Intraplacental choriocarcinoma coexisting with fetomaternal hemorrhage: Case report, chemotherapy management, and literature review. 2018

Qin She, and Zhi Cheng, and Darine El-Chaar, and Feng Luo, and Xiaoyan Guo, and Shi Wu Wen
Department of Obstetrics and Gynecology, the Six Affiliated Hospital, Guangzhou Medical University, Qingyuan, Guangdong Province, China OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa Ottawa Hospital Research Institute Clinical Epidemiology Program Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, ON, Canada Department of Pathology, the Six Affiliated Hospital, Guangzhou Medical University, Qingyuan, Guangdong Province, China School of Epidemiology, Public Health, and Preventive Medicine, University of Ottawa Faculty of Medicine, Ottawa, ON, Canada.

BACKGROUND Near-term intraplacental choriocarcinoma (IC) coexisting with massive fetomaternal hemorrhage (FMH) is rare, and its clinical course is poorly understood. Here, we report a new case from our hospital, with detailed discussion and literature review. METHODS A 21-year-old Chinese female at 35 weeks gestation was admitted to our hospital due to reduced fetal movement. Near-term IC coexisting with massive FMH was diagnosed after delivery. METHODS The mother and infant were followed 3 months after delivery. Beta-human chorionic gonadotropin (β-HCG), pathological examination of the placenta, and computed tomography scans were performed for the mother and β-HCG was performed for the infant. RESULTS The mother's β-HCG serum level increased from 31,280 IU/L (6 days postdelivery) to 192,070 IU/L (49 days postdelivery), and then steadily fell to 42,468 IU/L (3 months postdelivery) without chemotherapy. The mother died from metastasis and cerebral hemorrhage. The infant survived and his β-HCG serum level fell to within the normal range without chemotherapy. CONCLUSIONS FMH associated with near-term IC is a rare disease. Measurement of maternal β-HCG may therefore represent a useful parameter when IC is a possible differential diagnosis. A pathological examination of the placenta should be performed in all cases of FMH to better identify cases of IC. Future research should aim to develop methods of identifying which patients with IC should receive chemotherapy, whether we should use single- or multiagent chemotherapies, and whether there is a positive correlation between chemotherapy regimen and β-HCG serum levels.

UI MeSH Term Description Entries
D007231 Infant, Newborn An infant during the first 28 days after birth. Neonate,Newborns,Infants, Newborn,Neonates,Newborn,Newborn Infant,Newborn Infants
D008297 Male Males
D010920 Placenta A highly vascularized mammalian fetal-maternal organ and major site of transport of oxygen, nutrients, and fetal waste products. It includes a fetal portion (CHORIONIC VILLI) derived from TROPHOBLASTS and a maternal portion (DECIDUA) derived from the uterine ENDOMETRIUM. The placenta produces an array of steroid, protein and peptide hormones (PLACENTAL HORMONES). Placentoma, Normal,Placentome,Placentas,Placentomes
D010922 Placenta Diseases Pathological processes or abnormal functions of the PLACENTA. Placenta Disorders,Placental Diseases,Disease, Placenta,Disease, Placental,Diseases, Placenta,Diseases, Placental,Disorder, Placenta,Disorders, Placenta,Placenta Disease,Placenta Disorder,Placental Disease
D011247 Pregnancy The status during which female mammals carry their developing young (EMBRYOS or FETUSES) in utero before birth, beginning from FERTILIZATION to BIRTH. Gestation,Pregnancies
D002822 Choriocarcinoma A malignant metastatic form of trophoblastic tumors. Unlike the HYDATIDIFORM MOLE, choriocarcinoma contains no CHORIONIC VILLI but rather sheets of undifferentiated cytotrophoblasts and syncytiotrophoblasts (TROPHOBLASTS). It is characterized by the large amounts of CHORIONIC GONADOTROPIN produced. Tissue origins can be determined by DNA analyses: placental (fetal) origin or non-placental origin (CHORIOCARCINOMA, NON-GESTATIONAL). Choriocarcinomas
D005260 Female Females
D005331 Fetomaternal Transfusion Transplacental passage of fetal blood into the circulation of the maternal organism. (Dorland, 27th ed) Hemorrhage, Fetomaternal,Fetomaternal Hemorrhage,Fetomaternal Hemorrhages,Fetomaternal Transfusions,Hemorrhages, Fetomaternal,Transfusion, Fetomaternal,Transfusions, Fetomaternal
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000970 Antineoplastic Agents Substances that inhibit or prevent the proliferation of NEOPLASMS. Anticancer Agent,Antineoplastic,Antineoplastic Agent,Antineoplastic Drug,Antitumor Agent,Antitumor Drug,Cancer Chemotherapy Agent,Cancer Chemotherapy Drug,Anticancer Agents,Antineoplastic Drugs,Antineoplastics,Antitumor Agents,Antitumor Drugs,Cancer Chemotherapy Agents,Cancer Chemotherapy Drugs,Chemotherapeutic Anticancer Agents,Chemotherapeutic Anticancer Drug,Agent, Anticancer,Agent, Antineoplastic,Agent, Antitumor,Agent, Cancer Chemotherapy,Agents, Anticancer,Agents, Antineoplastic,Agents, Antitumor,Agents, Cancer Chemotherapy,Agents, Chemotherapeutic Anticancer,Chemotherapy Agent, Cancer,Chemotherapy Agents, Cancer,Chemotherapy Drug, Cancer,Chemotherapy Drugs, Cancer,Drug, Antineoplastic,Drug, Antitumor,Drug, Cancer Chemotherapy,Drug, Chemotherapeutic Anticancer,Drugs, Antineoplastic,Drugs, Antitumor,Drugs, Cancer Chemotherapy

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