Introduction: Non-gestational choriocarcinoma (NGCC) is an extremely rare cancer. We report a case presenting in extremis. Case Report: A 39-year-old woman presented with type 1 respiratory failure with a 1-month history of breathlessness. Computed tomography (CT) revealed widespread metastatic disease involving the lungs, liver, pancreas, and breast. Serum β-human chorionic gonadotropin was markedly raised. Over 72 h, she deteriorated and was started on high-flow nasal cannula to facilitate discussions and for comfort. Histology from a breast biopsy suggested a choriocarcinoma, and she was commenced on etoposide and cisplatin. Unfortunately she continued to deteriorate and died on day 11 of admission. Molecular genotyping received post-mortem confirmed non-gestational choriocarcinomatous differentiation within a high-grade tumour. Discussion: NGCC carries a worse prognosis compared with gestational choriocarcinoma and is historically less chemosensitive. However, differentiation between these two diagnoses is challenging due to a lack of immuno-histochemical differences. The NGCC in this case was likely to have originated in the lung due to a 12-cm mass in the lingula, and extensive emphysema on CT. Primary pulmonary choriocarcinoma has a rapidly fatal course in the majority of patients. Conclusion: This is the only case to our knowledge of NGCC presenting in extremis, where an accurate diagnosis was not achieved pre-mortem. This also demonstrates the merit of non-invasive ventilation within palliation to facilitate communication and comfort.

Previous studies indicate dietary phenylalanine and tyrosine restriction may be of value in managing advanced cancer patients. To further evaluate this approach, we performed a 60-day study in which four patients with advanced malignant melanoma received formula diets via nasogastric tube containing only 8 mg total phenylalanine and tyrosine per kg lean body mass per day. Two of three patients completing elemental balance studies were in negative nitrogen, potassium, and phosphorus balance, suggesting an essential nutrient deficiency. Three patients tolerated the diet well, but one was non-compliant. Although no serious toxicity developed, serum albumin, total iron binding capacity and cholesterol significantly decreased (p less than 0.01) in the three complaint patients. Fasting plasma phenylalanine and tyrosine values did not significantly change during the study, but two-hour postprandial plasma phenylalanine and tyrosine concentrations fell below normal and were significantly lower than preprandial levels (p less than 0.01). There were no tumor responses.

No abstract

No abstract

Mean 'pain' score changed from 1.9 to 1.2, with 47% of the 125 patients with pain improved . Mean 'breathlessness' score improved from 1.1 to 0.8, with 48% of the 64 patients with breathlessness improved . Mean 'anxiety' score changed from 1.9 to 1.3, with 42% of the 73 patients with anxiety improved . Mean 'feeling depressed' score changed from 1.5 to 1.0, with 52% of the 56 patients with depressed mood improved . Mean 'information needs' score changed from 1.2 to 0.9, with 78% of the 36 patients wanting more information improved.Conclusions For the first time in UK, an inpatient hospice has systematically used routinely-collected outcomes date to demonstrate the marked positive impact of the clinical care provided.