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GYNAECOLOGY AND OBSTETRICS IMAGING Table of Contents   
Year : 2006  |  Volume : 16  |  Issue : 4  |  Page : 801-803
Case report :Case of metastatic choricarcinoma,unusual metastatis


Dept of Radiology, Lilavati Hospital, Bandra (W), Mumbai - 50, India

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Date of Submission22-Jun-2005
Date of Acceptance10-Aug-2006
 

Keywords: metastatic choricarcinoma, metastasis, spleen $ liver.

How to cite this article:
Nimje K, Deore L, Deshmukh M, Pai B, Ruparel M, Kulkarni M. Case report :Case of metastatic choricarcinoma,unusual metastatis. Indian J Radiol Imaging 2006;16:801-3

How to cite this URL:
Nimje K, Deore L, Deshmukh M, Pai B, Ruparel M, Kulkarni M. Case report :Case of metastatic choricarcinoma,unusual metastatis. Indian J Radiol Imaging [serial online] 2006 [cited 2019 Aug 24];16:801-3. Available from: http://www.ijri.org/text.asp?2006/16/4/801/32352
Metastatic choricarcinoma are rare, highly malignant trophoblastic tumor of placenta.

The majority of metastases affect the lung (75%), vagina (50%), ovaries, brain $ ureter.

Hepatic involvement is not common, affecting only (10%) of patients, occurring late in the course of the disease .

Rare sites include gastrointestinal tract, spleen, and kidney. [1]

We present an incidence of women with a histopathologically proven metastatic choriocarcinoma, with metastasis to the lung, liver, spleen and lymph nodes.


   Case report Top


34 yrs old women presented with h/o preterm delivery 8 month before,

C/o swelling over back 1 month after delivery,

HP-metastatic choriocarcinoma

She started on chemotherapy 1 st dose.

Few days later she started getting hemoptysis, abdominal pain, distension

vomiting and weight loss

Lab Inv. Elevated levels of beta hCG,

Hb: 5.4%

The patient was reffered to us for imaging studies.

USG of the abdomen revealed multiple, large, ill- defined, liver lesions of variable sizes, splenic lesions and ascitis.

CT of the abdomen showed hepatomegaly with multiple large, illdefined heterogeneously enhancing liver lesions. peripheraly enhancing splenic lesions .mild ascitis.

retroperitoneal lymph node enlargement, diffuse nodular lung lesions.

Multiple, heterogeneously enhancing lesions in the liver, spleen and retroperitoneal lymph nodes.

Multiple pleural based nodules with patchy consolidation.

5 days later developed gross ascitis, on USG and about 1500cc of hemorrhagic fluid was evacuated from peritoneum

Hb was continuously decreasing .

She died after 16 days after admission to hospital.


   Discussion Top


Gestational trophoblastic disease, (GTD), a proliferative disease of the trophoblastic cells of placenta .

It has various clinical manifestations, ranging from the relatively benign hydatidiform mole to the more malignant invasive mole to metastatic choriocarcinoma.

The beta-subunit of human chorionic gonadotrophin (beta-hCG) serves as a useful marker of disease aggressiveness and progression.[2]

Testicular chorioca.in males occur in 4% of cases [3]

Choriocarcinoma is a rare ,highly malignant trophoblastic tumor (1:13,000 and 1:50,000 pregnancies [4].

Approx.50% occur after a molar pregnancy, 25% after a normal pregnancy, and 24% after spontaneous abortion.

01% after Ectopic pregnancy [1],[5]

Primary placental choriocarcinoma can easily be missed due to their small size.

Highly vascularized tumor and because of the affinity of trophoblasts for blood vessels, shows rapid hematogeneous metastasis

Causes:
" pregnancy
" genetic
" multiparity
" ectopic pregnancy
" abortion
" hydantiform mole
" advanced maternal age

The majority of metastases affect the lung (75%), vagina (50%), ovaries, brain $ ureter.

Hepatic involvement is not common, affecting only (10%) of patients, and occurring late in the course of the disease. [1].

Rare sites include gastrointestinal tract, spleen, and kidney.

Regression of the primary tumor after it has metastasized is not uncommon, and one-third of cases manifest as complications of metastatic disease [6],[7].

Complications:
" Tumoral hemorrhage, spontaneous or post-biopsy .
" Hemoperitoneum , intracerebral haemorrhage,malignanant effusion
" Severe anemia


   Imaging Top


The angiographic findings:
" Hypervascularity, arteriovenous shunt, oncocytic or fusiform aneurysm, and thrombosis (in CNS and renal mets).[8],[9],[10]
" liver metastasis are seen as hypervascular mass with aneurysmal dilatation of the peripheral end of the hepatic arteries (grape-like appearance) at the arterial phase, and persistent vascular lakes at the venous phase


   CT imaging Top

" Pulmonary mets: diffuse micronodular shadows resembling miliary disease to multiple large well defined masses (cannon balls).
" Liver/Spleen mets: Multiple, Heterogeneously enhancing hepatic masses of variable sizes. D/D:mets from HCC/ splenic angiosarcoma, multifocal HCC.

MRI imaging
" Magnetic resonance imaging (MRI) may be useful particularly for evaluating the cerebellum and brain stem, which are sites of occult metastases. [11]
" MR may demonstrate infarction, hemorrhage of various ages, dilated blood vessels, and/or aneurysms.

D/D for ICH mets from melanoma ,CA bronchus ,RCC [12],[13]
" The presence of intrauterine or ovarian disease also may be detected by MRI of the pelvis.


   Ultrasonography Top

" For demonstration of hydantiform and invasive mole
" Types of Hydantiform Mole :

Complete Mole (70%) involves the entire placenta, lacks fetus

Partial mole (30%): involves the portion of the placenta, usually associated with fetus.
" USG findings: Hyper echoic uterine mass filled with innumerable tiny cysts(hydropic villi)

Treatment and prognosis [14]:
" Choriocarcinoma is known to be sensitive to chemotherapy (80%cure rate) provided the appropriate therapy is given early in the course of the disease.
" Remission rates of 70% for patients with metastatic disease.
" The key factors for successful outcome is early diagnosis and vigorous therapy.
" Choriocarcinoma may recur ,usually within several months ,possibly as late as 3 years after treatment ends.

 
   References Top

1.Hillard AE, Allen RW, Beale G. Metastatic choriocarcinoma: correlation of MRI, CT, and angiography. South Med J 1993; 86:1299-1302  Back to cited text no. 1  [PUBMED]  
2.Medical oncology, June 2003, vol. 20, no. 2, pp. 189-194(6)   Back to cited text no. 2    
3.Bredael JJ, Vugrin D, Whitmore WF. Autopsy findings in 154 patients with germ cell tumors of the testis. Cancer 1982; 05:548-551.  Back to cited text no. 3    
4.Alveyn CG, Loehry CA. Hepatic metastases due to choriocarcinoma. Postgrad Med J 1988; 64:941-942  Back to cited text no. 4  [PUBMED]  
5.Green CL, Angtuaco TL, Shah HR, Parmley TH. Gestational trophoblastic disease: a spectrum of radiologic diagnosis. RadioGraphics 1996;16:1371-1384  Back to cited text no. 5  [PUBMED]  
6.Heatom GE, Matthews TH, Christopherson WM. Malignant trophoblastic tumors with massive hemorrhage presenting as liver primary: a report of two cases. Am J Surg Pathol 1986;10:342-347  Back to cited text no. 6    
7.Erb RE, Gibler WB. Massive hemoperitoneum following rupture of hepatic metastases from unsuspected choriocarcinoma. Am J Emerg Med 1989;7:196-198  Back to cited text no. 7  [PUBMED]  
8.Watanabe AS, Smoker WR. Computed tomography and angiographic findings in metastatic choriocarcinoma. J Comput Assist Tomogr 1989;13:319-322  Back to cited text no. 8  [PUBMED]  
9.Komeichi T, Igarashi K, Takigami M, et al. A case of metastatic choriocarcinoma associated with cerebral thrombosis and aneurysmal formation. No Shinkei Geka 1996;24:463-467  Back to cited text no. 9  [PUBMED]  
10.Yang DM, Yoon MH, Kim HS, Kim HS, Shin DB. Intrarenal pseudoaneurysms complicating renal choriocarcinoma metastases: treatment with coil embolization. Clin Imaging 2000; 24:217-220  Back to cited text no. 10  [PUBMED]  [FULLTEXT]
11.J Neurol Neurosurg Psychiatry 1998;65:939-941 ( December )  Back to cited text no. 11    
12.Mandybur TI. Intracranial hemorrhage caused by metastatic tumors. Neurology 1977;27:650-655  Back to cited text no. 12  [PUBMED]  
13.Graus F, Rogers LR, Posner JB. Cerebrovascular complications in patients with cancer. Medicine 1985;64:16-35.  Back to cited text no. 13  [PUBMED]  
14.Obstetrics and gynecology 1980;55:89-94,by the American Collage of Obstetrics and Gynecologist.   Back to cited text no. 14    

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Correspondence Address:
K Nimje
Dept of Radiology, Lilavati Hospital, Bandra (W), Mumbai - 50
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.32352

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    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6]

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