Maestá Izildinha, Leite Fábio Vicente, Michelin Odair Carlito, Rogatto Silvia Regina
Trophoblastic Diseases Center, Department of Gynecology, Botucatu Medical School, São Paulo State University/UNESP, Botucatu, São Paulo, Brazil.
J Reprod Med. 2010 Jul-Aug;55(7-8):311-6.
Primary pulmonary choriocarcinoma (PPC) is rare and frequently leads to death.
Two young patients presented with previous molar pregnancy and spontaneous serum human chorionic gonadotropin (hCG) normalization. Patient 1 was referred to our center after partial response to chemotherapy. Pulmonary lobectomy was performed, and hCG rapidly declined. During further chemotherapy, liver metastasis was detected by positron emission tomography. Right hepatectomy was performed, and hCG declined for 28 days, but increased again despite chemotherapy. This patient died from hepatic failure 3 years after diagnosis. Patient 2 presented with persistently high hCG, though the affected organ was not identified. Chemotherapy was unsuccessful. Patient reevaluation showed an isolated pulmonary mass. Pulmonary lobectomy was performed; 2 weeks later, hCG was normal and consolidation with 2 cycles of chemotherapy was administered. The patient has been in remission for 24 months. PPC was confirmed by histopathology and immunohistochemistry in both cases. Gestational origin of the tumor was confirmed by molecular genetic analysis (polymorphic microsatellite markers).
The possibility of choriocarcinoma cannot be overlooked in young women with an isolated pulmonary mass. Early diagnosis, prompt chemotherapy, and surgical resection in a specialized center improves the prognosis.
原发性肺绒毛膜癌（PPC）罕见且常导致死亡。
两名年轻患者既往有葡萄胎妊娠史且血清人绒毛膜促性腺激素（hCG）自发恢复正常。患者1在化疗部分缓解后转诊至我院。行肺叶切除术，hCG迅速下降。在后续化疗期间，正电子发射断层扫描检测到肝转移。行右肝切除术，hCG下降28天，但尽管继续化疗仍再次升高。该患者在诊断后3年死于肝衰竭。患者2的hCG持续升高，尽管未明确受累器官。化疗无效。重新评估发现孤立性肺肿块。行肺叶切除术；2周后，hCG正常，给予2个周期化疗巩固治疗。该患者已缓解24个月。两例均经组织病理学和免疫组化确诊为PPC。通过分子遗传学分析（多态性微卫星标记）证实肿瘤起源于妊娠。
孤立性肺肿块的年轻女性不能忽视绒毛膜癌的可能性。在专业中心进行早期诊断、及时化疗和手术切除可改善预后。
