1997 Volume 49 Issue 5 Pages 547-553
A case of gestational choriocarcinoma with lung and brain metastases was reported in this paper, and the complete remission was achieved by multidisciplinary treatments comprising chemotherapy, irradiation and surgery. The patient was a 27 year-old multiparous female. Her first pregnancy was a complete hydatidiform mole which required methotrexate single agent chemotherapy. It was followed by a missed abortion and two normal deliveries. She was referred to our hospital for evaluation of irregular menstruation and occasional abnormal vaginal bleeding for 6 months, and headache with vomiting for half a month. On admission, she had nystagmus, rigidity of the neck and swaying gait. There was no vaginal bleeding. The urinary hCG level was 115, 640 IU/day, and the serum free fl-hCG was 166ng/ml. Chest X-ray showed a round tumor of 10 cm in diameter in the left lower lung field. Brain computed tomography showed a round, hemorrhagic tumor of 3 cm in diameter in the right cerebellar hemisphere, pons herniation and hydrocephalus. Pelvic magnetic resonance imaging showed no pathological findings in the internal genitalia. Craniotomy was indicated due to signs of increased intracranial pressure. The resection of cerebellar tumor was performed. Postoperative pathological study revealed choriocarcinoma. EMA-CO combination chemotherapy and whole-brain irradiation was initiated at the first postsurgical week. The chemotherapy brought rapid decrease of both the urinary hCG level and size of the lung tumor. After the sixth course of the chemotherapy, left lower lobectomy with the partial resection of parietal pleura was performed and the urinary hCG level became undetectable. Three further courses of the chemotherpy were then administered. Finally, hysterectomy with left salpingo-oophorectomy and right salpingectomy was performed. At one year after discharge, she showed sign of neither recurrence, respiratory dysfunction nor neurological abnormality. [Adv Obstet Gynecol 49 (5); 547-553, 1997 (H9.9)]
