Haemoptysis from a pulmonary arteriovenous malformation in a post molar pregnancy gestational trophoblast tumour patient managed by radiological embolisation: a case report.
BACKGROUND
Gestational trophoblastic tumours are a rare form of malignancy, which in the majority of cases arise from abnormal trophoblast cells formed in a complete molar pregnancy. These tumours are extremely sensitive to chemotherapy and high cure rates approaching 100% can be expected. The disease is usually limited to the uterus where the abnormal trophoblast proliferation and human chorionic production can lead to vascular changes including the formation of arteriovenous malformations.


METHODS
We describe the case of a 28-year-old Caucasian woman who presented to the United Kingdom's Gestational Trophoblast Tumour Service with rising human chorionic gonadotropin levels following a uterine evacuation for a complete molar pregnancy. She was commenced on chemotherapy but subsequently reported two episodes of haemoptysis. Computed tomography imaging demonstrated findings consistent with a pulmonary arteriovenous malformation, probably due to a small pulmonary metastasis, complicated by recent haemorrhage. These findings were confirmed on emergency pulmonary arteriography, and the pulmonary arteriovenous malformation was successfully embolised.


CONCLUSIONS
Arteriovenous malformations secondary to gestational trophoblastic tumours at metastatic sites have only been reported in a very limited number of cases. When significant bleeding occurs, as in this case of a pulmonary lesion, urgent referral for embolisation is indicated.
Zoë
Z
McDonald-Burrows
Rhian
R
Davies
Elizabeth
E
Goode
Candice
C
Clarke
James
J
Jackson
Michael
M
Seckl
BCCA Vancouver Island, Victoria, BC V8R 6V5, Canada. Philip.Savage@bccancer.bc.ca.
Philip
P
Savage
D000328:Adult; D000792:Angiography; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006469:Hemoptysis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D006828:Hydatidiform Mole / Q000150:complications / Q000188:drug therapy* / Q000556:secondary; D008175:Lung Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000556:secondary; D011247:Pregnancy; D011651:Pulmonary Artery / Q000002:abnormalities / Q000000981:diagnostic imaging; D011667:Pulmonary Veins / Q000002:abnormalities / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000473:pathology