Haemoptysis from a pulmonary arteriovenous malformation in a post molar pregnancy gestational trophoblast tumour patient managed by radiological embolisation: a case report

Abstract

IntroductionGestational trophoblastic tumours are a rare form of malignancy, which in the majority of cases arise from abnormal trophoblast cells formed in a complete molar pregnancy. These tumours are extremely sensitive to chemotherapy and high cure rates approaching 100% can be expected. The disease is usually limited to the uterus where the abnormal trophoblast proliferation and human chorionic production can lead to vascular changes including the formation of arteriovenous malformations.Case presentationWe describe the case of a 28-year-old Caucasian woman who presented to the United Kingdom's Gestational Trophoblast Tumour Service with rising human chorionic gonadotropin levels following a uterine evacuation for a complete molar pregnancy. She was commenced on chemotherapy but subsequently reported two episodes of haemoptysis. Computed tomography imaging demonstrated findings consistent with a pulmonary arteriovenous malformation, probably due to a small pulmonary metastasis, complicated by recent haemorrhage. These findings were confirmed on emergency pulmonary arteriography, and the pulmonary arteriovenous malformation was successfully embolised.ConclusionsArteriovenous malformations secondary to gestational trophoblastic tumours at metastatic sites have only been reported in a very limited number of cases. When significant bleeding occurs, as in this case of a pulmonary lesion, urgent referral for embolisation is indicated.

Gestational Trophoblastic Disease: Clinical and Imaging Features

“…As with uterine AVMs, persistent arteriovenous shunts may develop within pulmonary metastases from choriocarcinoma after successful completion of chemotherapy (63,79,80). While patients with small lesions are generally asymptomatic, patients with larger lesions may present with hemoptysis, exertional dyspnea, cyanosis, and clubbing.…”

“…CT may reveal the supplying pulmonary artery and draining pulmonary vein (63). Perilesional ground-glass opacities (halos) may be seen in the setting of recent hemorrhage (80). Transcatheter embolization is the procedure of choice for treatment of amenable pulmonary AVFs (81).…”

Accompanying Pulmonary Arteriovenous Malformation in Patient with Hydatidiform Mole: A Case Report

“…GTD is a rare entity, and it manifests as an hCG-producing hypervascular tumor (2). The key regulatory role of hCG in angiogenesis and vascular function is well known (4).…”

“…Acquired pulmonary AVMs can occur in the context of a variety of physical injuries or disease processes such as liver cirrhosis, chest trauma, infection, metastatic carcinoma, mitral stenosis or systemic amyloidosis (7,8). Pulmonary metastases of GTD have the potential to form pulmonary AVMs, which can cause life-threatening hemorrhage or hemoptysis (2). A few studies have shown that pulmonary AVMs were secondary to GTD at the metastatic site during or after chemotherapy (2, 6, 9, 10).…”

“…GTD refers to a type of tumor which is, characteristically, highly vascularized and can cause heavy or life-threatening bleeding (2,3). The development of uterine arteriovenous malformations (AVMs) can be found in patients with GTD because of abnormal trophoblastic proliferation and increased angiogenesis caused by high production of human chorionic gonadotropin (hCG) (4).…”