Choriocarcinoma coexistent with intrauterine pregnancy: two additional cases and a review of the literature

Zanetta, Gerardo; Maggi, Roberto; Colombo, M.; Bratina, G; Mangioni, Costantino

doi:10.1046/j.1525-1438.1997.00406.x

Cited by 25 publications

(16 citation statements)

References 55 publications

(87 reference statements)

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“…Patients with pulmonary metastases, like our case, can present with chest pain, cough, shortness of breath, and/ or hemoptysis, or they can also be completely asymptomatic. However, in cases with brain metastases, as suspected in our patient, they are most often symptomatic and can present with vomiting, seizures, headache, hemiparesis, slurred speech, visual disturbance, or altered mentation from increased intracranial pressure or intracerebral bleeding (5).…”

Section: Discussionmentioning

confidence: 73%

Third-Trimester Intraplacental Choriocarcinoma Presenting With Respiratory Failure and Hyperthyroidism

Subang

Кониг

Staats

et al. 2016

AACE Clinical Case Reports

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Objective: Choriocarcinoma is an aggressive disease typically identified after a molar pregnancy. Diagnosis with a co-existing pregnancy is extremely rare. Only 35 cases have been reported from 1907 to 1995. We report a case of choriocarcinoma diagnosed during the third trimester of an intra-uterine pregnancy presenting with respiratory failure and biochemical hyperthyroidism.Methods: This is a case report of an intraplacental choriocarcinoma during the third trimester of pregnancy. We included a review of literature highlighting the rarity of this disease, diagnostic challenges, and treatment options.Results: A 34-year-old woman, 31 weeks pregnant, presented with dyspnea and hemoptysis for 2 weeks. Imaging showed bilateral pulmonary infiltrates, suggestive of pneumonia. Thyroid function tests checked due to tachycardia revealed hyperthyroidism, with thyroidstimulating hormone of 0.02 µIU/mL (normal range, 0.5 to 4.5 µIU/mL) and free thyroxine of 4.8 ng/dL (normal range, 0.7 to 1.8 ng/dL). Serum human chorionic gonadotropin was elevated, at 1,433,740 mIU/mL. Respiratory failure ensued, requiring ventilatory support. Emergent cesarean section was done due to worsening clinical status. Histopathologic findings of the placenta were diagnostic of intraplacental choriocarcinoma. Chemotherapy was given; however, the patient developed acute cerebral hemorrhage and she eventually expired.Conclusion: Diagnosis of choriocarcinoma co-existing with intra-uterine pregnancy can be difficult, as initial symptoms can be mistaken for other diseases, such as pneumonia in this case. Biochemical hyperthyroidism during the third trimester in a patient with no history of thyroid disease is rare, and choriocarcinoma should be considered. A timely diagnosis is imperative, as early intervention with chemotherapy can be curative and potentially life-saving.

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Section: Discussionmentioning

confidence: 73%

Third-Trimester Intraplacental Choriocarcinoma Presenting With Respiratory Failure and Hyperthyroidism

Subang

Кониг

Staats

et al. 2016

AACE Clinical Case Reports

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“…The diagnosis of GTT in a woman with a normal intrauterine pregnancy is extremely rare. At present, only 33 cases have been reported in world literature (1) . In the Philippines, the case presented is only the third documented case, and by far, the only one, wherein both the mother and the infant survived (2) .…”

Section: Discussionmentioning

confidence: 99%

“…Although the development from trophoblastic remnants of previous pregnancies cannot be excluded, the findings of incidental macroscopic and microscopic foci of choriocarcinoma in apparently normal placentas show the possible transformation of normal trophoblast into choriocarcinoma during an otherwise normal pregnancy. Zanetta et al (1) proposed several hypotheses to explain the origin of the disease: (1) from the placenta during a normal pregnancy, (2) from the placenta during a normal pregnancy, with subsequent spontaneous regression of the primary tumor in the placenta and persistence of the metastases, (3) malignant change in the chorionic remnants of a previous pregnancy, and (4) multiple pregnancy, with one conceptus undergoing malignant change to choriocarcinoma. In the case presented, the patient had a previous molar pregnancy.…”

Section: Discussionmentioning

confidence: 99%

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Gestational trophoblastic tumor in pregnancy: a case report and review of the literature

Echo¹,

Soriano-Estrella²

2006

Int J Gynecol Cancer

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A case of gestational trophoblastic tumor (GTT) concurrent with an intrauterine pregnancy is reported in a 21-year-old gravida 2 para 0 (0010) who presented with dyspnea, orthopnea, headache, and blurring of vision at 33 weeks age of gestation. She had a history of hydatidiform mole for which curettage was done. Chest radiograph showed pulmonary metastases, with pleural effusion on both lungs. Serum beta subunit of human chorionic gonadotropin was abnormally elevated for age of gestation. Due to worsening maternal pulmonary condition, the patient underwent primary, low segment cesarean section and was subsequently started on multidrug chemotherapy. This is the first reported case of GTT in pregnancy in the Philippines in which both the mother and the infant survived. Several hypotheses regarding its origin, its diagnosis, and its management and prognosis are presented. This case report emphasizes the importance of early diagnosis and treatment to improve the prognosis of both the mother and the infant.

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“…There are at least 35 recorded cases of choriocarcinoma co‐existing with a normal pregnancy recorded in the world literature, with the majority diagnosed with lung metastases [1,2]. This paper was the first to describe the use of VATS to perform directed biopsies and make the diagnosis of choriocarcinoma in a patient with a normal coexisting pregnancy.…”

mentioning

confidence: 97%

Metastatic choriocarcinoma to the lung coexistent with a viable pregnancy

Ahmed¹,

Geest²,

Natta³

et al. 2006

Intl J Gynecology & Obste

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A 31-year-old G4P2 at 33 weeks gestation was transferred from a local hospital for persistent cough and a right hemothorax. Her obstetric history was significant for two uncomplicated vaginal deliveries at term, followed by a spontaneous abortion 6 months prior to the current pregnancy.Significant labs included an elevated BHCG of 118,946. A CTscan of the chest showed multiple lung nodules without hilar adenopathy. The pulmonary service performed a diagnostic bronchoscopy, which was unsuccessful in making a diagnosis secondary to the peripheral location of the pulmonary nodules. Approximately 12 days after initial presentation, the patient underwent cervical mediastinoscopy, revealing negative mediastinal lymph nodes. Right VATS then allowed excisional biopsies of two right lower lobe lesions. The procedure was performed without any complications. Pathology returned as choriocarcinoma (Fig. 1). (A. Ahmed). Figure 1 Thoracoscopic view of lung metastases.

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Choriocarcinoma coexistent with intrauterine pregnancy: two additional cases and a review of the literature

Cited by 25 publications

References 55 publications

Third-Trimester Intraplacental Choriocarcinoma Presenting With Respiratory Failure and Hyperthyroidism

Third-Trimester Intraplacental Choriocarcinoma Presenting With Respiratory Failure and Hyperthyroidism

Gestational trophoblastic tumor in pregnancy: a case report and review of the literature

Metastatic choriocarcinoma to the lung coexistent with a viable pregnancy

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