Subscribe to RSS
DOI: 10.1055/s-0042-1758525
Gestational Choriocarcinoma Manifesting as Spontaneous Hemothorax in Third Trimester of Pregnancy: A Case Report
Funding None.
Abstract
Gestational trophoblastic neoplasia (GTN) is an aggressive malignancy arising from the trophoblastic tissue. It is rarely seen in association with advanced intrauterine pregnancy. Most common manifestations are due to bleeding caused by the rich vascularity of trophoblastic tissue. We describe here a case of a 28-year-old female patient who presented to us at 32 weeks of pregnancy with sudden onset dyspnea and hemodynamic instability. On evaluation, imaging techniques revealed a gross left hemothorax requiring intercostal tube insertion for stabilization. Emergency thoracotomy and hemothorax drainage were performed wherein a tumor mass in the lower lobe of left lung was identified and resected. Histopathological examination confirmed the diagnosis of choriocarcinoma. Beta HCG levels were found to be elevated. Final diagnosis of a FIGO stage IV high-risk gestational choriocarcinoma was made. Following this, six cycles of multi-agent EMA-CO chemotherapy was administered to the patient. Patient had an excellent response to treatment with documented serial fall in β HCG levels and she continues to be in remission after 6 months of follow-up. In conclusion, in the circumstance of any pregnant women presenting with abnormal bleeding symptoms such as hemothorax, choriocarcinoma as a cause should be considered for early diagnosis and effective management.
Declaration of Patient Consent
Informed consent of the patient was acquired.
Publication History
Article published online:
29 November 2022
© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 Berkowitz RS, Goldstein DP. Chorionic tumors. N Engl J Med 1996; 335 (23) 1740-1748 DOI: 10.1056/NEJM199612053352306.
- 2 Wreczycka-Cegielny P, Cegielny T, Oplawski M, Sawicki W, Kojs Z. Current treatment options for advanced choriocarcinoma on the basis of own case and review of the literature. Ginekol Pol 2018; 89 (12) 711-715 DOI: 10.5603/GP.a2018.0120.
- 3 Braun-Parvez L, Charlin E, Caillard S. et al. Gestational choriocarcinoma transmission following multiorgan donation. Am J Transplant 2010; 10 (11) 2541-2546 DOI: 10.1111/j.1600-6143.2010.03275.x.
- 4 Yu P, Diao W, Jiang X. A successfully treated metastatic choriocarcinoma coexistent with pregnancy: a case report of a 4-year follow-up. Medicine (Baltimore) 2016; 95 (21) e3505 DOI: 10.1097/MD.0000000000003505.
- 5 Álvarez-Sarrado L, González-Ballano I, Herrero-Serrano R, Giménez-Molina C, Rodríguez-Solanilla B, Campillos-Maza JM. Hemoptysis as the first symptom in the diagnosis of metastatic choriocarcinoma in the third trimester of pregnancy: a case report. Case Rep Womens Health 2020; 27: e00211
- 6 Mangla M, Singla D, Kaur H, Sharma S. Unusual clinical presentations of choriocarcinoma: a systematic review of case reports. Taiwan J Obstet Gynecol 2017; 56 (01) 1-8 DOI: 10.1016/j.tjog.2015.05.011.
- 7 Saha K, Basuthakur S, Jash D, Bandyopadhyay A. Gestational choriocarcinoma presenting as hemothorax. Indian J Med Sci 2010; 64 (05) 237-240
- 8 Steigrad SJ, Cheung AP, Osborn RA. Choriocarcinoma co-existent with an intact pregnancy: case report and review of the literature. J Obstet Gynaecol Res 1999; 25 (03) 197-203 DOI: 10.1111/j.1447-0756.1999.tb01147.x.
- 9 Soper JT, Mutch DG, Schink JC. American College of Obstetricians and Gynecologists. Diagnosis and treatment of gestational trophoblastic disease: ACOG Practice Bulletin No. 53. Gynecol Oncol 2004; 93 (03) 575-585 DOI: 10.1016/j.ygyno.2004.05.013.
- 10 Buckley JD. The epidemiology of molar pregnancy and choriocarcinoma. Clin Obstet Gynecol 1984; 27 (01) 153-159 DOI: 10.1097/00003081-198403000-00022.
- 11 Balagopal P, Pandey M, Chandramohan K, Somanathan T, Kumar A. Unusual presentation of choriocarcinoma. World J Surg Oncol 2003; 1 (01) 4
- 12 Huang CY, Chen CA, Hsieh CY, Cheng WF. Intracerebral hemorrhage as initial presentation of gestational choriocarcinoma: a case report and literature review. Int J Gynecol Cancer 2007; 17 (05) 1166-1171 DOI: 10.1111/j.1525-1438.2007.00934.x.
- 13 Kulkarni R, Lister UG. Metastatic choriocarcinoma coexisting with full term viable pregnancy. Postgrad Med J 1985; 61 (721) 1013-1014 DOI: 10.1136/pgmj.61.721.1013.
- 14 Sudduth CD, Strange C, Campbell BA, Sahn SA. Metastatic choriocarcinoma of the lung presenting as hemothorax. Chest 1991; 99 (02) 527-528 DOI: 10.1378/chest.99.2.527b.
- 15 DeFrance JH, Blewett Jr JH, Ricci JA, Patterson LT. Massive hemothorax: two unusual cases. Chest 1974; 66 (01) 82-84 DOI: 10.1378/chest.66.1.82.
- 16 Wolkove N, Gervais A, Kreisman H, Frank H, Lachance RC. Choriocarcinoma presenting as hemothorax. Can Med Assoc J 1981; 124 (12) 1599-1600
- 17 Lazovic B, Milenkovic V. Gestational choriocarcinoma with hemorrhagic pleural effusion. Arch Oncol 2010; 18 (03) 86-87 DOI: 10.2298/aoo1003086l.
- 18 Yangki S. Pulmonary metastatic choriocarcinoma presenting as hemodynamically unstable patient with hemothorax. The Turkish Journal of Thoracic and Cardiovascular Surgery. 2016; 24 (03) 582-584 DOI: 10.5606/tgkdc.dergisi.2016.11699.
- 19 Seetharaman ML, Arora R, Arora VK. Gestational choriocarcinoma with haemorrhagic pleural effusion. Indian J Chest Dis Allied Sci 1991; 33 (01) 39-42
- 20 Buza N, Baine I, Hui P. Precision genotyping diagnosis of lung tumors with trophoblastic morphology in young women. Mod Pathol 2019; 32 (09) 1271-1280 DOI: 10.1038/s41379- 019–0275-z.
- 21 Ngan HYS, Seckl MJ, Berkowitz RS. et al. Update on the diagnosis and management of gestational trophoblastic disease. Int J Gynaecol Obstet 2018; 143 (Suppl. 02) 79-85 DOI: 10.1002/ijgo.12615.
- 22 Dhanda S, Ramani S, Thakur M. Gestational trophoblastic disease: a multimodality imaging approach with impact on diagnosis and management. Radiol Res Pract 2014; 2014: 842751 DOI: 10.1155/2014/842751.
- 23 Cagayan MS. High-risk metastatic gestational trophoblastic neoplasia. Primary management with EMA-CO (etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine) chemotherapy. J Reprod Med 2012; 57 (5-6): 231-236
- 24 May T, Goldstein DP, Berkowitz RS. Current chemotherapeutic management of patients with gestational trophoblastic neoplasia. Chemother Res Pract 2011; 2011: 806256 DOI: 10.1155/2011/806256.
- 25 Frijstein MM, Lok CAR, Short D. et al. The results of treatment with high-dose chemotherapy and peripheral blood stem cell support for gestational trophoblastic neoplasia. Eur J Cancer 2019; 109: 162-171 DOI: 10.1016/j.ejca.2018.12.033.
- 26 Veras E, Kurman RJ, Wang TL, Shih IM. PD-L1 expression in human placentas and gestational trophoblastic diseases. Int J Gynecol Pathol 2017; 36 (02) 146-153 DOI: 10.1097/PGP.0000000000000305.
- 27 Ghorani E, Kaur B, Fisher RA. et al. Pembrolizumab is effective for drug-resistant gestational trophoblastic neoplasia. Lancet 2017; 390 (10110): 2343-2345 DOI: 10.1016/S0140-6736(17)32894-5.
- 28 Clark JJ, Slater S, Seckl MJ. Treatment of gestational trophoblastic disease in the 2020s. Curr Opin Obstet Gynecol 2021; 33 (01) 7-12 DOI: 10.1097/GCO.0000000000000674.
- 29 You B, Bolze PA, Lotz JP. et al. Avelumab in patients with gestational trophoblastic tumors with resistance to single-agent chemotherapy: cohort A of the TROPHIMMUN phase II trial. J Clin Oncol 2020; 38 (27) 3129-3137 DOI: 10.1200/JCO.20.00803.
- 30 Soper JT. Gestational trophoblastic disease: current evaluation and management. [published correction appears in Obstet Gynecol. 2022 Jan 1;139(1):149] Obstet Gynecol 2021; 137 (02) 355-370 DOI: 10.1097/AOG.0000000000004240.