Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL, USA.
Department of Wound Care and Hyperbaric Medicine, Southern Illinois Healthcare, Carbondale, IL, USA.
Am J Case Rep. 2022 Jun 18;23:e936451. doi: 10.12659/AJCR.936451.
BACKGROUND Despite the tendency to metastasize widely, Gestational Trophoblastic Neoplasia (GTN) is one of the most curable solid tumors with chemotherapy. CASE REPORT A 41-year-old female, G4P2A2, presented with a slowly growing lump on the left side of the scalp associated with a headache. The patient had intermittent, sharp left eye pain which radiated to the side of her face, photophobia, early morning blurring of vision, and nausea. Palpation over scalp lesion produced deep retro-orbital pain and pain was exacerbated with bending over. An ophthalmological evaluation was unremarkable. Ultrasonography (USG) of the left scalp showed an intramuscular mass superficial to the left frontal bone. During excision biopsy, the mass was found to be invading the frontal bone. Histopathology showed a metastatic trophoblastic tumor with mixed features of choriocarcinoma and placental site trophoblastic tumor. A pregnancy test was positive, the beta HCG level was elevated but USG did not show intrauterine pregnancy. CT head demonstrated an intracranial, dural-based mass that extended against the brain but did not breach the pial membrane. CT chest, abdomen, pelvis, and PET scan showed no evidence of metastatic disease. She was successfully treated with resection of the transcranial lesion followed by aggressive chemotherapy - Etoposide, Methotrexate, Actinomycin-D, Vincristine, and Cyclophosphamide. CONCLUSIONS This was an unusual case of GTN due to its primary presentation as skin metastasis, without any lung metastasis and no identifiable primary lesion. It is also very unusual to see a combination of choriocarcinoma and placental site trophoblastic tumor cells in the same tumor mass.
尽管Gestational Trophoblastic Neoplasia（GTN）有广泛转移的倾向，但它是化疗最可治愈的实体肿瘤之一。
一名 41 岁女性，G4P2A2，表现为左侧头皮上缓慢生长的肿块，伴有头痛。患者间歇性出现左眼剧烈疼痛，放射至面部，畏光，清晨视力模糊，恶心。头皮病变触诊产生深部眶后疼痛，弯腰时疼痛加剧。眼科评估无异常。左头皮超声检查显示左额骨前的肌肉内肿块。在切除活检过程中，发现肿块侵犯了额骨。组织病理学显示混合有绒癌和胎盘部位滋养细胞肿瘤特征的转移性滋养细胞肿瘤。妊娠试验阳性，β-HCG 水平升高，但超声未显示宫内妊娠。头部 CT 显示颅内硬膜基肿块，延伸至大脑，但未突破脑膜。胸部、腹部、骨盆 CT 和 PET 扫描均未显示转移病灶。她成功地接受了颅外病变切除术，随后进行了强化化疗-依托泊苷、甲氨蝶呤、放线菌素-D、长春新碱和环磷酰胺。
这是一个不寻常的 GTN 病例，因为其最初表现为皮肤转移，没有任何肺部转移，也没有明确的原发性病变。在同一肿瘤中同时看到绒癌和胎盘部位滋养细胞肿瘤细胞也非常罕见。
