Intraplacental choriocarcinoma metastasizing to the maternal lung.
BACKGROUND
Although normal pregnancy is the precursor of 25% of cases of maternal choriocarcinoma, intraplacental choriocarcinoma in an otherwise normal placenta associated with viable pregnancy has rarely been reported.


METHODS
Examination of the placenta after delivery of a pale and small-for-date infant at term revealed intraplacental choriocarcinoma. There was no evidence of metastatic disease in the mother or child, but the mother exhibited postpartum rising levels of beta-HCG. The mother refused chemotherapy and disappeared from follow-up. Nine months later, she presented with metastatic choriocarcinoma of the lung. Eleven courses of the multi-drug EMA CO regimen effected a decrease of beta-HCG to normal and disappearance of lung metastases. To date, 28 months after the end of chemotherapy, the patient is alive and without evidence of gestational trophoblastic disease. Moreover, since then she has given birth to an additional two children.


CONCLUSIONS
This case is an example of natural disease progression of intraplacental choriocarcinoma metastasizing to the mother. Furthermore, it supports common knowledge that the multi-drug EMA CO regimen is effective treatment in poor prognosis metastatic choriocarcinoma.
Landau
D
D
Department of Neonatology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Maor
E
E
Maymon
E
E
Rabinovich
A
A
Piura
B
B
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001707:Biopsy, Needle; D002822:Choriocarcinoma / Q000556:secondary*; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007150:Immunohistochemistry; D008175:Lung Neoplasms / Q000473:pathology / Q000556:secondary*; D009367:Neoplasm Staging; D010920:Placenta / Q000473:pathology; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis*; D011256:Pregnancy Outcome; D013902:Radiography, Thoracic; D018570:Risk Assessment; D016896:Treatment Outcome; D016312:Treatment Refusal; D014594:Uterine Neoplasms / Q000473:pathology*