Kumar Molly, McArthur Seamus
Department of Obstetrics and Gynaecology, Gosford Hospital, Australia.
Case Rep Womens Health. 2020 Jan 30;26:e00180. doi: 10.1016/j.crwh.2020.e00180. eCollection 2020 Apr.
Choriocarcinoma is a rare, invasive, gestational trophoblastic disease that secretes high levels of beta human chorionic gonadotropin (BhCG) and is thought to affect 1 in 40,000 pregnancies. We present a rare case of metastatic choriocarcinoma.
A 47-year-old woman presented with shortness of breath, anemia and an elevated serum BhCG level. Her most recent known pregnancy was 12 years previously. Following investigation, she was found to have FIGO stage IV choriocarcinoma with brain metastasis, despite having not experienced any abnormal vaginal bleeding. She was treated with chemotherapy; her treatment was complicated by neutropenic sepsis and a visceral perforation. The patient went into remission and received long-term follow-up.
It is unclear in this case whether the disease occurred following a pregnancy 12 years previously and was never detected or whether it was due to a recent unknown pregnancy or a non-gestational cause. Increased awareness of this condition will allow timely diagnosis, prompt management and improved prognosis. Following diagnosis, determination of BhCG levels is essential for monitoring and guiding treatment and a multidisciplinary approach should be taken towards care.
绒毛膜癌是一种罕见的、侵袭性的妊娠滋养细胞疾病，可分泌高水平的β-人绒毛膜促性腺激素（BhCG），据认为每40000次妊娠中有1例会受其影响。我们报告一例罕见的转移性绒毛膜癌病例。
一名47岁女性因呼吸急促、贫血和血清BhCG水平升高就诊。她最后一次已知妊娠是在12年前。经过检查，尽管她没有出现任何异常阴道出血，但被发现患有国际妇产科联盟（FIGO）IV期绒毛膜癌并伴有脑转移。她接受了化疗；治疗过程中出现了中性粒细胞减少性败血症和内脏穿孔等并发症。患者病情缓解并接受了长期随访。
在这个病例中，尚不清楚该疾病是发生在12年前的一次妊娠后但从未被发现，还是由于近期未知的妊娠或非妊娠原因所致。提高对这种疾病的认识将有助于及时诊断、迅速治疗并改善预后。诊断后，测定BhCG水平对于监测和指导治疗至关重要，并且应采取多学科方法进行护理。
