Choriocarcinoma: An unusual cause of hemoptysis

• Published in: The Journal of respiratory diseases Vol. 29; no. 10; p. 376
• Main Authors: John, Bijo K, Luo, Jean J, Lee, Paul C, Fleming, Robert A
• Format: Journal Article
• Language: English
• Published: Darien MultiMedia Healthcare Inc 01.10.2008
• ISSN: 0194-259X

Laboratory findings included the following values: hemoglobin, 12.1 g/dL; white blood cell count, 10,000/µL platelet count, 440,000 I\\L] activated partial thromboplastin time, 26.5 seconds; prothrombin time, 13.0 seconds; and international normalized ratio, 1.28. Arterial blood gas analysis (fraction of inspired oxygen, 50%) revealed a pH of 7.44; PcO^sub 2^ of 46 mm Hg; PO^sub 2^ of 90 mm Hg; and bicarbonate level of 20.5 mmol/L. Renal function and electrolyte levels were normal. The urinalysis was positive for β-human chorionic gonadotropin (β-HCG). The serum β-HCG level was elevated to 36,832 mlU/mL. Her serum β-HCG levels started increasing despite chemotherapy. Paclitaxel and cisplatin subsequently were added to the chemotherapy regimen. The patient's βHCG level dropped over the next several months to less than 1000 mlU/mL but then started to rise again. On readmission, a recurrence of pleural effusion was noted, and a chest tube was placed. One week after surgery, the patient was discharged. She was scheduled to receive the same chemotherapy regimen. Three months later, her β-HCG level was 12 mlU/mL. She was able to obtain records of her previous abortion, which revealed that she had had a molar pregnancy with a documented β-HCG level of 200,000 mlU/mL before the abortion. Choriocarcinoma belongs to a class of heterogeneous disorders defined as gestational trophoblastic disease (GTD). It primarily arises from abnormal proliferation of the trophoblastic epithelium of the placenta.1 This class of tumors has a distinct tumor marker, β-HCG, which helps in diagnosis, management, and monitoring response to treatment. The values in GTD are usually more than 100,000 mlU/mL. Histologically there are 5 types of GTD: