Background: Choriocarcinoma syndrome is rare and challenging in practice. The condition is fatal if it is associated with uncontrolled bleeding. Objectives: The current study aimed to present our experience managing a case of choriocarcinoma syndrome, which complicated a gestational trophoblastic disease. Patients and methods: A case of 35-year-old female with a history of molar pregnancy that was missed and diagnosed with choriocarcinoma stage 4. The patient suffered from a life-threatening gastrointestinal (GIT) bleeding. Results:The patient was managed by intensive transfusion protocol and chemotherapy [EMA-EP protocol (etoposide, methotrexate, actinomycin D, etoposide, cisplatin) and intercaecal methotrexate]. Severe life threating bleeding stopped after 72 hours of active management and blood transfusion. Following six cycles of this protocol, BHCG level returned to normal level with marked improvement of metastatic lesions. Conclusion: Choriocarcinoma syndrome is a life-threatening condition that requires intensive management. Cure-rate index is high if the condition is appropriately managed.

Background: A high prevalence of hepatitis C virus (HCV) seropositivity is found in patients with B-cell lymphoproliferative disorders. Many studies show improvement of lymphoid malignancies outcome with the use of anti HCV treatment in patients with HCV infection and lymphoid malignancies especially indolent B cell lymphoma.Objective: This study aimed to examine the hypothesis if sofosbuvir based direct-acting antivirals (DAAs) combination could improve the outcome of patients with B cell lymphoid malignancies and HCV infection. Patient and Methods: During the period from January 2017 to December 2019 all eligible patients diagnosed with Blymphoid malignancies presented at Sohag University Hospital and Sohag Cancer Institute were included in the study. HCV positive patients were randomized to receive sofosbuvir based DAAs combination either concomitant with or after the end of chemotherapy. Results: Patients with HCV infection are more likely to have advanced stage disease (stage 3/4), extra-nodal presentation, liver and BM infiltration. Disease free survival (DFS) and overall survival (OS) were better in the group that received sofosbuvir DAAs combination after the end of chemotherapy treatment compared to the other groups (P = 0.000, 0.000 respectively) and was not different between patients who received sofosbuvir based combination concomitant with chemotherapy and HCV negative B-lymphoid malignancies. Conclusion: Sofosbuvir based DAAs combination improve the outcome of different types of lymphoid malignancies (DFS, OS) in patients with HCV infection associated lymphoid malignancies especially when given after the end of chemotherapy.

Hepatotropic virus HCV, which can infect hepatocytes, is also lymphotropic and can infect lymphocytes as well. Epidemiological, clinical, and biological evidence suggests that the pathogenesis of at least a portion of B-cell non-Hodgkin lymphomas (NHLs) are related to HCV infection. In the last six years, the approval of the new IFN-free antiviral treatment (AVT) with DAAs revolutionized the treatment of chronic HCV infection and many studies show improvement of lymphoid malignancies associated with HCV infection upon the use of direct-acting antivirals (DAAs). DAAs alone can improve indolent lymphomas and DAAs combined with chemotherapy improve the outcome of more aggressive lymphomas as many studies show that patients with HCV infection and lymphoid malignancies usually presented with a higher stage, have a higher frequency of extranodal presentation and a lower response rate (RR), disease free survival (DFS), and overall survival (OS) compared with other patients with lymphoid malignancies without HCV infection. Moreover, a number of lymphoid malignancies had reported soon after DAAs treatment for HCV infection. This is a systematic review of DAAs and their effect on lymphoid malignancies when given either combined or without chemotherapy. In addition, the review contains all cases reported before for the development of lymphoid malignancies after DAAs treatment for HCV infection.