以難治性血尿表現的絨毛膜癌腎臟轉移－病例報告
江佩璋、高建璋、查岱龍、趙載光1、吳勝堂
三軍總醫院 外科部 泌尿外科，1病理部
Renal Metastasis from Choriocarcinoma Presenting as Intractable Hematuria:
Case Report and Literature Review
Pei-Jhang Chiang, Chien-Chang Kao, Tai-Lung Cha, Tai-Kuang Chao, Sheng-Tang Wu
Division of Urology, Department of Surgery and Department of Pathology1,
Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
Introduction: Choriocarcinoma, a subtype of gestational trophoblastic neoplasia, is considered as an aggressive and highly vascular tumor. Although choriocarcinoma was described as early hematogenous dissemination to lungs, liver, brain, and other visceral sites. Renal metastases were rare in literatures, and definite diagnosis was often confirmed following nephrectomy. Renal metastasis from choriocarcinoma is typically encountered by gynecologists, and most urologists are not familiar with this disease until referral.
Case report: A young female presented intermittent painless gross hematuria for months. Arteriovenous malformation with bleeding in the right kidney was suspected based on computed tomography scan. We performed right radical nephrectomy after failure of transarterial embolization. The nephrectomy specimen revealed gestational metastatic choriocarcinoma. Following computed tomography showed pulmonary metastases. But there was no tumor in the uterine cavity could be seen on pelvic ultrasound. Both single-agent adjuvant chemotherapy with methotrexate and cisplatin-based chemotherapy were failed based on elevated serum β-hCG. The patient is now still under treatment.
Conclusion: Choriocarcinoma is a rare but aggressive disease and easily distant metastases. The variant clinical manifestations depend on the nature of the primary tumor and the spread to distant organs. In young women suffering from intractable hematuria, unusual renal tumor and pulmonary metastasis, the diagnosis of renal metastasis from choriocarcinoma should be considered.