Metastatic Choriocarcinoma Research Articles

Biochemical remission by chemoradiotherapy in male mediastinal choriocarcinoma with diffuse lung metastasis: A case report.

Primary mediastinal choriocarcinoma is a rare malignancy that is characterized by multiple metastases at the time of diagnosis, poor response to therapy and short survival times. There is no standard treatment for this disease. The present study described the case of a 25-year-old man with metastatic mediastinal choriocarcinoma. The patient completed 8 cycles of standard combination chemotherapy consisting of etoposide [100 mg/m2; intravenous (IV) drip on days 1-3], cisplatin (20 mg/m2; IV drip on days 1-5) and bleomycin (20 mg/m2; intramuscular injection on days 1, 8 and 15 every 21 days). The α-fetoprotein level decreased to 2.36 ng/ml, the serum β-human chorionic gonadotropin (β-HCG) level markedly decreased to 8.69 IU/l, which was slightly higher than the normal upper limit, and the lactate dehydrogenase level decreased to a normal range. The computed tomography (CT) scan revealed that the number and size of the lung lesions was significantly reduced subsequent to 8 cycles of chemotherapy and the size of the mediastinal tumor was evidently reduced, with a less solid component and a more cystic component. The response assessment indicated partial remission. Following chemotherapy, a radiation dose of 50 Gy (2.0 Gy/fraction) was administered to the involved field of the mediastinum. Following radiotherapy, the β-HCG level had also decreased to normal levels, and CT evaluation revealed that the size of the residual lung lesions demonstrated no evident change, and the mediastinal tumor was slightly reduced in size, with a less solid component. The patient refused to undergo surgery and did not receive additional treatment following radiotherapy. At present, the patient has survived >16 months of follow-up without any symptoms.

Circulating Tumor DNA: A Potential Novel Diagnostic Approach in Gestational Trophoblastic Neoplasia

Circulating Tumor DNA: A Potential Novel Diagnostic Approach in Gestational Trophoblastic Neoplasia

Choriocarcinoma Presenting with Spinal Metastasis: Case Report and Review of the Literature

Gestational trophoblastic disease (GTD) is a spectrum of cellular proliferations originating from placental villous trophoblasts. Spinal metastasis of choriocarcinoma is rare, especially after a normal pregnancy. In this paper, we present a rare case of metastatic choriocarcinoma to the lumbar spine as the first manifestation of disease. The patient underwent surgery, and a dark red hemorrhagic, epidural mass was totally removed. Histopathologic studies on the mass and specimen from the episiotomy site led to a diagnosis of metastatic choriocarcinoma. Surgical resection has a limited role in metastatic choriocarcinoma, but it should be considered if rapid-onset neurological deficit appears due to spinal cord compression.

Choriocarcinoma Presenting with Thyrotoxicosis

We describe a 26-year-old man with metastatic choriocarcinoma who presented with hyperthyroidism associated with elevated β-human chorionic gonadotropin (B-HCG) and respiratory failure secondary to diffuse lung metastasis. After the first cycle of chemotherapy, the concentration of B-HCG dramatically decreased and the patient became euthyroid, allowing us to discontinue antithyroid medications. The patient's hyperthyroidism was caused by stimulation of the thyroid gland by high B-HCG levels, as shown by the marked improvement of the patient's thyroid function panel after chemotherapy.

Choriocarcinoma Presenting as Intracerebral Hemarrhage and No Evident Primary: A Rare Presentation

Choriocarcinoma is the most malignant tumor of gestational trophoblastic neoplasia. It grows rapidly and metastasizes to the lung, liver, and, less frequently, to the brain. One rare case of metastatic cerebral choriocarcinoma with initial presentation of intracerebral hemorrhage is reported. Our patient had metastasis to brain and lung with no evidence of genital disease. She has received systemic as well as intra-thecal chemotherapy, her β-HCG levels have come down, and she is on follow-up.

Chemotherapy Used to Halt Lower GI Bleeding in a Rare Case of Metastatic Choriocarcinoma to the GI Tract.

Choriocarcinoma, a nonseminomatous germ cell tumor, is a rare type of testicular malignancy that tends to occur in young males. It is, however, exceedingly rare for choriocarcinoma to involve the GI tract. In this article, we present a rare case of a 31-year-old male, diagnosed with choriocarcinoma of the left testes, along with several metastases to distant sites. The patient presented with headaches and severe lower GI bleeding due to metastases to the GI tract, which was eventually controlled with systemic chemotherapy, while requiring several units of packed RBCs during his admission to the hospital. An extensive literature review found very few cases of the occurrence of GI bleeding as a consequence of choriocarcinoma due to metastases to the GI tract.

Choriocarcinoma Metastatic to the Kidney Presenting With Prolonged Amenorrhea and Flank Pain

Introduction:: Gestational choriocarcinoma usually occurs following an intrauterine pregnancy. We report a case of metastatic choriocarcinoma to the left kidney and lungs with long term intermittent amenorrhea and vaginal bleeding after a normal vaginal delivery. Case presentation:: A 43-year-old rural woman presented with prolonged amenorrhea. Her last delivery was three years ago. She also complained of hematuria and left flank pain. Serum β-hCG level was considerably high. She underwent endometrial curettage. Pathologic examination of endometrial curettage specimen revealed choriocarcinoma. Ultrasound revealed enlarged uterus involved by an irregular mass with heterogenous echo pattern and extensive myometrial invasion. A mass with similar echo pattern was also evident in the left kidney. Computerized tomography confirmed the intrauterine mass and involvement of the left kidney. On chest X-ray, metastatic nodules were seen in both lungs and in the left retrocardiac space. The patient underwent 10 courses of chemotherapy (8 treatment courses and 2 courses for consolidation) with EMA-CO regimen (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine/oncovine). Following the fifth course of chemotherapy, she became pancytopenic and febrile. This condition was successfully managed with G-CSF, leukovorin and antibiotics. The patient is now well and still under the chemotherapy. Her serum β-hCG level has fallen to negative (3 IU/mL). Conclusions:: Gestational trophoblastic diseases should be considered in the differential diagnosis of prolonged amenorrhea in patients of reproductive age with a history of prior pregnancy. Moreover, symptoms related to metastatic involvement such as hematuria and flank pain may be among the first clinical manifestations of choriocarcinoma.

Coriocarcinoma metastásico en pulmón, riñón, e intestino delgado (yeyuno)

Se comunica el caso de una paciente de 39 años de edad, con antecedente de un embarazo molar 7 años atrás. Ella presentó sangrado vaginal de seis meses de evolución, melena y anemia severa. El estudio anatomopatológico mostró coriocarcinoma metastásico en pulmón, riñón e intestino delgado (yeyuno).

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.

Primary pulmonary cancer colliding with metastatic choriocarcinoma.

Collision tumors are rare in nature. Although lung is one of the main organs where metastatic tumors may occur, collision neoplasms consisting of a primary lung cancer and metastatic choriocarcinoma have never been reported so far. Here we describe a case of primary squamous-cell lung carcinoma (SCC) colliding with metastatic choriocarcinoma in a 55-year-old woman.

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.

Choriocarcinoma Presenting as Intracerebral Haemorrhage and No Evident Primary: Rare Presentation

Choriocarcinoma is the most malignant tumor of gestational trophoblastic neoplasia. It grows rapidly and metastasizes to the lung, liver, and, less frequently, to the brain. One rare case of metastatic cerebral choriocarcinoma with initial presentation of intracerebral Haemorrhage is reported. Our patient had metastasis to brain and lung with no evidence of genital disease. She has received systemic as well as intra-thecal chemotherapy and her β-HCG levels have come down and she is on follow-up.

Cutaneous Metastasis of Choriocarcinoma.

Dear Editor: Choriocarcinoma is a malignant tumor arising from trophoblastic cells and characterized by the secretion of human chorionic gonadotropin (hCG). The lung and the vagina are the common target organs of choriocarcinoma metastasis; however, in some rare cases, metastasis to the liver, brain, kidney, or gastrointestinal tract is also reported1,2. Skin metastasis is especially known to be extremely rare3. To the best of our knowledge, only 12 cases of cutaneous metastasis of choriocarcinoma have been reported in the literature. A 30-year-old female patient visited our hospital for the evaluation of a solitary cutaneous nodule on the scalp that had been present for 3 weeks. The lesion was a reddish, bean-sized firm nodule (Fig. 1). There were no subjective symptoms, and no significant findings on physical examination. She had undergone suction and curettage 33 months ago for a hydatidiform mole. A skin punch biopsy was performed. Histologic examination revealed typical histologic features of choriocarcinoma. Marked red blood cell extravasation and dermal infiltration of anaplastic malignant tumor cells were observed. Infiltrated tumor cells consisted of two cell types: (i) cytotrophoblastic cells that had a polygonal clear cytoplasm and large vesicular nuclei with prominent nucleoli, and (ii) syncytiotrophoblastic cells with hyperchromatic nuclei and an eosinophilic cytoplasm (Fig. 2). Moreover, immunohistochemical staining of the cytoplasm of syncytiotrophoblasts against hCG antigen showed a strong positive reaction, leading to the final diagnosis of metastatic choriocarcinoma (Fig. 2, inset). Other germ cell tumors such as polyembryoma, embryonal carcinoma, dysgerminoma, and mixed germ cell tumor can also contain syncytiotrophoblastic cells that will stain positive for hCG; however, in these cases, there are no dysplasias of cytotrophoblasts and syncytiotrophoblasts that will distinguish these diseases from choriocarcinoma4. She was referred to the gynecology department, and the laboratory tests showed an increased serum hCG (275,673 mIU/ml). In the ovary, no specific abnormal findings were observed with ultrasonography. However, multiple nodules that could be considered metastatic were seen on the chest radiograph. She was transferred to another hospital for chemotherapy. The primary site remained unknown, as there had been no further evaluations in this hospital. Fig. 1 A solitary bean-sized oval reddish nodule on the vertex of the scalp. Fig. 2 Marked red blood cell extravasation and dermal infiltration of anaplastic malignant tumor cells. Cytotrophoblastic cells (yellow arrow) with a polygonal clear cytoplasm and large vesicular nuclei with prominent nucleoli, and syncytiotrophoblastic cells ... Cutaneous metastasis of visceral malignancy is often reported (generally 1.4%~10.4% of the cases)2. However, cutaneous metastasis of choriocarcinoma is rare. According to Gleizal et al.5, the mean patient age in 11 cases of cutaneous metastasis of choriocarcinoma that had been reported until 2007 was 32 years (range, 22~74 years), and the clinical feature of a single reddish nodule similar to that of our patient was observed in 7 cases; however, the manifestation of the disease on the scalp was seen in only 1 other case. The diagnosis of the disease would be difficult with only physical examinations if the primary presentation of visceral malignancy is cutaneous metastasis; however, the diagnosis was easier in this case because the typical histological findings of choriocarcinoma were observed. This case emphasizes the importance of the histological examination of a skin metastatic lesion in making a conclusive diagnosis. Here, we report a case of scalp metastasis of choriocarcinoma.

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

Imaging features of thoracic metastases from gynecologic neoplasms.

Gynecologic malignancies are a heterogeneous group of common neoplasms and represent the fourth most common malignancy in women. Thoracic metastases exhibit various imaging patterns and are usually associated with locally invasive primary neoplasms with intra-abdominal spread. However, thoracic involvement may also occur many months to years after initial diagnosis or as an isolated finding in patients without evidence of intra-abdominal neoplastic involvement. Thoracic metastases from endometrial carcinoma typically manifest as pulmonary nodules and lymphadenopathy. Thoracic metastases from ovarian cancer often manifest with small pleural effusions and subtle pleural nodules. Thoracic metastases to the lungs, lymph nodes, and pleura may also exhibit calcification and mimic granulomatous disease. Metastases from fallopian tube carcinomas exhibit imaging features identical to those of ovarian cancers. Most cervical cancers are of squamous histology, and while solid pulmonary metastases are more common, cavitary metastases occur with some frequency. Metastatic choriocarcinoma to the lung characteristically manifests with solid pulmonary nodules. Some pulmonary metastases from gynecologic malignancies exhibit characteristic features such as cavitation (in squamous cell cervical cancer) and the "halo" sign (in hemorrhagic metastatic choriocarcinoma) at computed tomography (CT). However, metastases from common gynecologic malignancies may be subtle and indolent and may mimic benign conditions such as intrapulmonary lymph nodes and remote granulomatous disease. Therefore, radiologists should consider the presence of locoregional disease as well as elevated tumor marker levels when interpreting imaging studies because subtle imaging findings may represent metastatic disease. Positron emission tomography/CT may be helpful in identifying early locoregional and distant tumor spread.

Gastrointestinal hemorrhage and gynecomastia as first signs of metastatic testicular choriocarcinoma

Testicular choriocarcinoma is an infrequent non seminomatous germ cell tumor, usually presenting histologically as part of a mixed germ cell tumor, and rarely as pure form. It metastasizes early, usually along hematogenous routes, lungs being the most frequent sites of metastasis. Involvement of the gastro-intestinal tract as metastatic site is extremely uncommon and rarely described in the literature. We report the case of a 47 year-old male with gastric and pulmonary metastases from testicular mixed germ cell tumor mainly represented by choriocarcinoma as histological subtype, presenting with melena and gynecomastia as first clinical signs. Morphological and immunohistochemical analyses of biopsies taken from the endoscopically identified gastric hemorrhagic lesion and from lung nodules showed undifferentiated neoplastic epithelial cells in a necrotic and hemorrhagic background. Coexistence of gynecomastia addressed towards an hormonal-dependent tumor and prompted us to apply further morphological and immunohistochemical analyses, revealing the gonadal primary neoplasm, subsequently confirmed at surgery.

Cutaneous manifestation of metastatic infantile choriocarcinoma.

Infantile choriocarcinoma is a highly malignant rare germ cell tumor that arises from the placenta. Simultaneous intraplacental choriocarcinoma involving both mother and infant is extremely rare. Cutaneous metastasis in infantile choriocarcinoma is even rarer with only a few case reports available. Here we describe a case of a female neonate who presented to the ED with a rapidly growing and bleeding vascular lesion to her right cheek. She was eventually diagnosed by biopsy with metastatic choriocarcinoma. In addition to the cutaneous tumor, she also had metastatic disease in her lungs. Her mother was subsequently found to have choriocarcinoma with metastatic disease to the lungs as well.

Metastastic Choriocarcinoma in a Term Pregnancy

The focus of this article is choriocarcinoma (CC), a rare and aggressive obstetric/gynecologic cancer that occurs once in every 20,000 to 40,000 pregnancies. CC is a form of gestational trophoblastic disease, which is the result of abnormal trophoblastic activity encompassing a spectrum of nonmalignant and malignant disease. Forms of gestational trophoblastic disease include complete or partial mole, invasive mole, CC, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. Typically asymptomatic, the first symptom of CC in 80% of cases is shortness of breath, indicative of metastasis to the lungs. CC affects women of all ages and can occur during pregnancy, after birth, or even years remote from the antecedent pregnancy. It is highly responsive to chemotherapy, with an overall remission rate greater than 90%. This case study presents the story of a pregnant adolescent thought to have an uneventful pregnancy until metastatic CC at term was diagnosed. Available treatments, outcomes and surveillance for the disease, psychosocial aspects, and implications for nursing care are discussed.

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

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.