Write your message
Volume 6, Issue 1 (Winter 2021)                   J Obstet Gynecol Cancer Res 2021, 6(1): 35-41 | Back to browse issues page


XML Print


Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Ayatollahi H, Jahangard S. Gestational Trophoblastic Neoplasia with Brain Metastasis Presented with Initial Presentation of Dyspnea: A Case Report. J Obstet Gynecol Cancer Res. 2021; 6 (1) :35-41
URL: http://jogcr.com/article-1-321-en.html
1- Department of Obstetrics and Gynecology, School of Medicine, Solid Tumor Research Center, Research Institute on Cellular and Molecular Medicine, Shahid Motahari Hospital, Urmia University of Medical Sciences, Urmia, Iran , hayatollahi@yahoo.com
2- Department of Obstetrics and Gynecology, School of Medicine, Solid Tumor Research Center, Research Institute on Cellular and Molecular Medicine, Shahid Motahari Hospital, Urmia University of Medical Sciences, Urmia, Iran
Abstract:   (178 Views)
Background: Choriocarcinoma is the most aggressive kind of gestational trophoblastic neoplasia (GTN). Although the risk of brain metastasis in GTN is rare, in patients with choriocarcinoma, the incidence of brain metastasis is 11%. In this paper, we reported a case of choriocarcinoma with brain metastasis, which was successfully treated with an etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMACO) regimen.
Case presentation: A 34-year-old woman was presented with vaginal bleeding, dyspnea, and moderate abdominal pain. She had a menstrual delay of about two weeks. She had a primary β-human chorionic gonadotropin (β-hCG) of 132 600 mIU/mL. On lung computed tomography (CT) scan images, a metastatic lesion with a size of 68×50 mm was observed in the lower lobe of the left lung. The patient underwent dilation and curettage (D&C) that revealed choriocarcinoma. Brain magnetic resonance imaging (MRI) also showed a small metastatic mass with a size of 7 mm at the right occipital lobe. The patient was started on chemotherapy with an EMACO regimen. The patient’s β-hCG decreased continuously, and it was negative after the fourth cycle and six sessions of radiotherapy. It also remained negative six months after chemotherapy. The final examinations of the patient had no abnormal findings.   
Conclusion: Brain metastasis may be relatively asymptomatic in patients with choriocarcinoma, and it should be considered by physicians, even when there are no neurological symptoms. Also, the EMACO regimen seems to be an appropriate regimen for the treatment of metastatic choriocarcinoma. 
Full-Text [PDF 811 kb]   (49 Downloads) |   |   Full-Text (HTML)  (6 Views)  
Systematic Review: Case Report | Subject: Gynecology Oncology
Received: 2020/10/12 | Accepted: 2020/12/4 | Published: 2021/01/1

References
1. Piura E, Piura B. Brain metastases from gestational trophoblastic neoplasia: review of pertinent literature. European journal of gynaecological oncology. 2014;35(4):359-67.
2. Vickers NJ. Animal Communication: When I'm Calling You, Will You Answer Too? Current Biology. 2017;27(14):R713-R5. [DOI:10.1016/j.cub.2017.05.064] [PMID]
3. Altieri A, Franceschi S, Ferlay J, Smith J, La Vecchia C. Epidemiology and aetiology of gestational trophoblastic diseases. The lancet oncology. 2003;4(11):670-8. [DOI:10.1016/S1470-2045(03)01245-2]
4. Dadlani R, Furtado SV, Ghosal N, Prasanna K, Hegde A. Unusual clinical and radiological presentation of metastatic choriocarcinoma to the brain and long-term remission following emergency craniotomy and adjuvant EMA-CO chemotherapy. Journal of cancer research and therapeutics. 2010;6(4):552. [DOI:10.4103/0973-1482.77069] [PMID]
5. Ngan HY, Seckl MJ, Berkowitz RS, Xiang Y, Golfier F, Sekharan PK, et al. Update on the diagnosis and management of gestational trophoblastic disease. International Journal of Gynecology & Obstetrics. 2018;143:79-85. [DOI:10.1002/ijgo.12615] [PMID]
6. Ngan HY, Seckl MJ, Berkowitz RS, Xiang Y, Golfier F, Sekharan P, et al. Update on the diagnosis and management of gestational trophoblastic disease. International Journal of Gynecology & Obstetrics. 2015;131:S123-S6. [DOI:10.1016/j.ijgo.2015.06.008] [PMID]
7. Gavanier D, Leport H, Massardier J, Abbas F, Schott A-M, Hajri T, et al. Gestational trophoblastic neoplasia with brain metastasis at initial presentation: a retrospective study. International journal of clinical oncology. 2019;24(2):153-60. [DOI:10.1007/s10147-018-1337-9] [PMID]
8. Rustin G, Newlands ES, Begent R, Dent J, Bagshawe KD. Weekly alternating etoposide, methotrexate, and actinomycin/vincristine and cyclophosphamide chemotherapy for the treatment of CNS metastases of choriocarcinoma. Journal of Clinical Oncology. 1989;7(7):900-3. [DOI:10.1200/JCO.1989.7.7.900] [PMID]
9. Park SH, Park A, Kim JY, Kwon JH, Koh SB. A case of non-gestational choriocarcinoma arising in the ovary of a postmenopausal woman. Journal of gynecologic oncology. 2009;20(3):192-4. [DOI:10.3802/jgo.2009.20.3.192] [PMID] [PMCID]
10. Rodríguez MEC, Lahera JF, Labajo HG, Pelillo JCV, de Serrano MNM, Sánchez-Girón JG. Choriocarcinoma of the Lung. Archivos de Bronconeumología ((English Edition)). 2009;45(3):157-9. [DOI:10.1016/S1579-2129(09)70794-3]
11. Han V, Kaye S. A Rare Case of Gestational Choriocarcinoma Presenting as Cornual Ectopic Pregnancy. Journal of Obstetrics and Gynaecology Canada. 2018;40(3):351-3. [DOI:10.1016/j.jogc.2017.08.009] [PMID]
12. Mangla M, Singla D, Kaur H, Sharma S. Unusual clinical presentations of choriocarcinoma: A systematic review of case reports. Taiwanese Journal of Obstetrics and Gynecology. 2017;56(1):1-8. [DOI:10.1016/j.tjog.2015.05.011] [PMID]
13. Paradinas F. Pathology and classification of trophoblastic tumours. Gynaecologic Oncology (Edited by: Coppleson M) Churchill Livingstone, London. 1992;2:1013-26.
14. Wang J, Wang R, Zhao J. Ruptured cerebral aneurysm from choriocarcinoma. Journal of Clinical Neuroscience. 2013;20(9):1324-6. [DOI:10.1016/j.jocn.2012.09.045] [PMID]
15. Toyama K, Tanaka T, Hirota T, Misu N, Mizuno K. A case report of neoplastic aneurysm due to metastatic choriocarcinoma. No shinkei geka Neurological surgery. 1986;14(3 Suppl):385-90.
16. Rocque BG, Başkaya MK. Spontaneous acute subdural hematoma as an initial presentation of choriocarcinoma: A case report. Journal of medical case reports. 2008;2(1):211. [DOI:10.1186/1752-1947-2-211] [PMID] [PMCID]
17. Daniel CN, Ango I, Nwobodo E. Choriocarcinoma with cerebral metastasis presenting as a stroke-like lesion. Sahel Medical Journal. 2015;18(5):16. [DOI:10.4103/1118-8561.149498]
18. Xiao C, Yang J, Zhao J, Ren T, Feng F, Wan X, et al. Management and prognosis of patients with brain metastasis from gestational trophoblastic neoplasia: a 24-year experience in Peking :union: medical college hospital. BMC cancer. 2015;15(1):318. [DOI:10.1186/s12885-015-1325-7] [PMID] [PMCID]
19. Hiramatsu Y, Masuyama H, Ishida M, Murakami K, Sakurai M. Term delivery choriocarcinoma patient with brain and lung metastases successfully treated by etoposide, methotrexate, actomycin D, cyclophosphamide and vincristine (EMA-CO) chemotherapy. Acta medica Okayama. 2005;59(5):235.
20. Frost AS, Sherman JH, Rezaei K, Aron A, Lopez-Acevedo M. Choriocarcinoma with brain, lung and vaginal metastases successfully treated without brain radiation or intrathecal chemotherapy: A case report. Gynecologic oncology reports. 2017;20:97. [DOI:10.1016/j.gore.2017.03.014] [PMID] [PMCID]

Add your comments about this article : Your username or Email:
CAPTCHA

Send email to the article author


© 2021 All Rights Reserved | Journal of Obstetrics, Gynecology and Cancer Research (JOGCR)

Designed & Developed by : Yektaweb | Piblisher: Farname Inc.