RESUMO
PURPOSE: To report the outcomes of gestational trophoblastic neoplasia (GTN) at a single institution and to determine the factors affecting response to chemotherapy and survival. METHODS/PATIENTS: From 1979-2010, we retrospectively reviewed the data of 221 patients treated at our center. GTN Patients were assigned to low-risk (score ≤6) or high-risk (score ≥7) based on the WHO risk factor scoring system. Overall survival (OS) probabilities were estimated using Kaplan-Meier method. Logistic regression was applied to study the impact of different factors on the response to initial therapy. RESULTS: Patients' OS rate was 97 %. Median age at diagnosis was 37 year. 131 (59 %) patients had low-risk and 88 (40 %) cases had high-risk GTN. Complete remission rates to initial chemotherapy in low-risk group were 53 % and 87 % for single-agent methotrexate or dactinomycin, respectively. In high-risk group, 94 % achieved complete remission to initial chemotherapy with etoposide, methotrexate, dactinomycin, cyclophosphamide, and vincristine (EMA-CO). Etoposide, cisplatin, and dactinomycin as primary therapy in high-risk patients was successful in 70 %, while bleomycin, etoposide, and cisplatin (BEP) was successful in 53 % of cases. Salvage chemotherapy, surgical intervention or radiation therapy resulted in overall complete remission of 90 % in low-risk and 73 % in high-risk groups. Factors associated with resistance to initial chemotherapy were advanced-stage III/IV (p = 0.005), metastatic site other than lung or vagina (p = 0.005) and high-risk prognostic score (p = 0.05). OS was significantly influenced by the type of antecedent pregnancy (molar 98 % vs. others 93 %; p = 0.04), FIGO stage (I, II 100 % vs. III, IV 94 %; p = 0.02), score (low-risk 100 % vs. high-risk 92 %; p = 0.01), and site of metastasis (lung/vagina 98 % vs. others 85 %; p = 0.002). CONCLUSIONS: GTNs have excellent prognosis if properly treated at experienced centers. Single-agent dactinomycin seems more effective for low-risk GTN. EMA-CO remains the preferred primary treatment regimen for high-risk group. The excellent outcome reflects the success of salvage therapy.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Coriocarcinoma/terapia , Doença Trofoblástica Gestacional/terapia , Neoplasias Uterinas/terapia , Adolescente , Adulto , Bleomicina/uso terapêutico , Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/terapia , Coriocarcinoma/secundário , Cisplatino/uso terapêutico , Ciclofosfamida/uso terapêutico , Dactinomicina/uso terapêutico , Etoposídeo/uso terapêutico , Feminino , Doença Trofoblástica Gestacional/secundário , Humanos , Histerectomia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapia , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/terapia , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Gravidez , Indução de Remissão , Estudos Retrospectivos , Fatores de Risco , Terapia de Salvação , Taxa de Sobrevida , Neoplasias Uterinas/patologia , Neoplasias Vaginais/secundário , Neoplasias Vaginais/terapia , Vincristina/uso terapêutico , Adulto JovemRESUMO
The focus of this article is choriocarcinoma (CC), a rare and aggressive obstetric/gynecologic cancer that occurs once in every 20,000 to 40,000 pregnancies. CC is a form of gestational trophoblastic disease, which is the result of abnormal trophoblastic activity encompassing a spectrum of nonmalignant and malignant disease. Forms of gestational trophoblastic disease include complete or partial mole, invasive mole, CC, placental site trophoblastic tumor, and epithelioid trophoblastic tumor. Typically asymptomatic, the first symptom of CC in 80% of cases is shortness of breath, indicative of metastasis to the lungs. CC affects women of all ages and can occur during pregnancy, after birth, or even years remote from the antecedent pregnancy. It is highly responsive to chemotherapy, with an overall remission rate greater than 90%. This case study presents the story of a pregnant adolescent thought to have an uneventful pregnancy until metastatic CC at term was diagnosed. Available treatments, outcomes and surveillance for the disease, psychosocial aspects, and implications for nursing care are discussed.
Assuntos
Coriocarcinoma/secundário , Complicações Neoplásicas na Gravidez/patologia , Neoplasias Uterinas/patologia , Adolescente , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Estudos de Casos e Controles , Coriocarcinoma/diagnóstico , Coriocarcinoma/tratamento farmacológico , Coriocarcinoma/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Complicações Neoplásicas na Gravidez/tratamento farmacológico , Terceiro Trimestre da Gravidez , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/tratamento farmacológico , Adulto JovemRESUMO
Metastasic tumours to the oral cavity are extremely rare lesions that represent 1% of all oral and maxillofacial malignancies. Most reported cases involve the jaw bones than the soft tissues. Metastasis to the oral soft tissues most prevalently affects the gingiva and alveolar mucosa. Gingival metastasis may have an unremarkable clinical appearance and they can be difficult to distinguish from more common hyperplasic or reactive lesions that appear to be benign entities, such as peripheral giant-cell granuloma, pyogenic granuloma and peripheral ossifying fibroma. We present an unusual case of a testicular choriocarcinoma metastasized to the maxillary gingiva mimicking a reactive lesion. In addition, we also present a literature review of previous reported cases and a brief discussion about the etiopathogeny of testicular germ cell tumors, and how these malignant cells can reach the gingival tissues.
Los tumores metastásicos a la cavidad bucal son lesiones extremadamente raras que representan el 1% de todas las neoplasias malignas bucales y maxilofaciales. La mayoría de los casos reportados afectan más a los huesos maxilares que los tejidos blandos. Las metástasis a los tejidos blandos bucales involucran más prevalentemente a la encía y la mucosa alveolar. Las metástasis gingivales pueden tener un aspecto clínico no característico y suelen ser difíciles de distinguir de otras lesiones hiperplásicas o reactivas que parecen ser entidades benignas, tales como el granuloma periférico de células gigantes, el granuloma piogénico y el fibroma osificante periférico. Presentamos un inusual reporte de caso de un coriocarcinoma testicular metastásico a la encía maxilar simulando una lesión reactiva. Además, también se presenta una revisión de la literatura de los casos previamente publicados y una breve discusión acerca de la etiopatogenia de los tumores testiculares de células germinales, y cómo estas células malignas pueden llegar a los tejidos gingivales.
Assuntos
Humanos , Masculino , Adulto , Neoplasias Testiculares/patologia , Neoplasias Gengivais/secundário , Coriocarcinoma/secundário , Neoplasias Embrionárias de Células Germinativas , Gengiva/patologiaRESUMO
Five per cent of patients presenting with choriocarcinoma develop small bowel metastasis. Tumors of the small bowel are rare and the metastases are generally from lung and breast carcinoma or from melanoma. Clinical presentation is vague and the majority of cases are autopsy findings. The main symptoms are related to the presence of abdominal tumor or hemorrhage, or bowel obstruction or perforation. We present the cases of three patients with small bowel metastasis from choriocarcinoma. A 24-year-old woman with bowel obstruction secondary to intussusception caused by a metastatic choriocarcinoma polypoid mass and two men, one 18 years old and the other 24 years old, with a history of testicular tumor, who presented with gastrointestinal bleeding due to small bowel metastasis from choriocarcinoma, 2 and 10 months after orchiectomy, respectively. Management was endoscopic in one case and surgical in the other two. Two patients died in the early postoperative period and one patient died during the first year of follow-up. Choriocarcinoma metastases are very rare and their main clinical manifestations are hemorrhage and bowel obstruction. Management can be either medical or surgical. The majority of patients with choriocarcinoma respond to chemotherapy but prognosis is worse for those patients presenting with small bowel metastasis.
Assuntos
Coriocarcinoma/secundário , Neoplasias do Jejuno/secundário , Adolescente , Coriocarcinoma/patologia , Coriocarcinoma/cirurgia , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Neoplasias do Jejuno/patologia , Neoplasias do Jejuno/cirurgia , Masculino , Orquiectomia , Neoplasias Testiculares/patologia , Neoplasias Testiculares/cirurgia , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
Gestational trophoblastic disease has been reported to be responsive to chemotherapy, with a 90% cure rate. Several factors place patients at high risk of experiencing treatment failure with single agent chemotherapy. Choriocarcinoma following term pregnancy is very rare and associated with a poor prognosis and a mortality rate of 33-40%. We present a rare case of cutaneous metastasis of choriocarcinoma to the left third digit.
Assuntos
Coriocarcinoma/secundário , Dedos/patologia , Neoplasias de Cabeça e Pescoço/secundário , Transtornos Puerperais/patologia , Couro Cabeludo/patologia , Neoplasias Cutâneas/secundário , Neoplasias Uterinas/patologia , Biomarcadores Tumorais , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/secundário , Cesárea , Coriocarcinoma/sangue , Coriocarcinoma/diagnóstico , Gonadotropina Coriônica Humana Subunidade beta/sangue , Evolução Fatal , Feminino , Morte Fetal/etiologia , Neoplasias de Cabeça e Pescoço/diagnóstico , Humanos , Recém-Nascido , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/secundário , Neoplasias do Mediastino/diagnóstico , Neoplasias do Mediastino/secundário , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/patologia , Gravidez , Transtornos Puerperais/sangue , Transtornos Puerperais/diagnóstico , Neoplasias Cutâneas/diagnóstico , Neoplasias Uterinas/sangue , Neoplasias Uterinas/diagnóstico , Adulto JovemRESUMO
Choriocarcinoma is a highly malignant tumor that can arise from trophoblasts of any type of gestational event but most often from complete hydatidiform mole. IGF-II plays a fundamental role in placental development and may play a role in gestational trophoblastic diseases. Several studies have shown that IGF-II is expressed at high levels in hydatidiform moles and choriocarcinoma tissues; however, conflicting data exist on how IGF-II regulates the behaviour of choriocarcinoma cells. The purpose of this study was to determine the contribution of the receptors for IGF-I and insulin to the actions of IGF-II on the regulation of choriocarcinoma cells metastasis. An Immuno Radio Metric Assay was used to analyse the circulating and tissue levels of IGF-I and IGF-II in 24 cases of hydatidiform mole, two cases of choriocarcinoma and eight cases of spontaneous abortion at the same gestational age. The JEG-3 choriocarcinoma cell line was used to investigate the role of IGF-II in the regulation of cell invasion. We found that mole and choriocarcinoma tissue express high levels of IGF-II compared to first trimester placenta. Both IGF-I and IGF-II regulate choriocarcinoma cell invasion in a dose dependent manner but through a different mechanism. IGF-II effects involve the activation of the InsR while IGF-I uses the IGF-IR. The positive effects of IGF-II on invasion are the result of enhanced cell adhesion and chemotaxis (specifically towards collagen IV). The actions of IGF-II but not those of IGF-I were sensitive to inhibition by the insulin receptor inhibitor HNMPA(AM)3. Our results demonstrate that the insulin receptor regulates choriocarcinoma cell invasion.
Assuntos
Antígenos CD/metabolismo , Coriocarcinoma/secundário , Fator de Crescimento Insulin-Like II/fisiologia , Receptor de Insulina/metabolismo , Neoplasias Uterinas/patologia , Adulto , Adesão Celular , Linhagem Celular Tumoral , Movimento Celular , Coriocarcinoma/metabolismo , MAP Quinases Reguladas por Sinal Extracelular/metabolismo , Feminino , Humanos , Fator de Crescimento Insulin-Like I/análise , Fator de Crescimento Insulin-Like I/farmacologia , Fator de Crescimento Insulin-Like I/fisiologia , Fator de Crescimento Insulin-Like II/análise , Fator de Crescimento Insulin-Like II/farmacologia , Naftalenos/farmacologia , Organofosfonatos/farmacologia , Gravidez , Proteínas Proto-Oncogênicas c-akt/metabolismo , Receptor IGF Tipo 1/metabolismo , Receptor de Insulina/agonistas , Neoplasias Uterinas/metabolismoRESUMO
We hereby present a clinical case of a germinal tumour with a pulmonary and retroperitoneal dissemination in form of a great adenopathic mass that fistulizes into the duodenum, that obtained a complete resolution with chemotherapy.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Coriocarcinoma/secundário , Duodenopatias/etiologia , Fístula Intestinal/etiologia , Neoplasias Retroperitoneais/secundário , Neoplasias Testiculares/tratamento farmacológico , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Bleomicina/administração & dosagem , Coriocarcinoma/complicações , Coriocarcinoma/diagnóstico por imagem , Coriocarcinoma/tratamento farmacológico , Cisplatino/administração & dosagem , Criptorquidismo/complicações , Etoposídeo/administração & dosagem , Humanos , Masculino , Indução de Remissão , Neoplasias Retroperitoneais/complicações , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/tratamento farmacológico , Fumar , Neoplasias Testiculares/complicações , Tomografia Computadorizada por Raios XRESUMO
Las matástasis cutáneas son infrecuentes y excepcionalmente provienen de una neoplasia de testículo. Se presenta un paciente de sexo masculino con metástasis cutánea como primera manifestación de un coriocarcinoma de testículo. El diagnóstico fue realizado por biopsia de dicha lesión cutánea. Se comenta la frecuencia de las metástasis cutáneas en la población oncológica y se efectúa una revisión de la literatura (AU)
Assuntos
Masculino , Adulto , Humanos , Neoplasias Cutâneas/secundário , Neoplasias Testiculares/patologia , Coriocarcinoma/secundário , Metástase NeoplásicaRESUMO
A 26-year-old pregnant woman presenting with repeated episodes of vaginal bleeding, weight loss, and shortness of breath was diagnosed with choriocarcinoma with metastases to both lungs. Chorionic gonadotropin levels (hCG) were >2.5 x 10(6)mU/mL. Consistent with hCG-induced subclinical hyperthyroidism, she had a suppressed TSH of 0.037 mU/L (0.49 - 4.67), a T4 of 18.1 microg/dL (4.9 - 10.7), and T3 of 136 ng/dL (45 - 137). Chemotherapy with a combined regimen with etoposide, methotrexate, and dactinomycine was started. The initial course was complicated by urosepsis with respiratory distress requiring endotracheal intubation for 3 days. She then improved rapidly, and her thyroid function tests were within normal limits by day 12. Six months later, after ten cycles of chemotherapy, the patient was in remission without signs of residual tumor or hCG-induced paraneoplastic activity.
Assuntos
Coriocarcinoma/secundário , Gonadotropina Coriônica/metabolismo , Hipertireoidismo/etiologia , Neoplasias Pulmonares/secundário , Neoplasias Uterinas/patologia , Adulto , Feminino , Humanos , Hipertireoidismo/tratamento farmacológico , Gravidez , Receptores da Tireotropina/metabolismo , Testes de Função TireóideaRESUMO
Relatamos o caso de uma gestante de 26 anos apresentando episódios de sangramento vaginal, perda ponderal e dispnéia, que recebeu o diagnóstico de coriocarcinoma com metástases pulmonares. O nível de gonadotrofina coriônica (hCG) era >2,5 x 106mU/mL. O TSH era de 0,037mU/L (0,49 - 4,67), o T4 de 18,1ug/dL (4,9 - 10,7), e o T3 de 136ng/dL (45 - 137), confirmando o quadro de hipertireoidismo subclínico induzido pela hCG. A paciente foi submetida a um regime combinado de quimioterapia com etoposídeo, metotrexate e dactiomicina. A evolucão inicial foi complicada por um quadro de urosepsis com insuficiência respiratória, necessitando entubacão endotraqueal por 3 dias. Após, houve melhora progressiva com normalizacão dos testes de funcão tireoideana no 12º dia de internamento. Após 6 meses e 10 ciclos de quimioterapia, a paciente estava em remissão e sem sinais de tumor residual ou de atividade paraneoplásica dependente de hCG.