title: Metastatic choriocarcinoma in a viable intrauterine pregnancy treated with EMA-CO in the third trimester: a case report.
abstract: BACKGROUND
  Choriocarcinoma is a highly malignant tumor arising from any gestation. Several cases of metastatic choriocarcinoma have been reported in the literature during viable intrauterine pregnancies.
  
  
  METHODS
  We present a case of choriocarcinoma metastatic to the lungs, liver and brain in a 28-year-old female who received systemic chemotherapy, consisting of etoposide-methotrexate-actinomycin D-cyclophosphamide-vincristine (EMA-CO), during pregnancy and subsequently delivered a viable female infant at 32 weeks' gestation. This case is one of only a few presented in the literature in which metastatic choriocarcinoma was treated during pregnancy with delivery during the third trimester.
  
  
  CONCLUSIONS
  Most reported cases of metastatic choriocarcinoma involve immediate delivery, usually via cesarean section, of premature infants in an effort to initiate chemotherapy after delivery, avoiding inherent risks to the fetus. Our patient was successfully treated with EMA-CO regimen for high-risk gestational trophoblastic tumors and delivered a developmentally normal infant. This report details this case and the importance of early initiation of cytotoxic drugs.
authors.affiliation: Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute, Orlando, FL 32804, USA. lorna.brudie.do@flhosp.org
authors.forename: Lorna A
authors.initials: LA
authors.lastname: Brudie
authors.forename: Sarfraz
authors.initials: S
authors.lastname: Ahmad
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Radi
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Finkler
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000556:secondary / Q000628:therapy; D002822:Choriocarcinoma / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery / Q000628:therapy*; D005185:Fallopian Tube Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000628:therapy; D008175:Lung Neoplasms / Q000556:secondary / Q000628:therapy; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D011256:Pregnancy Outcome; D011263:Pregnancy Trimester, Third; D016896:Treatment Outcome