West China Xiamen hospital of Sichuan University, Xiamen, Fujian, 361000, China.
Department of Gynecology and Obstetrics, Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan, 610041, P.R. China.
BMC Womens Health. 2024 Oct 21;24(1):568. doi: 10.1186/s12905-024-03399-z.
Choriocarcinoma is an aggressively invasive neoplasm, characterized by its rapid proliferation and propensity for metastasis to distant organs via hematogenous dissemination. Lungs (80%), vagina (30%), pelvis (20%), liver (10%), and brain (10%) are the most frequently metastasized organs. Renal metastases are very rare. The clinical manifestations of choriocarcinoma varies depending on the site of disease, making diagnosis challenging. In this report, we provide a clinical case of choriocarcinoma with metastases to the renal and pulmonary systems, displaying symptoms akin to those observed in ectopic pregnancy.
A 27-year-old female, G2P1, with a previous history of full-term pregnancy in 2018, presented to the hospital with the onset of vaginal bleeding and accompanying abdominal aches. Investigations uncovered a left adnexal mass with a human chorionic gonadotropin (hCG) level of 77,4 mIU/mL and a left pulmonary nodule measuring 31 mm x 21 mm. Laparoscopy was performed due to the high suspicion of an ectopic pregnancy. However, no visible villi were identified during the surgery, and postoperative blood hCG levels continued to rise. A diagnostic curettage also failed to reveal any villi, maintaining the suspicion of a persistent ectopic pregnancy. Following two ineffective courses of methotrexate therapy, the patient was referred to our facility. Prior to her referral, an ultrasound had indicated a mass in the right kidney. However, upon arrival at our hospital, subsequent ultrasonography failed to detect any renal masses. Despite two months of outpatient monitoring, there was a sudden and significant increase in her serum hCG levels. An emergency laparoscopy was performed, revealing no pregnancy-related lesion. After surgery, the patient's hCG levels dropped dramatically to less than one-tenth of the original amount. Multisite enhanced computed tomography(CT)revealed suspicious lesions in both the renal and pulmonary regions. Upon thorough multidisciplinary consultation, a diagnosis of choriocarcinoma was entertained. Consequently, the patient successfully underwent eight cycles of chemotherapy and has remained recurrence-free for the past year.
This case underscores the potential for choriocarcinoma in women of reproductive age who exhibit radiological signs of renal masses. Early and accurate diagnosis, followed by prompt intervention, is essential to prevent needless surgery procedures.
绒癌是一种侵袭性很强的肿瘤，其特征是快速增殖，并通过血行播散倾向于转移到远处器官。肺（80%）、阴道（30%）、骨盆（20%）、肝（10%）和脑（10%）是最常转移的器官。肾转移非常罕见。绒癌的临床表现因病变部位而异，导致诊断具有挑战性。在本报告中，我们提供了一例绒癌转移至肾和肺系统的临床病例，其表现类似于异位妊娠。
一名 27 岁女性，G2P1，曾于 2018 年足月妊娠，因阴道出血和腹痛就诊。检查发现左侧附件区肿块，人绒毛膜促性腺激素（hCG）水平为 77400 mIU/mL，左肺结节大小为 31mm×21mm。由于高度怀疑异位妊娠，进行了腹腔镜检查。然而，手术中未发现明显的绒毛，术后 hCG 水平继续升高。诊断性刮宫也未发现绒毛，持续怀疑持续性异位妊娠。两次甲氨蝶呤治疗无效后，患者转至我院。转来我院前，超声提示右肾有一肿块。然而，当她到达我院时，随后的超声检查未能发现任何肾肿块。尽管进行了两个月的门诊监测，但她的血清 hCG 水平突然显著升高。紧急腹腔镜检查显示无妊娠相关病变。手术后，患者的 hCG 水平急剧下降至原来的十分之一以下。多部位增强 CT 显示肾和肺可疑病变。经过多学科全面会诊，考虑绒癌的诊断。因此，患者成功接受了 8 个周期的化疗，并且在过去的一年中没有复发。
对于有放射学肾肿块表现的育龄妇女，应考虑绒癌的可能性。早期准确诊断并及时干预至关重要，可避免不必要的手术。
