Chemo-resistant choriocarcinoma cured by pulmonary lobectomy and craniotomy

This is a case report of a 31 year-old female with choriocarcinomatous metastasis in brain and lung. Her serum beta-HCG level rose six times following normalization during 61 months of diverse multiagent systemic chemotherapy. Pulmonary lobectomy was done in March 1997 (57 months after initial diagnosis) due to persistent pulmonary nodule and poor response to chemotherapy. Histologic examination disclosed metastatic choriocarcinoma. However, her serum beta-HCG level did not normalize. Meanwhile, repeated measurement of beta-HCG concentration in cerebrospinal fluid was normal and imaging studies did not indicate evidence of metastasis. Sixty-one months after initial diagnosis fulminant intracerebral hemorrhage made emergency craniotomy mandatory. Histologic examination revealed metastatic choriocarcinoma. Serum beta-HCG levels returned to normal immediately after craniotomy and she reached complete remission after whole brain irradiation in January 2000. She is free of disease 91 months from initial diagnosis. The role of surgery in the treatment of patients with metastatic choriocarcinoma has been diminished by the responsiveness to chemotherapy. However, local resection of metastases still seems to play a significant role in controlling complications of gestational trophoblastic neoplasia and even in curing the disease in a small subset of patients.