Diagnosis and management of a metastatic mixed gestational trophoblastic neoplasia with synchronous primary lung cancer

• Published in: BMJ case reports Vol. 14; no. 5; p. e240606
• Main Authors: Iyengar, Varun, Mistry, Hetal, Hibbitt, Catherine, Shimanovsky, Alexei
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 26.05.2021; BMJ Publishing Group
• Subjects: Abdomen; Biopsy; Case Report; Case reports; Chemotherapy; Female; Gestational Trophoblastic Disease - diagnostic imaging; Gestational Trophoblastic Disease - therapy; Gynecological cancer; Humans; Hysterectomy; Lung cancer; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - therapy; Lymphatic system; Medical diagnosis; Metastasis; Pathology; Patient-centered care; Placenta; Pregnancy; Retrospective Studies; Smooth muscle; Tumors; Ultrasonic imaging; Uterine Neoplasms; Vagina; pathology; medical education; gynecological cancer; lung cancer (oncology)
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2020-240606

Mixed gestational trophoblastic neoplasias (GTNs) are rare placental tumours that arise from abnormal fertilisation events. To date, only 34 patients with mixed GTNs have been reported in the literature. As such, the management of such cases remains challenging. This report presents a case of a mixed GTN that was further complicated by a synchronous primary lung adenocarcinoma. Our patient was initially treated with hysterectomy, with surveillance labwork showing persistence of her malignancy. She then began combination chemotherapy, at the end of which she appeared to be in remission clinically. Unfortunately, subsequent imaging showed the persistence of pulmonary nodules that were ultimately resected, demonstrating a new primary lung adenocarcinoma. At present, she remains free of both cancers 2 years after her initial diagnosis. The complexity of this case underscores the importance of patient-centred treatment for rare tumours and the role of a multidisciplinary team in the effort to provide holistic care.