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Abstract：
BACKGROUND: Gestational trophoblastic neoplasia (GTN) with intracardiac metastasis is rare, and here we reported a patient with intracardiac metastasis of high-risk and refractory gestational choriocarcinoma and reviewed relevant literatures.
METHODS: A 37-year-old woman presented with vaginal bleeding and high level of β-human chorionic gonadotropin (β-hCG) at 199,060 (mIU/mL). It was clinically diagnosed with gestational choriocarcinoma. The patient initially received eight cycles of chemotherapy but unsatisfactory response was observed, and the level of β-hCG still ranged between 5000 and 10,000. Then there was found intracardiac masses in the right atrium (2.6*1.7 cm), anterior chordae tendineae of the tricuspid valve (1.4*0.7 cm) and the right ventricle (4.1*2.9 cm) by ultrasonic cardiogram (UCG). PET/CT highly suspected the intracardiac metastasis of choriocarcinoma (SUVmax = 9.3) and no disease was found in the lung and pelvis. The patient undertook complete intracardiac masses resection. The pathology confirmed the intracardiac metastasis of disease. After a week of operation, the UCG found a 5.4*4.2 cm mass in the right atrium again. Considering the poor prognosis, the patient received palliative care and eventually died of disease progression.
CONCLUSIONS: Intracardiac metastasis of GTN is an aggressive sign of disease. Patients can benefit from chemotherapy and surgery. Future investigation of PD-1 immunotherapy combines with chemotherapy are expected to improve the prognosis in this group of patients.
METHODS: A 37-year-old woman presented with vaginal bleeding and high level of β-human chorionic gonadotropin (β-hCG) at 199,060 (mIU/mL). It was clinically diagnosed with gestational choriocarcinoma. The patient initially received eight cycles of chemotherapy but unsatisfactory response was observed, and the level of β-hCG still ranged between 5000 and 10,000. Then there was found intracardiac masses in the right atrium (2.6*1.7 cm), anterior chordae tendineae of the tricuspid valve (1.4*0.7 cm) and the right ventricle (4.1*2.9 cm) by ultrasonic cardiogram (UCG). PET/CT highly suspected the intracardiac metastasis of choriocarcinoma (SUVmax = 9.3) and no disease was found in the lung and pelvis. The patient undertook complete intracardiac masses resection. The pathology confirmed the intracardiac metastasis of disease. After a week of operation, the UCG found a 5.4*4.2 cm mass in the right atrium again. Considering the poor prognosis, the patient received palliative care and eventually died of disease progression.
CONCLUSIONS: Intracardiac metastasis of GTN is an aggressive sign of disease. Patients can benefit from chemotherapy and surgery. Future investigation of PD-1 immunotherapy combines with chemotherapy are expected to improve the prognosis in this group of patients.
摘要：
背景：伴有心内转移的妊娠滋养细胞瘤（GTN）很少见，本文报道1例高危难治性妊娠绒毛膜癌心内转移患者并复习相关文献。
方法：一名37岁女性出现阴道出血，β-人绒毛膜促性腺激素（β-hCG）水平为199,060（mIU/mL）。临床诊断为妊娠绒毛膜癌。患者最初接受了八个周期的化疗，但观察到不令人满意的反应，β-hCG的水平仍然在5000到10,000之间。然后在右心房发现心内肿块（2.6*1.7cm），超声心动图（UCG）显示三尖瓣前腱索（1.4*0.7cm）和右心室（4.1*2.9cm）。PET/CT高度怀疑绒毛膜癌的心内转移（SUVmax=9.3），在肺和骨盆中未发现疾病。患者接受了完整的心内肿块切除术。病理证实疾病心内转移。手术一周后,UCG再次发现右心房有5.4*4.2厘米的肿块。考虑到预后不良,患者接受了姑息治疗,最终死于疾病进展.
结论：GTN的心内转移是一种侵袭性疾病。患者可以从化疗和手术中受益。PD-1免疫治疗联合化疗的未来研究有望改善该组患者的预后。
方法：一名37岁女性出现阴道出血，β-人绒毛膜促性腺激素（β-hCG）水平为199,060（mIU/mL）。临床诊断为妊娠绒毛膜癌。患者最初接受了八个周期的化疗，但观察到不令人满意的反应，β-hCG的水平仍然在5000到10,000之间。然后在右心房发现心内肿块（2.6*1.7cm），超声心动图（UCG）显示三尖瓣前腱索（1.4*0.7cm）和右心室（4.1*2.9cm）。PET/CT高度怀疑绒毛膜癌的心内转移（SUVmax=9.3），在肺和骨盆中未发现疾病。患者接受了完整的心内肿块切除术。病理证实疾病心内转移。手术一周后,UCG再次发现右心房有5.4*4.2厘米的肿块。考虑到预后不良,患者接受了姑息治疗,最终死于疾病进展.
结论：GTN的心内转移是一种侵袭性疾病。患者可以从化疗和手术中受益。PD-1免疫治疗联合化疗的未来研究有望改善该组患者的预后。
