renal metastasis. The renal metastasis was embolised to prevent further bleeding. To our knowledge, presentation of gestational trophoblastic tumour (GTT) with such symptoms has not been described in the recent literature. Our case illustrates that, although rare, non-gynaecological symptoms can be the first presentation of metastatic choriocarcinoma in the appropriate clinical settings. It also demonstrates that the acute bleed from a renal metastasis can be effectively managed by embolisation.

Metastatic Choriocarcinoma Presenting as a Renal Mass:

Metastatic Choriocarcinoma Presenting as a Renal Mass:

Unsuspected Metastatic Choriocarcinoma Presenting As Gastrointestinal Bleeding

Although metastatic lung choriocarcinoma causes respiratory symptoms, it can be manifested with atypical signs. A 20 years old patient is reported who presented with features of gastrointestinal bleeding due to polypoid choriocarcinoma of the stomach. Bloody vomiting are usually caused by peptic disease but may also be secondary to metastasis to the lung. Failure to recognize this as being to choriocarcinoma may led to a delay in diagnosis and effective treatment.

Unsuspected metastatic choriocarcinoma presenting as unilateral spontaneous pneumothorax

Spontaneous pneumothoraces are usually caused by subpleural apical blebs but may also be secondary to metastasis to the lung. We present the case of a 20-year-old woman with spontaneous pneumothorax secondary to choriocarcinoma metastatic to the lung.

Coexisting intraductal breast carcinoma and metastatic choriocarcinoma presenting as a breast mass

Identifying choriocarcinoma in breast tissue is a rare phenomenon. This report describes an unusual case of metastatic choriocarcinoma presenting as a breast mass and coexisting with an intraductal breast carcinoma. This is the first documented case of a choriocarcinoma metastatic to the breast that has responded to chemotherapy.