Choriocarcinoma with multiple lung metastases from complete hydatidiform mole with coexistent fetus during pregnancy

Abstract

Gestational trophoblastic neoplasm (GTN) is a serious morbidity of complete hydatidiform mole with coexistent fetus (CHMCF) and usually develops after termination of pregnancy. Here we report a case of choriocarcinoma derived from CHMCF during pregnancy. A 33-year-old multiparous woman with suspected CHMCF was admitted with a severe cough. Computed tomography revealed multiple lung metastases. Cesarean section and hysterectomy were performed at 31 weeks of gestation on diagnosis of high-risk GTN from International Federation of Gynecology and Obstetrics (FIGO) scoring. A live female infant weighing 1390 g was delivered. Choriocarcinoma was diagnosed from pathological findings. The patient received multi-agent chemotherapy and was discharged on the 40th postoperative day. In conclusion, CHMCF can result in high-risk GTN during pregnancy. For a suspected GTN, diagnosis from FIGO scoring should determine treatment strategy. If patients with CHMCF wish to continue their pregnancy, careful follow-up, including regular chest radiography and ultrasonography, is warranted.

A high-risk gestational trophoblastic neoplasia derived from a complete hydatidiform mole with coexisting fetus identified by short tandem repeats analysis: A case report

“…We determined that the CHMCF pregnancy was the source of the choriocarcinoma, which is similar to a case reported by Maeda et al [ 23 ]. Although the patient's prognosis was good with the multidrug combination chemotherapy shown in Table 2 , choriocarcinoma can metastasize to the brain and may have a significant impact on the patient's quality of life and fertility.…”

“…Sebire et al reported that only four cases of GTN occurring in 77 cases of CHMCF pregnancies (5.2%) required multidrug combination chemotherapy [ 5 ], suggesting CHMCF does not present a high risk for GTN. However, previous case reports describe diagnoses of high-risk GTN after CHMCF or cases requiring multidrug combination chemotherapy for GTN (presumed to be high-risk GTN) [ [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] ]. In six of 12 cases (50%), including the present case, single-agent chemotherapy was given as the initial chemotherapy for PTD.…”

“…To our knowledge, only one report exists in which the causative pregnancy of choriocarcinoma after CHMCF was identified by STR analysis [ 23 ]. In the STR analysis of the present case, the DNA of choriocarcinoma matched the haploid of the complete hydatidiform mole.…”

A Successfully Treated Multiple Metastatic Choriocarcinoma Coexistent With Live Fetus: A Case Report and Literature Review

“…The mean age of the patients was 28.7 years, and the mean gestational age at diagnosis was 26.5 weeks. The most common sites of metastases included lungs (89%), brain (39%), vagina (17%), and liver (11%) (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).…”

Short Tandem Repeats Define a Gestational Origin for Metastatic Choriocarcinoma

“…These tumors are characterized by hemorrhage and necrosis, with diffuse staining for cytokeratin 7 and 20. The clinical presentation of metastatic gestational choriocarcinoma to the lung is well described, and more commonly it includes hydatidiform moles (complete or partial), invasive moles, and choriocarcinoma subtypes [2][3][4]. However, spontaneous hemothorax is an uncommon presentation of metastatic gestational choriocarcinoma and has not been reported previously in the United States.…”