Published online Oct 26, 2020. doi: 10.12998/wjcc.v8.i20.5036
Peer-review started: May 27, 2020
First decision: June 13, 2020
Revised: June 18, 2020
Accepted: September 1, 2020
Article in press: September 1, 2020
Published online: October 26, 2020
Processing time: 152 Days and 7.4 Hours
Choriocarcinoma is a highly malignant trophoblastic tumor that presents with early symptoms similar to those of an ectopic pregnancy. Here we present a patient with suspected ectopic pregnancy diagnosed by laparoscopic surgery in our hospital. The patient was found to have choriocarcinoma that had metastasized to the lumbar muscle and presented with symptoms similar to those of an ectopic pregnancy.
The patient was a 34-year-old female who complained of amenorrhea lasting 53 d, 7 d of right lower back pain, and 3 d of right lower abdominal pain. Transvaginal ultrasonography revealed the absence of a gestational sac in the uterus and a mass in the left adnexa. After 6 d of re-examination, ultrasound and computed tomography (CT) examination were performed on the mass located in the left adnexa area. We also noted that the patient’s serum β-human chorionic gonadotropin (hCG) level was increased. Considering an ectopic pregnancy, we performed a laparoscopy and hysteroscopy. During the operation, a left ovarian mixed echogenic mass approximately 2.5 cm × 2.0 cm with no villous tissue was found. Postoperative levels of serum hCG continued to increase. Lung CT examination showed lung nodules. Both CT and magnetic resonance imaging showed a mixed echogenic mass in the lumbar muscle. Considering lumbar metastasis of choriocarcinoma, six courses of cisplatin, dactinomycin, and etoposide chemotherapy were given after surgery. The patient’s serum β-hCG level decreased to normal and the mixed echogenic mass in the lumbar muscle decreased in size after the fifth course of chemotherapy. All symptoms subsequently disappeared after treatment.
In summary, lumbar metastasis from choriocarcinoma is extremely rare. Appropriate chemotherapy can successfully treat these metastasized tumors.
Core Tip: Choriocarcinoma is a highly malignant trophoblastic tumor. Depending on the disease site, the clinical manifestations of choriocarcinoma are diverse and unique in each case, making diagnosis a challenge. We report the case of a patient with choriocarcinoma that metastasized to the lumbar muscle and caused symptoms similar to those of an ectopic pregnancy. Considering the lumbar metastasis of choriocarcinoma, 6 courses of cisplatin, dactinomycin, and etoposide chemotherapy were given after surgery. The patient's serum β-human chorionic gonadotropin level decreased to normal and the mixed echogenic mass in the lumbar muscle decreased after the 5th course of chemotherapy, and her symptoms disappeared.