背景:绒毛膜癌综合征被认为是肿瘤出血的致命并发症,经常发生在肿瘤转移部位。
方法:一名有60年吸烟史的59岁男子因咯血被转诊至我院。胸部计算机断层扫描(CT)显示一个28×18mm的结节,其空洞浸润了左上叶。进行了经支气管肺活检,组织病理学检查显示腺癌。没有观察到远处或区域转移,因此,患者接受了左上叶切除和淋巴结清扫术.组织学检查显示肿瘤由低分化腺癌细胞和绒毛膜癌成分组成;未观察到多发性肺转移和纵隔淋巴结转移。免疫组织化学分析显示,在绒毛膜癌的合胞体滋养细胞中,人绒毛膜促性腺激素的免疫反应呈阳性。手术后一个月,患者出现大咯血。CT显示两肺弥漫性肺泡浸润。支气管镜检查显示右上支气管出血。穿刺细胞学检查显示为癌。尽管在重症监护室进行了输血和管理,患者在诊断后一个半月死亡。
结论:我们在此报告一例患者,在肺绒毛膜癌和腺癌联合切除后1个月出现绒毛膜癌综合征。绒毛膜癌综合征是一种罕见且危及生命的并发症,可能发生在原发性肺绒毛膜癌患者中。然而,在治疗大咯血患者时,我们需要考虑这种综合征的风险。
BACKGROUND: Choriocarcinoma syndrome is known as a lethal complication from tumoral hemorrhage, which frequently occurs at the site of tumor metastasis.
METHODS: A 59-year-old man with 60-pack-year smoking history was referred to our hospital because of hemoptysis. Chest computed tomography (CT) showed a 28 × 18 mm spiculated nodule with a cavity infiltrating the left upper lobe. A transbronchial lung biopsy was performed, and histopathological examinations revealed adenocarcinoma. No distant or regional metastasis was observed, and therefore, the patient underwent a left upper lobectomy with lymphadenectomy. Histological examinations showed that the tumor consisted of poorly differentiated adenocarcinoma cells and a choriocarcinomatous component; no multiple pulmonary metastases and mediastinal lymph node metastasis were observed. Immunohistochemical analysis showed a positive immunoreaction for human chorionic gonadotropin in the syncytiotrophoblastic cells of the choriocarcinoma. One month after the operation, the patient developed massive hemoptysis. CT showed diffuse alveolar infiltration in both the lungs. A bronchoscopic examination showed bleeding from the right upper bronchus. Aspiration cytology showed carcinoma. Despite blood transfusion and management in the intensive care unit, the patient died one and a half month after diagnosis.
CONCLUSIONS: We herein report a
case of a man who developed choriocarcinoma syndrome 1 month after resection for combined choriocarcinoma and adenocarcinoma of the lung. Choriocarcinoma syndrome is a rare and life-threatening complication which may occur in patients with primary pulmonary choriocarcinoma. However, we need to consider the risk of this syndrome while dealing with patients who have massive hemoptysis.