Journal of Datta Meghe Institute of Medical Sciences University

CASE REPORT
Year
: 2021  |  Volume : 16  |  Issue : 2  |  Page : 386--387

Surgical and medical management of choriocarcinoma


Ashishkumar Bhatt 
 Department of Obstetric and Gyanacology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (M), Wardha, Maharashtra, India

Correspondence Address:
Dr. Ashishkumar Bhatt
Room No. 8, Meghe Height Building No. 2, Datta Meghe Medical College Campus, Sawangi, Wardha - 442 001, Maharashtra
India

Abstract

Gestational choriocarcinoma is rare but highly malignant tumor of trophoblastic tissue. Although choriocarcinoma has a greater tendency to metastasize to various sites, it also has a very high cure rate. Our study emphasizes the case of choriocarcinoma developed after molar pregnancy which was treated successfully with the combination of surgery and chemotherapy.



How to cite this article:
Bhatt A. Surgical and medical management of choriocarcinoma.J Datta Meghe Inst Med Sci Univ 2021;16:386-387


How to cite this URL:
Bhatt A. Surgical and medical management of choriocarcinoma. J Datta Meghe Inst Med Sci Univ [serial online] 2021 [cited 2022 Jun 30 ];16:386-387
Available from: http://www.journaldmims.com/text.asp?2021/16/2/386/328450


Full Text



 Introduction



Choriocarcinoma is a rare form of malignant tumor of the trophoblastic tissue. Its incidence is highly uncommon constituting about 0.04% of the gestational trophoblastic disease (GTD)[1] but presents as highly aggressive malignant tumor. The risk of GTD is higher in older and multiparous women and in very young women.[2]

Gestational choriocarcinoma may follow any type of pregnancy and mostly is associated with coincident or antecedent pregnancy. It may result from abortion, full-term pregnancy, and molar pregnancy. The majority arise following a nonmolar pregnancy. Here is a case report of a young woman of choriocarcinoma presented after consecutive third abortion managed with surgery and chemotherapy.

 Case Report



A 21-year-old woman, gravida 3 with two abortions was admitted for bleeding per vaginum with 9 weeks of amenorrhea. Per abdominal examination showed a soft abdomen with no guarding, tenderness, or rigidity. Per speculum examination, the cervix was congested with minimal bleed and per vaginum examination suggestive of the uterine size of 8 weeks size and fornices were free. Per speculum examination revealed bleeding through os. The patient's ultrasound examination was suggestive of incomplete abortion. Sonography and Doppler of the pelvic region showed bulky uterus with fundal endometrial hyperechoic rounded lesion measuring 5.7 cm × 4.2 cm with significant vascularity. A significant thinning if the perifocal posterior myometrial wall extending to the subserosal peripheral plane was noted [Figure 1]. The adjacent parametrium appeared normal with the anterior wall relatively well maintained. Thinning of the lower endometrium was noted. There was no evidence of free fluid in the pelvis or adnexal mass. Both the ovaries appeared normal in size, shape, and follicular pattern. The pelvic sonography was suggestive of vesicular mole invading the posterior wall extending peripheral myometrial zone. The findings on the magnetic resonance imaging revealed enlarged, partially retroverted uterus with the large lesion in the fundal cavity appeared as an invasive mole invading fundal as well as the posterior wall of the uterus. No lymph node involvement was seen. Human chorionic gonadotropin (βhCG) titer was 110,000 mUI/ml. Imaging investigation of the chest, abdomen, and pelvis did not show any metastasis. These findings were consistent with molar pregnancy with no metastasis to adjacent organs or pelvic lymph nodes. Dilatation and curettage were done and the product of conception was sent for histopathology, the sections of which showed a malignant tumor composed of cluster of atypical cytotrophoblast separated by streaming sheets of syncytiotrophoblast, many mitotic figures, and cytologic atypia. Extensive areas of necrosis and hemorrhage were also seen. There was no lymphovascular emboli noted. These findings were consistent with choriocarcinoma. The patient was kept under observation and serial βhCG monitoring done, which reduced to 39,400 mIU/ml after 15 days of curettage. After the medical oncologist's consultation, EMACO regimen was started as a prophylactic treatment as the βHCG levels were high. After 1 cycle of treatment, βHCG decreased to 11,460 mUI/ml. The posttreatment hemoglobin was 8.3 g/dl as compared to her pretreatment hemoglobin of 10.2 g/dl, injection granulocyte colony-stimulating factor was given.{Figure 1}

 Discussion



Choriocarcinoma also known as trophoblastic tumor is a rare form of cancer associated with molar pregnancy, ectopic pregnancy, miscarriage, or abortion. Although rare, it can rapidly invade and metastasize to other sites.

Our case presented with bleeding per vaginum clinically, molar pregnancy on ultrasound examination, high βHCG titer levels and histopathological findings of clusters of atypical cytotrophoblast separated by streaming sheets of syncytiotrophoblast, many mitotic figures, and cytologic atypia which are classic features of choriocarcinoma.[3]

Ultrasound has become the standard protocol in aiding in the diagnosis of suspected choriocarcinoma[4] which are further co-related with high titers of βHCG. Chest X-ray was taken to note any metastasis.

The main management for complete or partial moles is through surgical uterine evacuation (dilation and evacuation, suction curettage).[5] Hysterectomy can be a considerable option for patients who have completed childbearing.[6] As the patient in our case was young and nulliparous, it was necessary to preserve her future fertility, hence hysterectomy was contraindicated. Choriocarcinoma is very sensitive to chemotherapy and recent data from Charing Cross Hospital shows the EMACO regimen to be an effective treatment.[7] Therefore, a cycle of EMACO regimen was given to the patient as the βHCG levels remained elevated after dilatation and curettage. The patient recovered well with decrease in βHCG levels after chemotherapy.

 Conclusions



Our case report highlights the possibility of choriocarcinoma after any abortion. Early diagnosis with ultrasound and histopathological examination with timely surgical intervention and chemotherapy with EMACO, choriocarcinoma can be effectively treated. Early detection and treatment improves the outcome of choriocarcinoma.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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