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Haemoptysis from a pulmonary arteriovenous malformation in a post molar pregnancy gestational trophoblast tumour patient managed by radiological embolisation: a case report.

McDonald-Burrows Z, Davies R, Goode E, Clarke C, Jackson J, Seckl M, Savage P - J Med Case Rep (2014)

Bottom Line: These findings were confirmed on emergency pulmonary arteriography, and the pulmonary arteriovenous malformation was successfully embolised.Arteriovenous malformations secondary to gestational trophoblastic tumours at metastatic sites have only been reported in a very limited number of cases.When significant bleeding occurs, as in this case of a pulmonary lesion, urgent referral for embolisation is indicated.

View Article: PubMed Central - HTML - PubMed

Affiliation: BCCA Vancouver Island, Victoria, BC V8R 6V5, Canada. Philip.Savage@bccancer.bc.ca.

ABSTRACT

Introduction: Gestational trophoblastic tumours are a rare form of malignancy, which in the majority of cases arise from abnormal trophoblast cells formed in a complete molar pregnancy. These tumours are extremely sensitive to chemotherapy and high cure rates approaching 100% can be expected. The disease is usually limited to the uterus where the abnormal trophoblast proliferation and human chorionic production can lead to vascular changes including the formation of arteriovenous malformations.

Case presentation: We describe the case of a 28-year-old Caucasian woman who presented to the United Kingdom's Gestational Trophoblast Tumour Service with rising human chorionic gonadotropin levels following a uterine evacuation for a complete molar pregnancy. She was commenced on chemotherapy but subsequently reported two episodes of haemoptysis. Computed tomography imaging demonstrated findings consistent with a pulmonary arteriovenous malformation, probably due to a small pulmonary metastasis, complicated by recent haemorrhage. These findings were confirmed on emergency pulmonary arteriography, and the pulmonary arteriovenous malformation was successfully embolised.

Conclusions: Arteriovenous malformations secondary to gestational trophoblastic tumours at metastatic sites have only been reported in a very limited number of cases. When significant bleeding occurs, as in this case of a pulmonary lesion, urgent referral for embolisation is indicated.

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Postembolization pulmonary arteriogram demonstrates complete occlusion of the pulmonary arteriovenous malformation.
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Figure 3: Postembolization pulmonary arteriogram demonstrates complete occlusion of the pulmonary arteriovenous malformation.

Mentions: She had an unremarkable medical history, with two normal pregnancies, no major surgery or illnesses and no regular medications. The routine investigations demonstrated an hCG value of 2070IU/L, a normal chest X-ray and no visible uterine mass on the pelvic Doppler ultrasound but some increased vascularity. These results confirmed the indications for treatment and produced an International Federation of Gynecology and Obstetrics (FIGO) prognostic score of 1. Following the UK’s standard treatment protocols, chemotherapy treatment was commenced with the low-risk regimen of methotrexate and folinic acid [3].The patient was well 6 weeks after the commencement of chemotherapy but reported two modest episodes of haemoptysis and was readmitted for emergency investigation. Initial blood tests confirmed a normal clotting screen and platelet count, whereas a computed tomography (CT) scan of her thorax demonstrated a 17mm lobulated nodule in the apical segment of her left lower lobe. Surrounding this lesion, there was patchy ground glass opacification consistent with pulmonary haemorrhage (Figure 1). The CT findings were typical of a pAVM, probably due to a small pulmonary metastasis, complicated by recent haemorrhage.An urgent referral was made to the interventional radiology team and emergency pulmonary arteriography confirmed the presence of a pAVM (Figure 2) with two separate feeding vessels. The pAVM was successfully embolised with magnetic resonance-compatible coils as shown in Figure 3 and led to resolution of the haemoptysis. A follow-up thoracic CT 4 years after embolisation confirmed that the pAVM had been cured as shown in Figure 4.


Haemoptysis from a pulmonary arteriovenous malformation in a post molar pregnancy gestational trophoblast tumour patient managed by radiological embolisation: a case report.

McDonald-Burrows Z, Davies R, Goode E, Clarke C, Jackson J, Seckl M, Savage P - J Med Case Rep (2014)

Postembolization pulmonary arteriogram demonstrates complete occlusion of the pulmonary arteriovenous malformation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4066323&req=5

Figure 3: Postembolization pulmonary arteriogram demonstrates complete occlusion of the pulmonary arteriovenous malformation.
Mentions: She had an unremarkable medical history, with two normal pregnancies, no major surgery or illnesses and no regular medications. The routine investigations demonstrated an hCG value of 2070IU/L, a normal chest X-ray and no visible uterine mass on the pelvic Doppler ultrasound but some increased vascularity. These results confirmed the indications for treatment and produced an International Federation of Gynecology and Obstetrics (FIGO) prognostic score of 1. Following the UK’s standard treatment protocols, chemotherapy treatment was commenced with the low-risk regimen of methotrexate and folinic acid [3].The patient was well 6 weeks after the commencement of chemotherapy but reported two modest episodes of haemoptysis and was readmitted for emergency investigation. Initial blood tests confirmed a normal clotting screen and platelet count, whereas a computed tomography (CT) scan of her thorax demonstrated a 17mm lobulated nodule in the apical segment of her left lower lobe. Surrounding this lesion, there was patchy ground glass opacification consistent with pulmonary haemorrhage (Figure 1). The CT findings were typical of a pAVM, probably due to a small pulmonary metastasis, complicated by recent haemorrhage.An urgent referral was made to the interventional radiology team and emergency pulmonary arteriography confirmed the presence of a pAVM (Figure 2) with two separate feeding vessels. The pAVM was successfully embolised with magnetic resonance-compatible coils as shown in Figure 3 and led to resolution of the haemoptysis. A follow-up thoracic CT 4 years after embolisation confirmed that the pAVM had been cured as shown in Figure 4.

Bottom Line: These findings were confirmed on emergency pulmonary arteriography, and the pulmonary arteriovenous malformation was successfully embolised.Arteriovenous malformations secondary to gestational trophoblastic tumours at metastatic sites have only been reported in a very limited number of cases.When significant bleeding occurs, as in this case of a pulmonary lesion, urgent referral for embolisation is indicated.

View Article: PubMed Central - HTML - PubMed

Affiliation: BCCA Vancouver Island, Victoria, BC V8R 6V5, Canada. Philip.Savage@bccancer.bc.ca.

ABSTRACT

Introduction: Gestational trophoblastic tumours are a rare form of malignancy, which in the majority of cases arise from abnormal trophoblast cells formed in a complete molar pregnancy. These tumours are extremely sensitive to chemotherapy and high cure rates approaching 100% can be expected. The disease is usually limited to the uterus where the abnormal trophoblast proliferation and human chorionic production can lead to vascular changes including the formation of arteriovenous malformations.

Case presentation: We describe the case of a 28-year-old Caucasian woman who presented to the United Kingdom's Gestational Trophoblast Tumour Service with rising human chorionic gonadotropin levels following a uterine evacuation for a complete molar pregnancy. She was commenced on chemotherapy but subsequently reported two episodes of haemoptysis. Computed tomography imaging demonstrated findings consistent with a pulmonary arteriovenous malformation, probably due to a small pulmonary metastasis, complicated by recent haemorrhage. These findings were confirmed on emergency pulmonary arteriography, and the pulmonary arteriovenous malformation was successfully embolised.

Conclusions: Arteriovenous malformations secondary to gestational trophoblastic tumours at metastatic sites have only been reported in a very limited number of cases. When significant bleeding occurs, as in this case of a pulmonary lesion, urgent referral for embolisation is indicated.

Show MeSH
Related in: MedlinePlus