title: Gestational choriocarcinoma with renal and pulmonary metastases lacking a primary uterine origin.
abstract: OBJECTIVE
  We describe a case of gestational choriocarcinoma metastasized to the kidney and lung, which presented initially as refractory hematuria after a term pregnancy 5 years earlier.
  
  
  METHODS
  A 35-year-old woman, G2P1, with a previous history of full-term pregnancy in 2009, presented to the emergency department complaining of intermittent gross hematuria for 2 months. Abdominal computed tomography showed a suspicious arteriovenous malformation in the right kidney and a thrombus within the right renal vein. Transarterial embolization was performed twice to treat the refractory hematuria but was unsuccessful, and radical nephrectomy of the right kidney was performed. The diagnosis was gestational metastatic choriocarcinoma of the kidney based on morphological, immunohistochemical, and DNA studies. Lung metastases were found by computed tomography of the chest. Pelvic ultrasound was performed but showed no primary tumor in the uterine cavity. After surgical intervention, adjuvant chemotherapy involving first single-agent chemotherapy with methotrexate followed by multiagent chemotherapy (EMACO regimen) failed.
  
  
  CONCLUSIONS
  In women of reproductive age, unexplained hematuria should raise concerns about possible choriocarcinoma, either metastatic gestational or primary nongestational choriocarcinoma of the kidney.
authors.affiliation: Department of General Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Hao-Ming
authors.initials: HM
authors.lastname: Li
authors.affiliation: Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Wen-Chien
authors.initials: WC
authors.lastname: Hou
authors.affiliation: Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Yu-Ju
authors.initials: YJ
authors.lastname: Lai
authors.affiliation: Section of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Chien-Chang
authors.initials: CC
authors.lastname: Kao
authors.affiliation: Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Tai-Kuang
authors.initials: TK
authors.lastname: Chao
authors.affiliation: Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors.forename: Mu-Hsien
authors.initials: MH
authors.lastname: Yu
authors.affiliation: Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. Electronic address: su108868@gmail.com.
authors.forename: Her-Young
authors.initials: HY
authors.lastname: Su
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols; D002822:Choriocarcinoma / Q000000981:diagnostic imaging / Q000556:secondary*; D003520:Cyclophosphamide; D003609:Dactinomycin; D005047:Etoposide; D005260:Female; D006417:Hematuria / Q000209:etiology; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary*; D008279:Magnetic Resonance Imaging; D008727:Methotrexate; D009382:Neoplasms, Unknown Primary / Q000473:pathology*; D011247:Pregnancy; D014750:Vincristine
chemical_list: D003609:Dactinomycin; D014750:Vincristine; D005047:Etoposide; D003520:Cyclophosphamide; D008727:Methotrexate
keywords: choriocarcinoma; gestational; hematuria; kidney; metastasis