[Cerebral metastasis in choriocarcinoma a case report].
Choriocarcinoma are malignant neoplastic tumors from the trophoblastic tissue with a tendency to early metastases. Beside pulmonary metastases there are often cerebral metastases, leading to intracerebral hemorrhage often responsible for the first clinical symptoms. In young women, symptoms like vaginal or pulmonary bleeding or neurologic disturbances shortly after a hydatiform mole or a normal pregnancy, accompanied by high levels of HCG in serum and CSF, choriocarcinoma should be considered. Choriocarcinoma are very sensitive to chemotherapy, which consists--depending on the stage of the disease--of a mono- or polychemotherapy. Cure rates are high, even in extended stages with cerebral metastases--as in the case described. Brain metastases with or without oncotic aneurysms can be rapidly controlled by immediate whole brain irradiation. Surgical interventions may be necessary in the case of life threatening bleedings. Levels of HCG in serum and cerebrospinal fluid are good markers to control the effect of therapy. But--as shown in this patient--levels of HCG in CSF may decrease protracted without affecting prognosis. Oncotic aneurysms are rarely reported and mostly detected post mortem. The presented case leads to a more optimistic attitude and demonstrates efficacy of immediately started radio- and chemotherapy.
Zentrum für Onkologie/Hämatologie und Transfusionsmedizin, Kantonsspital Aarau.
E
E
Baertschi
M
M
Notter
A
A
Mironov
M
M
Wernli
M J
MJ
Bargetzi
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001766:Blindness / Q000209:etiology; D001932:Brain Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary*; D002533:Cerebral Angiography; D002822:Choriocarcinoma / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary*; D006063:Chorionic Gonadotropin / Q000097:blood / Q000134:cerebrospinal fluid; D003131:Combined Modality Therapy; D003609:Dactinomycin / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging; D002955:Leucovorin / Q000627:therapeutic use; D008727:Methotrexate / Q000627:therapeutic use; D011247:Pregnancy; D011379:Prognosis; D011879:Radiotherapy Dosage; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014594:Uterine Neoplasms; D014750:Vincristine / Q000627:therapeutic use
D006063:Chorionic Gonadotropin; D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D002955:Leucovorin; D008727:Methotrexate