RESUMO
Choriocarcinoma syndrome is a life-threatening lysis syndrome caused by blood vessel rupture and subsequent tumor bleeding. We describe a case of pretreatment choriocarcinoma syndrome that developed in a 27-year-old man. He underwent a high orchiectomy at a local hospital and was diagnosed with metastatic testicular tumor given the high serum human chorionic gonadotropin levels (943,601 mIU/mL). Thus, he was referred to our institution. Although he had bulky lung metastases and alveolar bleeding, we were able to administer full-dose chemotherapy with etoposide and cisplatin. On day 3 of chemotherapy, he presented with severe hypoxia and worsening of alveolar bleeding. Thus, he underwent tracheal intubation at the Intensive Care Unit. Full-dose chemotherapy was continued, and the patient was extubated upon improvement. He is currently alive and continuing treatment at another hospital.
Assuntos
Coriocarcinoma/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Orquiectomia/efeitos adversos , Neoplasias Testiculares/tratamento farmacológico , Vasos Sanguíneos/patologia , Coriocarcinoma/diagnóstico por imagem , Coriocarcinoma/patologia , Coriocarcinoma/cirurgia , Gonadotropina Coriônica/sangue , Cisplatino/administração & dosagem , Etoposídeo/administração & dosagem , Hemorragia , Humanos , Quimioterapia de Indução , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Masculino , Neoplasias Testiculares/patologia , Neoplasias Testiculares/secundário , Neoplasias Testiculares/cirurgia , Procedimentos Cirúrgicos VascularesRESUMO
A 22-year-old woman was diagnosed with a duplicated renal collecting system with hydronephrosis and parenchymal loss in the upper pole of the left kidney. She underwent laparoscopic left upper-pole nephrectomy. Although a complex hilar vascular anatomy was identified during the operation, preoperative three-dimensional computed tomographic reconstruction using a three-dimensional image analysis device (Synapse Vincent; Fuji Medical Systems, Tokyo, Japan) greatly helped to accurately identify the anatomical renal hilum. For further detail, virtual partial nephrectomy analysis using a Voronoi decomposition was used to visualize the area supplied by a selected arterial branch including the atrophic cleavage line. We controlled the bleeding with selective clamping and safely carried out upper-pole heminephrectomy according to the preoperative plan.
