J Gynecol Oncol.  2011 Sep;22(3):203-206. 10.3802/jgo.2011.22.3.203.

Chemo-resistant choriocarcinoma metastatic to colon cured by low-anterior resection

• Ryu JH
• Choi CH
• Kim TJ
• Lee JW
• Kim BG
• Bae DS

• KMID: 2055709
• DOI: http://doi.org/10.3802/jgo.2011.22.3.203

Abstract

The role of surgery in the treatment of patients with metastatic choriocarcinoma has diminished. We present a case of chemo-resistant metastatic choriocarcinoma salvaged by surgery. A 48-year-old patient presented with uterine perforation and severe intractable hemorrhage, and histological examination revealed a choriocarcinoma. After 6 years of disease-free state, recurrence occurred in the rectosigmoid colon. Seven cycles of EMACO chemotherapy was administered, and the human chorionic gonadotropin level was normalized. Three months after the chemotherapy, the rectosigmoid colon metastasis progressed. Low anterior resection with lymphadenectomy up to the level of the inferior mesenteric artery was conducted. After the operation, the human chorionic gonadotropin level decreased to within the normal range. There has been no evidence of disease for 13 months since the operation. Local resection of metastases seems to play a significant role in curing the disease in a small subset of patients.

Keyword

Choriocarcinoma; Colon; Low anterior resection

MeSH Terms

Choriocarcinoma
Chorionic Gonadotropin
Colon
Female
Hemorrhage
Humans
Lymph Node Excision
Mesenteric Artery, Inferior
Middle Aged
Neoplasm Metastasis
Pregnancy
Recurrence
Reference Values
Uterine Perforation
Chorionic Gonadotropin

Figure

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  Fig. 1 (A) Magnetic resonance imaging showing the metastatic choriocarcinoma involving the rectosigmoid colon. (B) Sigmoidoscopy display a lobulating mass which was confirmed as choriocarcinoma. (C) Positron emission tomography scan showing increased fludeoxyglucose (FDG) uptake in the rectosigmoid colon which is consistent with malignant tissue. Choriocarcinoma with syncytiotrophoblastic and cytotrophoblastic elements which metastasized to the colon. (D) There is extensive inflammatory response with no chorionic villi. The left side is the mucosal aspect, and the right side is the serosal aspect (H&E, ×200).

Reference

1. Hammond CB, Weed JC Jr, Currie JL. The role of operation in the current therapy of gestational trophoblastic disease. Am J Obstet Gynecol. 1980. 136:844–858.

2. Feng F, Xiang Y. Surgical management of chemotherapy-resistant gestational trophoblastic neoplasia. Expert Rev Anticancer Ther. 2010. 10:71–80.

3. Newlands ES. The management of recurrent and drug-resistant gestational trophoblastic neoplasia (GTN). Best Pract Res Clin Obstet Gynaecol. 2003. 17:905–923.

4. Lewis J Jr, Ketcham AS, Hertz R. Surgical intervention during chemotherapy of gestational trophoblastic neoplasms. Cancer. 1966. 19:1517–1522.

5. Wong LC, Choo YC, Ma HK. Hepatic metastases in gestational trophoblastic disease. Obstet Gynecol. 1986. 67:107–111.

6. Lurain JR, Singh DK, Schink JC. Role of surgery in the management of high-risk gestational trophoblastic neoplasia. J Reprod Med. 2006. 51:773–776.

7. Fleming EL, Garrett L, Growdon WB, Callahan M, Nevadunsky N, Ghosh S, et al. The changing role of thoracotomy in gestational trophoblastic neoplasia at the New England Trophoblastic Disease Center. J Reprod Med. 2008. 53:493–498.

8. Evans AC Jr, Soper JT, Clarke-Pearson DL, Berchuck A, Rodriguez GC, Hammond CB. Gestational trophoblastic disease metastatic to the central nervous system. Gynecol Oncol. 1995. 59:226–230.

9. Feng F, Xiang Y, Li L, Wan X, Yang X. Clinical parameters predicting therapeutic response to surgical management in patients with chemotherapy-resistant gestational trophoblastic neoplasia. Gynecol Oncol. 2009. 113:312–315.

10. Dhillon T, Palmieri C, Sebire NJ, Lindsay I, Newlands ES, Schmid P, et al. Value of whole body 18FDG-PET to identify the active site of gestational trophoblastic neoplasia. J Reprod Med. 2006. 51:879–887.