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Long-term treatment in infantile choriocarcinoma
1Department of Pediatrics, Hamamatsu University School of Medicine, Japan.
Insights
This study details the treatment of a rare infantile choriocarcinoma causing precocious puberty. A combination of surgery, irradiation, and chemotherapy led to a partially successful outcome in a previously untreatable condition.
Area of Science:
- Pediatric Oncology
- Endocrinology
- Medical Oncology
Background:
- Infantile choriocarcinoma is a rare malignancy with a historically poor prognosis.
- Precocious puberty in infants can be a sign of underlying malignancy, such as choriocarcinoma producing human chorionic gonadotropin (hCG).
Observation:
- A 5-month-old boy presented with precocious puberty due to a choriocarcinoma producing hCG.
- This case represents one of the few reported instances of infantile choriocarcinoma.
Findings:
- A multimodal treatment approach was employed, including embolization of hepatic tumors, irradiation of lung and submandibular tumors, and multi-agent chemotherapy (methotrexate, actinomycin D, cyclophosphamide, etoposide).
- Surgical interventions such as splenectomy and hepatic lobectomy were performed.
- High-dose melphalan followed by autologous marrow reinfusion was used to treat residual hepatic tumors, achieving a partially successful outcome.
Implications:
- This case highlights the potential efficacy of aggressive multimodal therapy in managing rare pediatric malignancies.
- The described treatment protocol offers a potential strategy for previously untreatable infantile choriocarcinoma.
- Further research into novel therapeutic combinations for infantile choriocarcinoma is warranted.
Abstract:
The long-term treatment of a 5 month old boy with precocious puberty secondary to the production of chorionic gonadotropin (hCG) by a choriocarcinoma is described. Of 13 cases of infantile choriocarcinoma reported in the literature, none were successfully treated. The present study describes a partially successful outcome with embolization of a hepatic tumor, irradiation of lung and right submandibular tumors, chemotherapy with methotrexate (MTX), actinomycin D (ACD), cyclophosphamide (CPA) and etoposide (VP16), and splenectomy and hepatic lobectomy. Subsequently, the residual hepatic tumors were treated with high dose melphalan (HDM) followed by reinfusion of unpurged autologous marrow.