Lumbar metastasis of choriocarcinoma.
METHODS
A case of lumbar metastasis of a choriocarcinoma is presented.


OBJECTIVE
To present and review a rare case of metastatic choriocarcinoma in the lumbar spine.


BACKGROUND
Choriocarcinoma is a highly anaplastic malignancy derived from trophoblastic cells characterized by the secretion of human chorionic gonadotropin (hCG) and early hematogenous metastasis. However, metastatic choriocarcinoma in the spine is extremely rare. Although 2 cases of metastasis in lumbar and/or sacral vertebra have been reported, the efficacy of surgical treatment for the spinal metastasis of choriocarcinoma is not yet known.


METHODS
The clinical course, radiologic features, pathology, and outcome of the treatment of metastatic choriocarcinoma of the lumbar spine is reported.


RESULTS
A 38-year-old female patient with abnormal uterine bleeding 6 weeks after a normal-term delivery showed high serum levels of hCG. A whole body image analysis revealed a lesion in the L2 vertebra. After computed tomography-guided needle biopsy, a clinical and pathologic diagnosis of lumbar metastasis of choriocarcinoma was made. Surgical resection of the localized L2 vertebra lesion was performed by total en bloc spondylectomy after a poor response to initial chemotherapy with methotrexate. Postsurgically, the serum level of hCG explosively increased and local recurrences around the original L2 vertebra and epidural metastasis abruptly developed. Lung metastases also occurred concurrently and progressed and the patient eventually died to the disease.


CONCLUSIONS
We have reported a rare case of lumbar metastasis of choriocarcinoma after a normal-term pregnancy. This is the first report of lumbar metastasis of choriocarcinoma treated by spinal surgery. Because surgical resection of a lumbar metastasis of choriocarcinoma involves a substantial risk of profuse hemorrhage, local recurrence and the spread of metastasis, multiagent chemotherapy in combination with radiotherapy should be preformed before surgical resection.
Naito
Yohei
Y
Departments of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie, Japan.
Akeda
Koji
K
Kasai
Yuichi
Y
Matsumine
Akihiko
A
Tabata
Tsutomu
T
Nagao
Kenji
K
Uchida
Atsumasa
A
D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000097:blood; D001706:Biopsy; D002822:Choriocarcinoma / Q000556:secondary* / Q000601:surgery; D006063:Chorionic Gonadotropin / Q000097:blood / Q000378:metabolism; D004358:Drug Therapy / Q000379:methods / Q000592:standards; D015174:Epidural Neoplasms / Q000556:secondary; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D006828:Hydatidiform Mole / Q000150:complications / Q000503:physiopathology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008175:Lung Neoplasms / Q000556:secondary; D009362:Neoplasm Metastasis / Q000473:pathology / Q000503:physiopathology; D009364:Neoplasm Recurrence, Local; D019635:Neurosurgical Procedures; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000473:pathology* / Q000503:physiopathology; D011859:Radiography; D013125:Spinal Neoplasms / Q000556:secondary* / Q000601:surgery; D017211:Treatment Failure; D014594:Uterine Neoplasms / Q000473:pathology*
D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D006063:Chorionic Gonadotropin