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Gestational trophoblastic tumor with liver metastatsis after misoprostol abortion

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Abstract

Background

Early elective medical abortion is performed frequently in different countries of the world. Serious complications like gestational trophoblastic neoplasia (GTN) are uncommon and mostly nonmetastatic. High risk metastatic GTN following medical abortion is a rare event which may occur coincidentally.

Case

A 26 year-old-woman, gravida 2 para 1, 6 weeks after misoprostol abortion presented with sever nausea, vomiting, and right upper abdominal pain. Human chorionic gonadotropin (hCG) level was 2,500,000 mIU/ml and metastatic work up revealed multiple liver metastases. She totally received nine cycles of EMA-CO (ethoposide- methotrexate- actinomycin- cyclophosphamide, vincristine) regimen for treatment and consolidation. Six months after treatment she is in complete remission.

Conclusion

Follow up of patients after medical abortion by means of single serum hCG measurement is highly recommended for early diagnosis of complications including gestational trophoblastic tumor. EMA-CO regimen seems to be an effective and safe treatment for liver metastatic gestational trophoblastic neoplasia.

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References

  1. Bakri YN, Subhi J, Amer M, Ezzat A, Sinner W, Tweijry A, Jabbar FA (1993) Liver metastases of gestational trophoblastic tumor. Gynecol Oncol Volume 48(1):110–113

    Article  CAS  Google Scholar 

  2. Barnard DE, Woodward KT, Yancey SG, Weed JC Jr, Hammond CB (1986) Hepatic metastases of choriocarcinoma: a report of 15 patients. Gynecol Oncol 25(1):73–83. doi:10.1016/0090-8258(86)90067-3

    Article  PubMed  CAS  Google Scholar 

  3. Berkowitz RS, Goldstein DP (2005) Gestational trophoblastic Disease. In: Hoskins WJ, Perez CA, Young RC, Barakat R, Markman M, Randall M (eds) Principles and practice of gynecologic oncology, 4th edn. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  4. Escobar PF, Lurain JR, Singh DK, Bozorgi K, Fishman DA (2003) Treatment of high- risk gestational trophoblastic neoplasia with etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine chemotherapy. Gynecol Oncol 91(3):552. doi:10.1016/j.ygyno.2003.08.028

    Article  PubMed  CAS  Google Scholar 

  5. Fiala C, Safar P, Bygdeman M, Gemzell-Danielsson K (2003) Verifying the effectiveness of medical abortion; ultrasound versus hCG testing. Eur J Obstet Gynecol Reprod Biol 109(2):190–195. doi:10.1016/S0301-2115(03)00012-5

    Article  PubMed  CAS  Google Scholar 

  6. Hershman JM (2004) Physiological and pathological aspects of the effect of human chorionic gonadotropin on the thyroid. Best Pract Res Clin Endocrinol Metab 18(2):249–265. doi:10.1016/j.beem.2004.03.010

    Article  PubMed  CAS  Google Scholar 

  7. Jin L, Fan G, Yang X (2000) Clinical study of four cases with malignant gestational trophoblastic tumor after mifepristone abortion. Zhonghua Fu Chan Ke Za Zhi 35(12):733–735

    PubMed  CAS  Google Scholar 

  8. Kato K, Mostafa MH, Mann K, Schindler AE, Hoermann R (2004) The human chorionic gonadotropin molecule from patients with trophoblastic diseases has a high thyrotropic activity but is less active in the ovary. Gynecol Endocrinol 18(5):269–277. doi:10.1080/09513590410001667247

    Article  PubMed  CAS  Google Scholar 

  9. Lichtenberg ES (2003) Gestational trophoblastic tumor after medical abortion. Obstet Gynecol 101(5 Pt 2):1137–1139. doi:10.1016/S0029-7844(03)00062-0

    Article  PubMed  Google Scholar 

  10. Lyon FA, Adcock LL (1980) Choriocarcinoma presenting as a complication of elective first trimester abortion. Minn Med 63(10):733–735

    PubMed  CAS  Google Scholar 

  11. Paul M, Schaff E, Nichols M (2000) The roles of clinical assessment, human chorionic gonadotropin assays, and ultrasonography in medical abortion practice. Am J Obstet Gynecol 183(Suppl 2):s34–s43. doi:10.1067/mob.2000.108230

    Article  PubMed  CAS  Google Scholar 

  12. Soper JT, Mutch DG, Schink JC (2004) Diagnosis and treatment of gestational trophoblastic disease: ACOG practice Bulletin No. 53. Gynecol Oncol 93:575–585. doi:10.1016/j.ygyno.2004.05.013

    Article  PubMed  Google Scholar 

  13. Valenzuela CY (2003) Scientific ethics of therapeutic abortion. Rev Med Chil 131(5):562–568

    PubMed  Google Scholar 

  14. Xiang Y, Yang X, Yang N, Chen C, Cao T, Song H (2000) Diagnosis and management of gestational trophoblastic tumor with liver metastases. Zhongguo UI Xue Ke Xue Yuan Xue Bao 22(1):41–43

    CAS  Google Scholar 

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Authors and Affiliations

  1. Gynecology Oncology Department, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran

    S. A. Mousavi & F. Behnamfar

  2. Kashan University of Medical Sciences, Kashan, Iran

    F. Behnamfar

Authors
  1. S. A. Mousavi
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  2. F. Behnamfar
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Correspondence to F. Behnamfar.

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Mousavi, S.A., Behnamfar, F. Gestational trophoblastic tumor with liver metastatsis after misoprostol abortion. Arch Gynecol Obstet 279, 587–590 (2009). https://doi.org/10.1007/s00404-008-0756-7

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  • DOI: https://doi.org/10.1007/s00404-008-0756-7

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