Bekele Fitsum Solomon, Beyene Andualem Deneke, Belete Dagnachew Tamrat, Moges Mulugeta Bekele, Gebregiorgis Bemnet Taye
Tikur Anbessa Specialized Hospital, Addis Ababa University, College of Health Sciences, School of Medicine, Ethiopia.
Tikur Anbessa Specialized Hospital, Addis Ababa University, College of Health Sciences, School of Medicine, Ethiopia.
Int J Surg Case Rep. 2024 Jun;119:109649. doi: 10.1016/j.ijscr.2024.109649. Epub 2024 Apr 24.
Choricocarcinoma is a highly malignant tumor. It metastasize commonly to the lungs. Metastasis to the kidney is uncommon, and bilateral metastasis is described rarely. Initial presentation with spontaneous bleeding of the renal metastatic tumor is scarce in the literatures. Here we present a case report of a choriocarcinoma patient with bilateral renal metastasis, presenting with spontaneous renal hemorrhage.
A 22 years old female presented to our emergency department with sudden onset of left flank pain. She has history of spontaneous abortion 02 years back with biopsy from the manual vacuum aspiration (MVA) showing molar pregnancy. Up on evaluation, patient was anemic. CT scan showed left renal bleeding tumor. Exploratory laparotomy and radical nephrectomy was done with the impression of bleeding renal cell carcinoma. The biopsy revealed choriocarcinoma. On her follow up, CT scan showed right renal and brain metastasis. She was given multi agent chemotherapy and her serum beta-hCG became undetectable after 01 year.
Choriocarcinoma can be gestational or nongestational. The commonest route of metastasis is hematogenous. Presenting symptoms of renal metastasis can be hematuria, pain or more commonly incidental finding during work up. Choriocarcinoma is highly chemo sensitive.
Bilateral renal metastatic choriocarcinoma is uncommon. Spontaneous renal hemorrhage as an initial presentation is even rare, and it can mimic a bleeding renal cell carcinoma. High index of suspicion is needed in a young women with recent history of spontaneous abortion.
绒毛膜癌是一种高度恶性的肿瘤。它通常转移至肺部。转移至肾脏并不常见，双侧转移则鲜有报道。文献中很少有肾转移性肿瘤以自发性出血为首发表现的情况。在此，我们报告一例绒毛膜癌患者发生双侧肾转移并出现自发性肾出血的病例。
一名22岁女性因突发左侧腰痛就诊于我院急诊科。她有2年前自然流产史，人工负压吸引术（MVA）活检显示为葡萄胎妊娠。经评估，患者贫血。CT扫描显示左肾有出血性肿瘤。行剖腹探查及根治性肾切除术，初步诊断为出血性肾细胞癌。活检显示为绒毛膜癌。随访时，CT扫描显示右肾及脑转移。给予多药联合化疗，1年后其血清β-hCG检测不到。
绒毛膜癌可分为妊娠性或非妊娠性。最常见的转移途径是血行转移。肾转移的表现症状可为血尿、疼痛，或更常见的是在检查过程中偶然发现。绒毛膜癌对化疗高度敏感。
双侧肾转移性绒毛膜癌并不常见。以自发性肾出血为首发表现的情况更为罕见，且可能类似出血性肾细胞癌。对于近期有自然流产史的年轻女性，需要高度怀疑。
