Guo Na, Yin Rutie, Li Qingli, Song Liang, Wang Danqing
The Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University, Chengdu, Sichuan, China.
Key laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China.
Menopause. 2018 Feb;25(2):239-241. doi: 10.1097/GME.0000000000000968.
Choriocarcinoma is rare in postmenopausal women, and an early diagnosis contributes to a potential cure.
We report a rare case of a postmenopausal woman with choriocarcinoma. The 61-year-old patient presented with irregular vaginal bleeding, 11 years after menopause and 30 years after the birth of the last child.
Radiological investigation found a 3-cm mass on the lower left part of the vaginal wall, and also bilateral lung nodules. Gynecological examination found 3-4 cm blue and purple nodules in the lower left part of the vaginal wall. Her serum CA125 and serum β-hCG levels were 10.2 and 9273.9 mIU/mL, respectively. The early diagnosis was a choriocarcinoma, and combination chemotherapy (etoposide, kengshengmycin, methotrexate, leucovorin, vincristine, and cyclophosphamide [EMACO]) was administered. After the sixth chemotherapy session, her serum β-hCG level was <2 mIU/mL, and two additional consolidation chemotherapy sessions were performed. She achieved serological remission, but 4 months after completion of the chemotherapy, a rise in serum β-hCG level was observed. Therefore, she was subjected to a second treatment with EMACO and fluorouracil (5-Fu) local injection chemotherapy. After nine chemotherapy sessions and three local 5-Fu injections, she showed a normal β-hCG level, with negative radiological results, and negative pigmentation in the lower left part of the vaginal wall. After a 4-year follow-up period, no local recurrence or distant metastases was found.
This patient has shown a mild response to chemotherapy when compared with patients in reproductive age, and the combination of standard chemotherapy with local injection chemotherapy may be helpful for treating similar clinical cases.
绒毛膜癌在绝经后女性中较为罕见，早期诊断有助于实现潜在治愈。
我们报告一例绝经后女性绒毛膜癌的罕见病例。该61岁患者在绝经11年后、最后一次分娩30年后出现不规则阴道出血。
影像学检查发现阴道壁左下部有一个3厘米的肿块，同时还有双侧肺结节。妇科检查发现阴道壁左下部有3 - 4厘米的蓝紫色结节。她的血清CA125和血清β - hCG水平分别为10.2和9273.9 mIU/mL。早期诊断为绒毛膜癌，并给予联合化疗（依托泊苷、更生霉素、甲氨蝶呤、亚叶酸钙、长春新碱和环磷酰胺[EMACO]）。在第六次化疗疗程后，她的血清β - hCG水平<2 mIU/mL，并进行了另外两个巩固化疗疗程。她实现了血清学缓解，但化疗完成4个月后，血清β - hCG水平出现上升。因此，她接受了第二次EMACO和氟尿嘧啶（5 - Fu）局部注射化疗。经过九个化疗疗程和三次局部5 - Fu注射后，她的β - hCG水平恢复正常，影像学检查结果为阴性，阴道壁左下部色素沉着阴性。经过4年的随访期，未发现局部复发或远处转移。
与育龄期患者相比，该患者对化疗的反应较轻，标准化疗与局部注射化疗联合可能有助于治疗类似临床病例。
