Lee, Ji-Hoon
(Department of Neurosurgery, Gachon University of Medical & Science, Gil Medical Center)
,
Park, Chan-Woo
(Department of Neurosurgery, Gachon University of Medical & Science, Gil Medical Center)
,
Chung, Dong-Hae
(Department of Pathology, Gachon University of Medical & Science, Gil Medical Center)
,
Kim, Woo-Kyung
(Department of Neurosurgery, Gachon University of Medical & Science, Gil Medical Center)
We report here on an uncommon case of metastatic choriocarcinoma to the lung, brain and lumbar spine. A 33-year-old woman was admitted to the pulmonary department with headache, dyspnea and hemoptysis. There was a history of cesarean section due to intrauterine fetal death at 37-weeks gestation and ...
We report here on an uncommon case of metastatic choriocarcinoma to the lung, brain and lumbar spine. A 33-year-old woman was admitted to the pulmonary department with headache, dyspnea and hemoptysis. There was a history of cesarean section due to intrauterine fetal death at 37-weeks gestation and this occurred 2 weeks before admission to the pulmonary department. The radiological studies revealed a nodular lung mass with hypervascularity in the left upper lobe and also a brain parenchymal lesion in the parietal lobe with marginal bleeding and surrounding edema. She underwent embolization for the lung lesion, which was suspected to be an arteriovenous malformation according to the pulmonary arteriogram. Approximately 10 days after discharge from the pulmonary department, she was readmitted due to back pain and progressive paraparesis. The neuroradiological studies revealed a hypervascular tumor occupying the entire L3 vertebral body and pedicle, and the tumor extended to the epidural area. She underwent embolization of the hypervascular lesion of the lumbar spine, and after which injection of polymethylmethacrylate in the L3 vertebral body, total laminectomy of L3, subtotal removal of the epidural mass and screw fixation of L2 and L4 were performed. The result of biopsy was a choriocarcinoma.
We report here on an uncommon case of metastatic choriocarcinoma to the lung, brain and lumbar spine. A 33-year-old woman was admitted to the pulmonary department with headache, dyspnea and hemoptysis. There was a history of cesarean section due to intrauterine fetal death at 37-weeks gestation and this occurred 2 weeks before admission to the pulmonary department. The radiological studies revealed a nodular lung mass with hypervascularity in the left upper lobe and also a brain parenchymal lesion in the parietal lobe with marginal bleeding and surrounding edema. She underwent embolization for the lung lesion, which was suspected to be an arteriovenous malformation according to the pulmonary arteriogram. Approximately 10 days after discharge from the pulmonary department, she was readmitted due to back pain and progressive paraparesis. The neuroradiological studies revealed a hypervascular tumor occupying the entire L3 vertebral body and pedicle, and the tumor extended to the epidural area. She underwent embolization of the hypervascular lesion of the lumbar spine, and after which injection of polymethylmethacrylate in the L3 vertebral body, total laminectomy of L3, subtotal removal of the epidural mass and screw fixation of L2 and L4 were performed. The result of biopsy was a choriocarcinoma.
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가설 설정
Histological findings of the removed mass. A: There is a mixture of cytotrophoblastic and syncytiotrophoblastic cells (H & E, x200). B: Human chorionic gonadotrophin positive cells are observed immunohistochemically (x200).
A: There is a mixture of cytotrophoblastic and syncytiotrophoblastic cells (H & E, x200). B: Human chorionic gonadotrophin positive cells are observed immunohistochemically (x200).
제안 방법
Other sites of metastases, such as the skin, gastrointestinal tract, kidney breast or bones, are extremely rare2, 4, 11, 12, 15, 20-24). In this stud% we report on a case of metastatic choriocarcinoma that presented with intracerebral hemorrhage and pulmonary hemorrhage and it metastasized to the lumbar spine, and this metastasis to the spine radiologically mimicked an extraosseous extension of vertebral hemangioma.
Yet, metastasis in the musculoskeletal system, such as the spine, is extremely rare and this can be seen from the scant reported cases4, 14'16, 20, 211. This current report presents an unusual metastatic choriocarcinoma in the lumbar spine and it extended to the epidural space.
대상 데이터
A 33-year-old female patient was admitted to the pulmonary depanment with headache, dyspnea and hemoptysis. Her medical history included a cesarean section due to intrauterine fetal death at 37-weeks gestation and this occurred 2 weeks before admission to the pulmonary department.
성능/효과
There was improvement of the neurological status with chemotherapy; and she became able to walk around. Ten months after operation, the follow-up MR images showed a significant decrease in the size of the epidural lesion and an intact bony contour (Fig. 3) and her j8-HCG level in the serum returned to normal (1 mIU/mL). She is currendy being regularly monitored in the gynecology department.
참고문헌 (25)
Allen SD, Lim AK, Seckl MJ, Blunt DM, Mitchell AW : Radiology of gestational trophoblastic neoplasia. Clin Radiol 61 : 301-313, 2006
Baik EJ, Jung JE, Son WI, Song JC, Kim MR, Jung DY, et al. : Clinical analysis of brain metastasis of choriocarcinoma. J Korean Cancer Assoc 25 : 673-679, 1993
Bas T, Aparisi F, Bas JL : Efficacy and safety of ethanol injection in 18 cases of vertebral hemangioma : a mean follow-up of 2 years. Spine (Phila Pa 1976) 26 : 1577-1582, 2001
Chi JH, Manley GT, Chou D : Pregnancy-related vertebral hemangioma : Case report, review of the literature, and management algorithm. Neurosurg Focus 19 : E7, 2005
Christopher C, Ming-Shian K, Deborah G : Incidental placental choriocarcinoma in a term pregnancy : a case report. J Med Case Reports 2 : 330, 2008
Cole LA, Khanlian SA, Muller CY, Giddings A, Kohorn E, Berkowitz R : Gestational trophoblastic disease : 3. Human chorionic gonadotropin-free beta-subunit, a reliable marker of placenter site trophoblastic tumors. Gynecol Oncol 102 : 160-164, 2006
Doppman JL, Oldfield EH, Heiss JD : Symptomatic vertebral hemangiomas : treatment by means of direct intralesional injection of ethanol. Radiology 214 : 341-348, 2000
Heiss JD, Doppman JL, Oldfield EN : Brief report : relief of spinal cord compression from vertebral hemangioma by intralesional injection of absolute ethanol. N Engl J Med 25 : 508-511, 1994
Huang CY, Chen CA, Hsieh CY, Cheng WF : Intracerebral hemorrhage as initial presentation of gestational choriocarcinoma : a case report and literature review. Int J Gynecol Cancer 17 : 1166-1171, 2007
Hwang SH, Lee HS, Park YK, Park IS, Kim ES, Jung JM, et al. : Metastatic choriocarcinoma associated with intracranial hemorrhage-case report. J Korean Neurosurg Soc 25 : 1727-1731, 1996
Inamasu J, Nichols TA, Guiot BH : Vertebral hemangioma symptomatic during pregnancy treatd by posterior decompression, intraoperative vertebroplasty, and segmental fixation. J Spinal Disord Tech 19 : 451-454, 2006
Safavi-Abbasi S, Feiz-Erfan I, Spetzler RF, Kim L, Dogan S, Porter RW, et al. : Hemorrhage of carvernous malformations during pregnancy and in the peripartum period : causal or coincidence? Case report. Neurosurg Focus 21 : e12, 2006
Scully RE, Bonfiglio TA, Kurman RJ, Silverberg SG : Histological typing of female genital tract tumors in Scully RE, Poulsen HE, Sobin LH(eds) : WHO international classification of tumors, ed2. New York : Springer Verlag, 1994, pp31-38
Sierra-Bergua B, Sanchez-Marteles M, Cabrerizo-Garcia JL, Sanjoaquin-Conde I : Choriocarcinoma with pulmonary and cerebral metastases. Singapore Med J 49 : e286-e288, 2008
Singh G, Mathur B, Ladha BL, Nuwal P : Metastatic choriocarcinoma in skeletal muscle. Internet J Gynecol Obstet 3 : 1-3, 2004
Suresh TN, Santosh V, Shastry Kolluri VR, Jayakumar PN, Yasha TC, Mahadevan A, et al. : Intracranial haemorrhage resulting from unsuspected choriocarcinoma metastasis. Neurol India 49 : 231-236, 2001
Takahashi M, Koyama M, Matsubara T, Murata H, Miura K, Nagano A : Mixed germinoma and choriocarcinoma in the intramedullary spinal cord : case report and review of the literature. J Neurooncol 76 : 71-75, 2006
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