Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, University of Lampung/RSUD Abdul Moeloek, Bandar Lampung, 35141, Indonesia.
Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Jl. Kesehatan No. 1, Yogyakarta, 55281, Indonesia.
J Med Case Rep. 2024 Jul 15;18(1):323. doi: 10.1186/s13256-024-04664-3.
Diagnosing non-gestational uterine choriocarcinoma in children is challenging because of its rarity and nonspecific imaging findings. Herein, we report a case of non-gestational uterine choriocarcinoma in a child, which was unexpectedly found during exploratory laparotomy and confirmed by histopathological findings. However, the tumor did not respond to chemotherapy.
A 4-year-old Indonesian female patient was brought into the emergency unit with chief complaint of vaginal bleeding. She had suffered from vaginal spotting 4 months before being admitted to the hospital. Physical examination revealed a distended abdomen in the left lumbar region and a palpable fixed mass with a smooth surface. Abdominal computed tomography scans revealed a large mass (10 × 6 × 12 cm) with fluid density and calcification. Thus, we suspected left ovarian teratoma. The patient's luteinizing hormone, follicle-stimulating hormone, and lactate dehydrogenase levels were 25.2 mIU/ml, 0.1 mIU/ml, and 406 U/l, respectively. According to the clinical and radiological findings, we decided to perform an exploratory laparotomy and found a tumor originating from the uterus, not the ovarium. We did not observe liver nodules and any enlargement of abdominal lymph nodes. Subsequently, we performed hysterectomy. The histopathological findings supported the diagnosis of choriocarcinoma. The patient was discharged uneventfully on postoperative day 5. Thereafter, the patient underwent nine cycles of chemotherapy, including carboplatin (600 mg/m IV), etoposide (120 mg/m IV), and bleomycin (15 mg/m IV). However, on the basis of the clinical findings of a palpable mass and partial intestinal obstruction, the tumor relapsed soon after the ninth cycle of chemotherapy. Currently, the patient is undergoing chemotherapy again.
Although pure non-gestational uterine choriocarcinoma is rare, it should be considered as one of the differential diagnoses for intraabdominal tumors in a child, so as to better guide and counsel families regarding the surgical plan and prognosis, respectively. In the present case, the patient's response to chemotherapy was poor, implying that the treatment of non-gestational choriocarcinoma is still challenging, particularly in the pediatric population.
由于其罕见性和非特异性影像学表现，儿童非妊娠性绒毛膜癌的诊断具有挑战性。在此，我们报告一例儿童非妊娠性绒毛膜癌病例，该病例是在剖腹探查术中意外发现的，并通过组织病理学发现得到证实。然而，该肿瘤对化疗没有反应。
一名 4 岁印度尼西亚女性患者因阴道出血主诉被送入急诊室。她在入院前 4 个月曾出现阴道点状出血。体格检查显示左腰区腹部膨隆，可触及固定的肿块，表面光滑。腹部 CT 扫描显示一个大肿块（10×6×12cm），呈液体密度伴钙化。因此，我们怀疑左侧卵巢畸胎瘤。患者的黄体生成素、卵泡刺激素和乳酸脱氢酶水平分别为 25.2mIU/ml、0.1mIU/ml 和 406U/l。根据临床和影像学表现，我们决定行剖腹探查术，发现肿瘤来源于子宫，而不是卵巢。我们没有观察到肝结节和腹部淋巴结肿大。随后，我们进行了子宫切除术。组织病理学发现支持绒毛膜癌的诊断。患者术后第 5 天顺利出院。此后，患者接受了 9 个周期的化疗，包括卡铂（600mg/m IV）、依托泊苷（120mg/m IV）和博来霉素（15mg/m IV）。然而，在第 9 个周期化疗后不久，基于可触及肿块和部分肠梗阻的临床发现，肿瘤复发。目前，患者正在再次接受化疗。
尽管纯非妊娠性子宫绒毛膜癌很少见，但应将其视为儿童腹腔内肿瘤的鉴别诊断之一，以便分别更好地指导和告知家属手术计划和预后。在本病例中，患者对化疗的反应不佳，这意味着非妊娠性绒毛膜癌的治疗仍然具有挑战性，特别是在儿科人群中。
