Gestational trophoblastic neoplasia with retroperitoneal metastases: A fatal complication
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CASE REPORT
WORLD JOURNAL OF SURGICAL ONCOLOGY
Open Access
Gestational trophoblastic neoplasia with retroperitoneal metastases: A fatal complication Nikolaos Thomakos1, Alexandros Rodolakis1, Panayiotis Belitsos1, Flora Zagouri2, Ioannis Chatzinikolaou2, Athanassios-Meletios Dimopoulos2, Christos A Papadimitriou2*, Aris Antsaklis1
Abstract Background: Gestational Trophoblastic Neoplasia (GTN) is a pathologic entity that can affect any pregnancy and develop long after the termination of the pregnancy. Its course can be complicated by metastases to distant sites such as the lung, brain, liver, kidney and vagina. The therapeutic approach of this condition includes both surgical intervention and chemotherapy. The prognosis depends on many prognostic factors that determine the stage of the disease. Case Report: We present a woman with GTN and retroperitoneal metastatic disease who came to our department and was diagnosed as having high risk metastatic GTN. Accordingly she received chemotherapy as primary treatment but unfortunately developed massive bleeding after the first course of chemotherapy, was operated in an attempt to control bleeding but finally succumbed. Conclusion: This case demonstrates that GTN, while usually curable, can be a deadly disease requiring improved diagnostic, treatment modalities and chemotherapeutic agents. The gynaecologist should be aware of all possible metastatic sites of GTN and the patient immediately referred to a specialist center for further assessment and treatment.
Introduction Gestational Trophoblastic Neoplasia (GTN) refers to a pathologic condition that is characterized by aggressive invasion of the endometrium and myometrium by trophoblastic cells and is divided to four different pathologic entities: invasive mole, gestational choriocarcinoma, placental site trophoblastic tumour and epithelioid trophoblastic tumour [1]. GTN typically develops with or follows some form of pregnancy, but occasionally an antecedent gestation cannot be confirmed with certainty. Most cases follow a hydatidiform mole. Rarely, GTN develops after a live birth, miscarriage, or termination [2]. Metastases in GTN develop in about 4% after evacuation of a complete mole [3] but are more often seen when GTN develops after non-molar pregnancies. High propensity of distant metastases characterizes gestational choriocarcinoma which develops in approximately 1 in 30,000 non-molar pregnancies [3-5]. Two thirds of such * Correspondence: [email protected] 2 Department of Clinical and Therapeutics, Alexandra Hospital, School of Medicine, University of Athens, Greece Full list of author information is available at the end of the article
cases follow term pregnancies, and a third develops after a spontaneous abortion or pregnancy termination [3]. Choriocarcinoma should be suspected in any woman of reproductive age with metastatic disease from an unknown primary [4,5]. Moreover, it may be suspected in any abnormal bleeding for more than 6 weeks following a pregnancy; in this case human Chorionic Gonadotrophin
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