Cancer Res Treat.  2017 Jan;49(1):279-282. 10.4143/crt.2016.125.

Treatment of Pulmonary Tumor Embolism from Choriocarcinoma: Extracorporeal Membrane Oxygenation as a Bridge through Chemotherapy

• Chung JH
• Yeo HJ
• Cho HM
• Jang JO
• Ye BM
• Yoon G
• Shin DH
• Kim D
• Cho WH

• KMID: 2367526
• DOI: http://doi.org/10.4143/crt.2016.125

Abstract

A 22-year-old woman with a 1-month history of shortness of breath that was treated as a case of tuberculosis and pulmonary embolism was referred to the authors' hospital. Because of the hemodynamic instability in this patient, venoarterial extracorporeal membrane oxygenation (ECMO) was administered in the intensive care unit. She underwent a pulmonary embolectomy for the treatment of progressive circulatory collapse secondary to a pulmonary embolism. The histopathologic result was consistent with a metastatic choriocarcinoma. Despite the surgical management, persistent refractory cardiogenic shock occurred. Subsequently, the patient was treated with chemotherapy in the presence of ECMO and responded well to chemotherapy. She was discharged after 3 months. This case suggests that metastatic choriocarcinoma should be considered as a differential diagnosis in women of childbearing age presenting with a pulmonary embolism, and ECMO may be beneficial in patients with pulmonary embolism for bridging to surgical embolectomy and chemotherapy.

Keyword

Choriocarcinoma; Pulmonary embolism; Extracorporeal membrane oxygenation

MeSH Terms

Choriocarcinoma*
Diagnosis, Differential
Drug Therapy*
Dyspnea
Embolectomy
Extracorporeal Membrane Oxygenation*
Female
Hemodynamics
Humans
Intensive Care Units
Neoplastic Cells, Circulating*
Pregnancy
Pulmonary Embolism
Shock
Shock, Cardiogenic
Tuberculosis
Young Adult

Figure

• 

  Fig. 1. (A) A chest enhanced computed tomography, demonstrating a filling defect in the left inferior pulmonary artery. (B) Pulmonary angiography, showing a large filling defect in the left pulmonary artery.

• 

  Fig. 2. (A) Diffuse sheets of cytotrophoblastic and syncytiotrophoblastic cells (H&E staining, ×400). (B) Tumor cells with diffuse positive cytoplasmic immunostaining for beta human chorionic gonadotropin (×100). (C) Tumor cells with positivity for pan cytokeratin (×40).

Reference

References

1. Khakural P, Shrestha KR, Sapkota R, Shrestha UK. An unusual case of pulmonary embolism. J Surg Case Rep. 2015; 2015:rjv006.

2. Yang L, Xu P, Xi M, Wang H. FIGO stage IV gestational choriocarcinoma misdiagnosed as pulmonary tuberculosis: a case report. Oncol Lett. 2015; 10:1924–6.

3. Watanabe S, Shimokawa S, Sakasegawa K, Masuda H, Sakata R, Higashi M. Choriocarcinoma in the pulmonary artery treated with emergency pulmonary embolectomy. Chest. 2002; 121:654–6.

4. Darze ES, Latado AL, Guimaraes AG, Guedes RA, Santos AB, de Moura SS, et al. Acute pulmonary embolism is an independent predictor of adverse events in severe decompensated heart failure patients. Chest. 2007; 131:1838–43.

5. Chowdhury MA, Moza A, Siddiqui NS, Bonnell M, Cooper CJ. Emergent echocardiography and extracorporeal membrane oxygenation: Lifesaving in massive pulmonary embolism. Heart Lung. 2015; 44:344–6.

6. Worku B, DeBois W, Sobol I, Gulkarov I, Horn EM, Salemi A. Extracorporeal membrane oxygenation as a bridge through chemotherapy in B-cell lymphoma. J Extra Corpor Technol. 2015; 47:52–4.