Treatment of Pulmonary Tumor Embolism from Choriocarcinoma: Extracorporeal Membrane Oxygenation as a Bridge through Chemotherapy

Abstract

A 22-year-old woman with a 1-month history of shortness of breath that was treated as a case of tuberculosis and pulmonary embolism was referred to the authors’ hospital. Because of the hemodynamic instability in this patient, venoarterial extracorporeal membrane oxygenation (ECMO) was administered in the intensive care unit. She underwent a pulmonary embolectomy for the treatment of progressive circulatory collapse secondary to a pulmonary embolism. The histopathologic result was consistent with a metastatic choriocarcinoma. Despite the surgical management, persistent refractory cardiogenic shock occurred. Subsequently, the patient was treated with chemotherapy in the presence of ECMO and responded well to chemotherapy. She was discharged after 3 months. This case suggests that metastatic choriocarcinoma should be considered as a differential diagnosis in women of childbearing age presenting with a pulmonary embolism, and ECMO may be beneficial in patients with pulmonary embolism for bridging to surgical embolectomy and chemotherapy.

Possibility of venoarterial extracorporeal membranous oxygenator being a bridging therapy for hemodynamic deterioration of pulmonary tumor thrombotic microangiopathy prior to initiating chemotherapy

“…However, considering 2 previous case reports, describing PTTM patients whom hemodynamic deterioration was treated successfully by VA-ECMO and started imatinib or chemotherapy during VA-ECMO run and achieved short-term survival. [ 3 , 13 ] These previous cases and our current experience suggest that the appropriate treatment strategy for PTTM should include VA-ECMO for hemodynamic deterioration, with the early use of imatinib for recanalization of pulmonary thrombosis by fibrocellular intimal proliferation and chemotherapy for the causative cancer initiated during the VA-ECMO run. In conclusion, VA-ECMO should be considered as a possible bridging therapy for patients with undiagnosed deterioration of PTTM.…”

Lessons from a patient with cardiac arrest due to massive pulmonary embolism as the initial presentation of Wilms tumor: a case report and literature review

“…Non-neonatal pediatric ECMO cases with a variety of indications have increased [12]. In the past tumor-related reports, ECPR was performed for a patient with metastatic choriocarcinoma, a patient with lymphoma, and another patient with leukemia who developed PE [13–15]. The case with choriocarcinoma presented with severe dyspnea, massive hemoptysis, and decreased mean BP in the hospital.…”

Pulmonary micro‐tumor emboli resulting in paradoxical emboli: a case report

“…In rare cases, early chemotherapy and oncological surgery were associated with prolonged survival. 20 , 21 Regardless of the treatment, however, prognosis is currently poor. Earlier diagnosis is nonetheless essential to lengthen the therapeutic window in patients eligible for aggressive therapy.…”