背景:绒毛膜癌是一种罕见且高度恶性的妊娠滋养细胞疾病,可能在怀孕后发展,流产,或者葡萄胎.磨牙后绒毛膜癌累及肾转移的情况更为罕见。在这个案例报告中,我们描述了一个独特的病例,在没有原发性子宫肿瘤和其他部位转移的情况下,磨牙后绒毛膜癌具有孤立的肾转移。表现为泌尿系统症状和自发性肾出血。
方法:一名41岁的波斯妇女,有完全葡萄胎病史,表现为严重的侧腹疼痛,恶心,呕吐,肉眼血尿,还有阴道出血.实验室测试表明血清β人绒毛膜促性腺激素水平为60,000mIU/mL。影像学检查显示,左肾下极有一个病灶,有血肿包围的活动性出血,以及空的子宫腔。此外,检测到双侧胸腔积液,肺内无任何病变。随后,病人做了剖腹手术,肾部分切除术,和左卵巢旁膀胱切除术。还进行了子宫内膜刮治。组织病理学报告显示绒毛膜癌肾转移高表达β人绒毛膜促性腺激素,细胞角蛋白7和Ki67。此外,子宫内膜刮宫标本中没有恶性细胞,在卵巢囊肿旁发现黄体囊肿。进一步的调查显示胸腔积液中没有恶性细胞,大脑中没有转移性病变的证据.因此,病人被转诊到肿瘤科接受化疗,在接受依托泊苷标准方案疗程后,β人绒毛膜促性腺激素水平降至5mIU/mL,甲氨蝶呤,放线菌素D,环磷酰胺,和长春新碱/oncovin超过3周。最后,每月测量β人绒毛膜促性腺激素水平6个月,表明水平一直保持在正常范围内,没有复发或新转移的证据。
结论:尿路症状如血尿或自发性肾出血可能是磨牙后绒毛膜癌受累肾的唯一表现。因此,它可以是有益的测量血清β人绒毛膜促性腺激素水平的育龄女性谁出现无法解释的泌尿系统症状,特别是如果有葡萄胎的历史。
BACKGROUND: Choriocarcinoma is a rare and highly malignant form of gestational trophoblastic disease that may develop following pregnancy, abortion, or a hydatiform mole. Renal metastatic involvement by post molar choriocarcinoma is even rarer. In this case report, we describe a unique case of post molar choriocarcinoma with a solitary renal metastasis in the absence of a primary uterine tumor and metastases in other sites, which presented with urological symptoms and spontaneous renal hemorrhage.
METHODS: A 41-year-old Persian woman with history of complete hydatiform mole presented with severe flank pain, nausea, vomiting, gross hematuria, and vaginal bleeding. Laboratory tests demonstrated a serum beta human chorionic gonadotropin hormone level of 60,000 mIU/mL. Imaging studies showed a lesion at the lower pole of the left kidney with active bleeding surrounded by hematoma, as well as an empty uterine cavity. Additionally, bilateral pleural effusion was detected without any lesion within the lungs. Subsequently, the patient underwent laparotomy, partial nephrectomy, and left para-ovarian cystectomy. Endometrial curettage was also carried out. The histopathology report revealed choriocarcinoma renal metastasis with high expression of beta human chorionic gonadotropin, cytokeratin 7, and Ki 67. Moreover, there were no malignant cells in the endometrial curettage specimens, and a corpus luteum cyst was found within the para-ovarian cyst. Further investigations revealed that the pleural effusion was free of malignant cells, and there was no evidence of metastatic lesions in the brain. As a result, the patient was referred to the oncology department to receive chemotherapy, and the beta human chorionic gonadotropin levels dropped to 5 mIU/mL after receiving courses of a standard regimen of etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine/oncovin over 3 weeks. Finally, monthly measurements of beta human chorionic gonadotropin levels for 6 months indicated that levels have constantly remained within normal ranges, showing no evidence of recurrence or new metastasis.
CONCLUSIONS: Urological symptoms such as hematuria or spontaneous renal hemorrhage might be the only presentation of post molar choriocarcinoma with renal involvement. Thus, it can be beneficial to measure serum beta human chorionic gonadotropin levels among females of childbearing age who present with unexplained urological symptoms, especially if there is a history of prior hydatiform mole.