A Case of Misdiagnosed Gestational TrophoblasticNeoplasia with Brain and Lungs Metastasis;Complications and Modified Treatment: A Case Report

Introduction:

 Timely diagnosis of gestational trophoblastic neoplasia (GTN) is essential for successful management of the condition and preservation of fertility. The aim of the present study was to describe a case of misdiagnosis GTN with brain and lungs metastasis.

Patient information :

the present case study was conducted in Imam Khomeini hospital, Tehran, Iran, in 2017. A 35-year-old woman presented with acute headaches and left hemiplegia one month after the conclusion of her term pregnancy. The patient was previously diagnosed as a case of subarachnoid hemorrhage and inferior sagittal sinus thrombosis and was unsuccessfully treated with anticoagulant drugs leading to worsening signs and symptoms. Her initial β-hCG at admission to the hospital was 22,000,000IU/L, which lead to diagnosis of GTN with extensive metastatic lesions in the lungs and brain. Due to extensive intracranial hemorrhage, the patient was first treated with whole brain radiation therapy for 10 sessions daily (Total Dose=3000cGy). EMA-EP treatment was initially withheld due to concern for bleeding during concurrent radiation therapy. Following the brain radiation therapy, the chemotherapy was started for the patient. Upon completion of 3 cycles of EMAEP, the patient’s hCG was lowered to 5IU/L. The treatment was continued for 5 more cycles and resulted in hCG reading of under 2IU/L at her last visit.

Conclusion :

This case highlights the variable presentation of GTN which might easily cause misdiagnosis and delayed treatment and shows excellent response to treatment despite late treatment and massive tumor burden with some modifications to plan of treatment