Résumé
Choriocarcinoma associated with a normal pregnancy is rare. Futhermore, choriocarcinoma coexistent with a viable pregnancy is even rarer and associated with a greater risk of hepatic and cerebral involvement. So timely diagnosis of the disease is important for successful treatment and aggressive diagnostic procedures may therefore warranted. The patient should be treated with primary intensive combination chemotherapy(EMA-CO) and the selective use of irradiation and surgical therapy. We experienced a case of metastatic choriocarcinoma of lung and kidney following preterm delivery at 34th week of pregnancy and so present it with brief review of literature.
Sujets)
Femelle , Humains , Grossesse , Grossesse , Choriocarcinome , Diagnostic , Rein , PoumonRésumé
Six cases of metastatic choriocarcinoma without a primary growth in the uterus are presented. Three cases followed early abortion, two cases after term pregnancy, and one case after hydatidiform moleTheories as to the occurrence of metastatic choriocarcinoma without primary lesion in the uterus are presentedThe normal chorionic cell has no inherent property of malignancy. It has an invasive property, it is true, but only to a limited extent for the implantation and nourishment of the fertilized ovum. When detached from the ovum and carried away by the circulation, the normal chorionic cell in time disintegrates and is eventually absorbed. When the fetus dies or is expelled, the normal chorionic cell degenerates and is eventually absorbed or discharged from the uterine cavityChorionic malignancy results from the abnormal chorionic cell produced by a defective gene. It has an inherent property of malignancy which may be potential (where malignancy is manifested after some time) or actual. The abnormal chorionic cell occurs only in certain specific cells among myriads of normal chorionic cells of a given pregnancy. The presence of the actually malignant cell in a given pregnancy explains the co-existence of choriocarcinoma and normal pregnancy with a living fetus and normal placentaThere are different degrees of malignancy. The highly malignant type manifest itself earlier than that of lesser malignancy, and it is most resistant to any form of treatment.(summary)
Sujets)
UtérusRésumé
Choriocarcinoma associated with a normal pregnancy is rare. Especially, choriocarcinoma coexistent with a viable pregnancy is even rarer and commonly presents with widespread metastatic disease. We experienced a patient at 34th week of pregnancy with dyspnea and sputum production due to pulmonary metastasis of choriocarcinoma. The serum B-hCG level was extremely elevated and the placenta had multifocal choriocarcinoma. After vaginal delivery, the patient was successfully treated with combination chemotherapy (EMA-CO). The patient is receiving follow up with monthly measurement of hCG values. We report one case of metastatic choriocarcinoma with viable pregnancy with review of literature.
Sujets)
Femelle , Humains , Grossesse , Grossesse , Choriocarcinome , Association de médicaments , Dyspnée , Études de suivi , Métastase tumorale , Placenta , ExpectorationRésumé
Among metastatic brain tumors, choriocarcinoma has a highly malignant nature and because of the vascular invasion of trophoblastic cells,tends to hemorrhage. Surgery is recommended for patients with a single cerebral metastasis, or for those who fail to respond to chemotherapy. We encountered two unusual cases in which early rebleeding occurred after the total removal of a hematoma arising from metastatic choriocarcinoma, and confirmed by post-operative tissue biopsy.
Sujets)
Femelle , Humains , Grossesse , Biopsie , Tumeurs du cerveau , Choriocarcinome , Traitement médicamenteux , Hématome , Hémorragie , Métastase tumorale , TrophoblastesRésumé
The authors report 2 cases of metastatic choriocarcinoma associated with intracranial hemorrhage. One of them had intracranial hemorrhage on the right frontal lobe and the other one developed intracranial hemorrhage and enhancing mass on the parietal lobe revealed by admission brain CT. They had rebled intracranially 2 and 3 times, respectively. Even though the patients had received intracranial decompressive operations, they eventually died of intracranial rebleeding or hemothorax, respectively. These tumors generally occur in women of childbearing age and commonly produce signs and symptoms of subarachnoid hemorrhage, intracerebral hemorrhage, or brain tumor. Metastatic choriocarcinoma of the brain is a curable lesion. Cure is geerally achieved by extirpation of the tumor, chemotherapy, and irradiation of the site of the cerebral metastasis. The two cases in this report have ben unsuccessful in their management.