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EP1135 A series of missing primaries: pulmonary metastasis in gestational trophoblastic neoplasia in the absence of uterine tumors
  1. GP Gonzalez1,2 and
  2. A Estrella3
  1. 1Obstetrics and Gynecology, Philippine General Hospital, Manila
  2. 2Obstetrics and Gynecology, The Medical City South Luzon, Santa Rosa
  3. 3Philippine General Hospital, Manila, Philippines


Introduction/Background Gestational trophoblastic neoplasias (GTNs) are extremely aggressive tumors derived from placental trophoblasts. These tumors are always the sequalae of a pregnancy. Choriocarcinoma is the most common of these, in which early extra-pelvic hematogenous spread is typical. As progression of illness is rapid, timely diagnosis and treatment will favor improved chances for cure, whereas late commencement of therapy will make resolution difficult. The diagnosis of GTN is straightforward, because of elevated beta human chorionic gonadotropin (bhCG) and distinct sonographic features of the tumors inside the uterus. However, very rarely, this disease may occur in the absence of uterine tumors.

Methodology This presents a series of three patients with choriocarcinoma who consulted for evaluation of abnormal clinical and radiologic chest findings.

Results In all cases, the patients presented with a radiographically documented pulmonary mass with accompanying lower respiratory symptoms. Pulmonary carcinoma was ruled out. All patients underwent chemotherapy with 2/3 achieving a favorable outcome

Conclusion It is imperative for any clinician to have a high index of suspicion, backed by a thorough analysis of the clinical findings, in order to appropriately diagnose and treat patients with choriocarcinoma. Ample recognition of the various manifestations of metastatic choriocarcinoma and greater use of assays for HCG should result in prompt diagnosis and an improved long-term prognosis in these patients. Varied forms of treatment are available. Based on sound judgment, the clinician must decide which of these will best attain the treatment goals set the patient and the physician.

Disclosure Nothing to disclose

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