Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran.
Clinical Research Development Unit (CRDU), 5azar Hospital, Golestan University of Medical Sciences, Azar 6th, 5 Azar St, P.O. Box 49189-36316, Gorgan, Iran.
J Med Case Rep. 2024 Mar 30;18(1):132. doi: 10.1186/s13256-024-04464-9.
Choriocarcinoma is a rare and highly malignant form of gestational trophoblastic disease that may develop following pregnancy, abortion, or a hydatiform mole. Renal metastatic involvement by post molar choriocarcinoma is even rarer. In this case report, we describe a unique case of post molar choriocarcinoma with a solitary renal metastasis in the absence of a primary uterine tumor and metastases in other sites, which presented with urological symptoms and spontaneous renal hemorrhage.
A 41-year-old Persian woman with history of complete hydatiform mole presented with severe flank pain, nausea, vomiting, gross hematuria, and vaginal bleeding. Laboratory tests demonstrated a serum beta human chorionic gonadotropin hormone level of 60,000 mIU/mL. Imaging studies showed a lesion at the lower pole of the left kidney with active bleeding surrounded by hematoma, as well as an empty uterine cavity. Additionally, bilateral pleural effusion was detected without any lesion within the lungs. Subsequently, the patient underwent laparotomy, partial nephrectomy, and left para-ovarian cystectomy. Endometrial curettage was also carried out. The histopathology report revealed choriocarcinoma renal metastasis with high expression of beta human chorionic gonadotropin, cytokeratin 7, and Ki 67. Moreover, there were no malignant cells in the endometrial curettage specimens, and a corpus luteum cyst was found within the para-ovarian cyst. Further investigations revealed that the pleural effusion was free of malignant cells, and there was no evidence of metastatic lesions in the brain. As a result, the patient was referred to the oncology department to receive chemotherapy, and the beta human chorionic gonadotropin levels dropped to 5 mIU/mL after receiving courses of a standard regimen of etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine/oncovin over 3 weeks. Finally, monthly measurements of beta human chorionic gonadotropin levels for 6 months indicated that levels have constantly remained within normal ranges, showing no evidence of recurrence or new metastasis.
Urological symptoms such as hematuria or spontaneous renal hemorrhage might be the only presentation of post molar choriocarcinoma with renal involvement. Thus, it can be beneficial to measure serum beta human chorionic gonadotropin levels among females of childbearing age who present with unexplained urological symptoms, especially if there is a history of prior hydatiform mole.
绒癌是一种罕见且高度恶性的妊娠滋养细胞疾病，可继发于妊娠、流产或葡萄胎之后。绒癌的肾脏转移更为罕见。本病例报告描述了一例罕见的绒癌病例，该患者无原发性子宫肿瘤及其他部位转移，仅表现为肾脏转移，且合并单侧肾脏孤立性转移灶，同时伴有泌尿系统症状和自发性肾出血。
一名 41 岁的波斯女性，因完全性葡萄胎就诊，主要症状为严重腰痛、恶心、呕吐、肉眼血尿和阴道出血。实验室检查显示血清β人绒毛膜促性腺激素（β-HCG）水平为 60000mIU/ml。影像学检查显示左肾下极有一个病灶，病灶内有活动性出血，周围有血肿，且宫腔空虚。此外，双侧胸腔有积液，但肺部未见病灶。随后，患者接受了剖腹探查术、左肾部分切除术和左卵巢旁囊肿切除术。同时还进行了子宫内膜刮宫术。组织病理学报告显示为绒癌肾转移，β-HCG、细胞角蛋白 7（CK7）和 Ki-67 高表达。此外，子宫内膜刮宫标本中未见恶性细胞，卵巢旁囊肿内可见黄体囊肿。进一步检查显示胸腔积液中无恶性细胞，脑部无转移病灶。因此，患者被转至肿瘤科接受化疗。接受依托泊苷、甲氨蝶呤、放线菌素 D、环磷酰胺和长春新碱/长春花碱标准方案 3 周后，β-HCG 水平下降至 5mIU/ml。最后，6 个月内每月测量β-HCG 水平，结果均在正常范围内，未发现复发或新的转移。
泌尿系统症状，如血尿或自发性肾出血，可能是绒癌合并肾脏转移的唯一表现。因此，对于不明原因泌尿系统症状且有既往葡萄胎病史的育龄期女性，检测血清β-HCG 水平可能会有所帮助。
