title: Metastatic choriocarcinoma as initial presentation of small bowel perforation in absence of primary uterine lesion: a case report.
abstract: BACKGROUND
  Choriocarcinoma is a highly malignant tumor of gestational trophoblastic neoplasia that characteristically spreads via the bloodstream. Small bowel metastasis is very rare, and a small number of cases of choriocarcinoma metastasis to small bowel have been reported.
  
  
  METHODS
  We report a case of a 40-year-old woman presenting with acute abdominal pain and vaginal bleeding due to small bowel perforation secondary to jejunal metastasis. In our case, metastatic choriocarcinoma was present in the small bowel, lung, and liver, but no primary lesion was apparent.
  
  
  RESULTS
  After resection and anastomosis of the perforated small bowel, chemotherapy was performed. The patient began chemotherapy with etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMA-CO) for 9 cycles. When the 4th cycle of chemotherapy was finished, β-human chorionic gonadotropin (hCG) level was normalized and follow-up computed tomography scans showed regression of the liver metastasis and small bowel lesion and significantly decreased lung metastasis. After 9 cycles of chemotherapy were completed, the patient showed complete response.
  
  
  CONCLUSIONS
  If patients have high β-hCG of unknown origin and suspected panperitonitis, which are suspicious of choriocarcinoma metastasis to small bowel, the pathologic findings are important. It is essential to confirm the histopathologic diagnosis postoperatively. Choriocarcinoma can spread to various organs and show aggressive manifestations. Therefore, we should be aware of possible metastatic sites and remain alert to its diagnosis.
authors.affiliation: Department of Obstetrics and Gynecology, Busan Paik Hospital, Inje University, Busan - Korea.
authors.forename: En Bee
authors.initials: EB
authors.lastname: Cho
authors.affiliation: Department of Obstetrics and Gynecology, Busan Paik Hospital, Inje University, Busan - Korea.|Paik Institute for Clinical Research, Busan Paik Hospital, Inje University, Busan - Korea.
authors.forename: Jung Mi
authors.initials: JM
authors.lastname: Byun
authors.affiliation: Department of Obstetrics and Gynecology, Busan Paik Hospital, Inje University, Busan - Korea.|Paik Institute for Clinical Research, Busan Paik Hospital, Inje University, Busan - Korea.
authors.forename: Dae Hoon
authors.initials: DH
authors.lastname: Jeong
authors.affiliation: Department of Pathology, Busan Paik Hospital, Inje University, Busan - Korea.
authors.forename: Hye Kyoung
authors.initials: HK
authors.lastname: Yoon
authors.affiliation: Department of Obstetrics and Gynecology, Busan Paik Hospital, Inje University, Busan - Korea.|Paik Institute for Clinical Research, Busan Paik Hospital, Inje University, Busan - Korea.
authors.forename: Young Nam
authors.initials: YN
authors.lastname: Kim
authors.affiliation: Department of Obstetrics and Gynecology, Busan Paik Hospital, Inje University, Busan - Korea.
authors.forename: Moon Su
authors.initials: MS
authors.lastname: Sung
authors.affiliation: Department of Obstetrics and Gynecology, Busan Paik Hospital, Inje University, Busan - Korea.
authors.forename: Kyung Bok
authors.initials: KB
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynecology, Busan Paik Hospital, Inje University, Busan - Korea.|Paik Institute for Clinical Research, Busan Paik Hospital, Inje University, Busan - Korea.
authors.forename: Ki Tae
authors.initials: KT
authors.lastname: Kim
mesh_terms: D000328:Adult; D015415:Biomarkers; D002822:Choriocarcinoma / Q000175:diagnosis / Q000473:pathology*; D018997:Chorionic Gonadotropin, beta Subunit, Human / Q000378:metabolism; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007414:Intestinal Neoplasms / Q000175:diagnosis* / Q000556:secondary* / Q000628:therapy; D007416:Intestinal Perforation / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D007421:Intestine, Small / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D015415:Biomarkers; D018997:Chorionic Gonadotropin, beta Subunit, Human