Huang Hui-Qiong, Gong Feng-Ming, Yin Ru-Tie, Lin Xiao-Juan
Gynecological Oncology of Biotherapy Laboratory, Department of Gynecology and Obstetrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
World J Clin Cases. 2021 Oct 26;9(30):9174-9181. doi: 10.12998/wjcc.v9.i30.9174.
Choriocarcinoma is a subtype of gestational trophoblastic disease, gestational trophoblastic neoplasia. Patients with brain metastasis are rare and information on the optimal treatment and patient outcome is limited. In order to improve the prognosis of this disease, accurate and timely treatments are very important for the patient of brain metastasis by choriocarcinoma.
A 17-year-old unmarried girl was misdiagnosed with a cerebral hemangioma with intracranial hemorrhage in a local hospital after presentation with severe head pain. She underwent craniotomy three times for treatment. The pathological results of posterior intracranial hematoma showed choriocarcinoma, and the patient was diagnosed as choriocarcinoma (21 points in stage IV). After uterine artery embolization, etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine chemotherapy for 7 cycles, and whole brain radiotherapy, the patient achieved remission. She has been followed for 2 years with no signs of tumor recurrence.
For female patients of childbearing age with an intracranial hematoma, the possibility of brain metastasis by choriocarcinoma should be considered. It is necessary to obtain a detailed history, including menstruation, beginning age of first sex, contraception, The level of β-human chorionic gonadotropin should be tested at the beginning, and a stratified treatment should be administered according to the International Federation of Gynecology and Obstetrics staging and World Health Organization prognostic scoring systems.
绒毛膜癌是妊娠滋养细胞疾病、妊娠滋养细胞肿瘤的一种亚型。脑转移患者较为罕见,关于最佳治疗方法及患者预后的信息有限。为改善该疾病的预后,准确及时的治疗对于绒毛膜癌脑转移患者非常重要。
一名17岁未婚女孩因剧烈头痛就诊于当地医院,被误诊为脑血管瘤伴颅内出血。她接受了3次开颅手术治疗。颅内后血肿的病理结果显示为绒毛膜癌,患者被诊断为绒毛膜癌(IV期,21分)。经子宫动脉栓塞、依托泊苷、甲氨蝶呤、放线菌素D、环磷酰胺和长春新碱化疗7个周期以及全脑放疗后,患者病情缓解。随访2年,无肿瘤复发迹象。
对于有颅内血肿的育龄期女性患者,应考虑绒毛膜癌脑转移的可能性。有必要详细询问病史,包括月经情况、首次性行为开始年龄、避孕情况等。初始时应检测β-人绒毛膜促性腺激素水平,并根据国际妇产科联盟分期和世界卫生组织预后评分系统进行分层治疗。