Rare ultrasound image of malignant trophoblastic tumor
Chekalova M.A., Meshcheryakova L.A., Streltsova O.N., Cherkasov E.Yu., Berdnikov S.N., Torosyan I.V.
Background: Ultrasound assessment of the pelvic organs, along with the serum levels of human chorionic gonadotropin (hCG) is a key step in the diagnosis of malignant trophoblastic tumors. However, despite the great experience and achieved success in ultrasound diagnosis of trophoblastic tumors, rare types of the disease are associated with an unusual picture; thus, it is necessary to perform additional magnetic resonance imaging with a comprehensive evaluation of the obtained data by a group of experts in the field of diagnosis and treatment of trophoblastic disease.
Case report: This case study presents an observation of an atypical clinical picture of placental site trophoblastic tumor in a 37-year-old patient. During the diagnostic phase, an ambiguous ultrasound image of trophoblastic tumor was obtained. The diagnosis was made by a group of experts in the field of trophoblast pathology on the basis of obstetric history and examination findings: slightly elevated hCG with a tendency to slow increase with a massive locally advanced tumor process in the pelvis according to ultrasound examination and MRI, and high placental lactogen levels. EMA-ER chemotherapy was prescribed. The patient underwent a total of 5 courses of chemotherapy according to the recommended scheme; the 6th course was terminated due to complications. Taking into account the resistance of placental site trophoblastic tumor to standard high-dose chemotherapy which is accompanied by severe complications, immunotherapy was administered to the patient according to the following scheme: pembrolizumab 200 mg intravenously 1 h every 3 weeks in a day hospital. During treatment, hCG and echography indicators were monitored every 3 months; positive dynamics was noted. There were 24 cycles of pembrolizumab, the last 4 were consolidation ones. Complete clinical remission was confirmed. Menstrual function gradually restored.
Conclusion: In this clinical observation, the treatment was successfully achieved through the combination of standard high-dose chemotherapy and immunotherapy, which represents a novel approach. The result was not only a cure, but also the preservation of the young patient’s ability to have children in the future. Thus, consolidation of knowledge and clinical experience of experts in the field of diagnosis and treatment of trophoblast pathology should always be the standard of specialized medical care for patients with this disease.
Authors’ contributions: Chekalova M.A., Torosyan I.V. – concept and design of the study, writing the text, editing; Meshcheryakova L.A., Chekalova M.A., Torosyan I.V. – preparation of material, editing; Berdnikov S.N. – concept and design of the study, material collection; Cherkasov E.Yu. – concept and design of the study, editing; Streltsova O.N. – collection and editing of material.
Conflicts of interest: Authors declare lack of the possible conflicts of interests.
Funding: The study was carried out without sponsorship.
Patient Consent for Publication: The patient provided an informed consent for the publication of her data and associated images.
For citation: Chekalova M.A., Meshcheryakova L.A., Streltsova O.N., Cherkasov E.Yu., Berdnikov S.N., Torosyan I.V. Rare ultrasound image of malignant trophoblastic tumor.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (9): 198-205 (in Russian)
https://dx.doi.org/10.18565/aig.2024.131
Keywords
malignant trophoblastic tumors
placental site trophoblastic tumors
ultrasonography
magnetic resonance imaging
placental lactogen
arteriovenous malformations
chemotherapy
immunotherapy
References
- WHO Classification of Tumours Editorial Board. WHO Classification of Tumours. Female genital tumours. 5th ed. Vol. 4. Geneva: WHO; 2020. 641p.
- Новикова Л.А., Григорова Т.М. Хорионэпителиома матки. Л.: Медицина; 1968. 160 c. [Novikova L.A., Grigorova T.M. Uterine chorionepithelioma. Leningrad: Medicine; 1968. 160 p. (in Russian)].
- Мещерякова Л.А. Трофобластическая болезнь. В кн.: Каприн А.Д., Ашрафян Л.А., Стилиди И.С., ред. Онкогинекология: национальное руководство. М: ГЭОТАР-Медиа; 2019: 273-93. [Meshcheryakova L.A. Trophoblastic disease. In: Kaprin A.D., Ashrafyan L.A., Stilidi I.S., ed. Oncogynecology: a national guide. Moscow: GEOTAR-Media; 2019: 273-93. (in Russian)].
- Чекалова М.А. Ультразвуковая диагностика в онкогинекологии. В кн.: Каприн А.Д., Ашрафян Л.А., Стилиди И.С., ред. Онкогинекология: национальное руководство. М: ГЭОТАР-Медиа; 2019. Раздел II: 1-50. [Chekalova M.A. Ultrasound diagnostics in oncogynecology. In: Kaprin A.D., Ashrafyan L.A., Stilidi I.S., ed. Oncogynecology: a national guide. Moscow: GEOTAR-Media; 2019. Part II: 1-50. (in Russian)].
- Мартусова Ю.С., Чекалова М.А., Мещерякова Л.А., Мороз Е.А. Опыт ультразвуковой диагностики трофобластической опухоли плацентарного ложа. Ультразвуковая и функциональная диагностика. 2014; 4: 42-9. [Martusova Yu.S., Chekalova M.A., Meshcheryakova L.A., Moroz E.A. Ultrasound of placental site trophoblastic tumor. Ultrasound and Functional Diagnostics. 2014; (4): 42-9. (in Russian)].
- Agarwal R., Harding V., Short D., Fisher R.A., Sebire N.J., Harvey R. et al. Uterine artery pulsatility index: a predictor of methotrexate resistance in gestational trophoblastic neoplasia. Br. J. Cancer. 2012; 106(6): 1089-94. https://dx.doi.org/10.1038/bjc.2012.65.
- Zhou Y., Lu H., Yu C., Tian Q., Lu W. Sonographic characteristics of placental site trophoblastic tumor. Ultrasound Obstet. Gynecol. 2013; 41(6): 679-84. https://dx.doi.org/10.1002/uog.12269.
- Мещерякова Л.А., Жарова А.С., Масленников А.Ф., Чекалова М.А., Комаров И.Г., Мещерякова Н.А., Давыдова И.Ю., Гиголаева Н.М., Мещеряков А.А. Резистентные трофобластические опухоли. Современные возможности лечения. Медицинский оппонент. 2021; 2: 70-80. [Meshcheryakova L.A., Zharova A.S., Maslennikov A.F., Chekalova M.A., Komarov I.G., Meshcheryakova N.A., Davydova I.Yu., Gigolaeva N.M., Meshcheryakov A.A. Resistant trophoblastic tumors. Modern treatment options. Medical Opponent. 2021; (2): 70-80. (in Russian)].
- Каприн А.Д., Старинский В.В., Петрова Г.В., ред. Злокачественные новообразования в России в 2017 году (заболеваемость и смертность). М.: МНИОИ им. П.А. Герцена - филиал ФГБУ «НМИЦ радиологии» Минздрава России; 2018. 250 c. [Kaprin A.D., Starinsky V.V., Petrova G.V., ed. Malignant neoplasms in Russia in 2017 (morbidity and mortality). Moscow: MNIOI im. P.A. Herzena - filial FGBU “NMITs radiologii” Minzdrava Rossii; 2018. 250 p. (in Russian)].
- Sheikhhasani S., Abdolrazaghnejad A., Mousavi A.S., Akhavan S., Zamani N., Feizabad E. Resistance to single-agent chemotherapy in low-risk gestational trophoblastic neoplasia. Caspian J. Intern. Med. 2023; 14(1): 47-52. https://dx.doi.org/10.22088/cjim.14.1.47.
- Мещерякова Л.А., Жарова А.С., Масленников А.Ф., Кузнецов В.В., Чекалова М.А., Комаров И.Г., Давыдова И.Ю., Молчанов Г.В., Гиголаева Н.М., Мещеряков А.А. Опыт лечения рецидивов злокачественных трофобластических опухолей. Российский онкологический журнал. 2020: 25(1): 9-16. [Meshcheryakova L.A., Zharova A.S, Maslennikov A.F., Kuznetsov V.V., Chekalova M.A., Komarov I.G., Davydova I.Yu., Molchanov G.V., Gigolaeva N.M., Meshcheryakov A.A. Treatment of relapses of gestational trophoblastic neoplasias. Russian Journal of Oncology. 2020: 25(1): 9-16. (in Russian)]. https://dx.doi.org/10.18821/1028-9984-2020-25-1-9-16.
- Русакевич П.С., Литвинова Т.М. Трофобластическая болезнь: диагностический и лечебный менеджмент. Минск: БелМАПО; 2016. 141 c. [Rusakevich P.S., Litvinova T.M. Trophoblastic disease: diagnostic and medical management. Minsk: BelMAPO; 2016. 141 p. (in Russian)].
- Mousavi Seresht L., Farazestanian M., Yousefi Z. Single-agent chemotherapy in low-risk gestational trophoblastic neoplasia. Caspian J. Intern. Med. 2023; 14(1): 108-11. https://dx.doi.org/10.22088/cjim.14.1.108.
- Agarwal R., Strickland S., McNeish I.A., Patel D.C., Foskett M., Boultbee J.E. et al. Doppler ultrasonography of the uterine artery and the response to chemotherapy in patients with gestational trophoblastic tumors. Clin. Cancer Res. 2002; 8(5): 1142-7.
- Betel C., Atri M., Arenson A.M., Khalifa M., Osborne R., Tomlinson G. Sonographic diagnosis of gestational trophoblastic disease and comparison with retained products of conception. J. Ultrasound Med. 2006; 25(8): 985-93. https://dx.doi.org/10.7863/jum.2006.25.8.985.
- Cavoretto P., Gentile C., Mangili G., Garavaglia E., Valsecchi L., Spagnolo D. et al. Transvaginal ultrasound predicts delayed response to chemotherapy and drug resistance in stage I low-risk trophoblastic neoplasia. Ultrasound Obstet. Gynecol. 2012; 40(1): 99-105. https://dx.doi.org/10.1002/uog.11097.
- Кондриков Н.И., Баринова И.В. Патология матки. Руководство для врачей. 2-е изд. М: Практическая медицина; 2019. 347 c. [Kondrikov N.I., Barinova I.V. Uterine pathology. A guide for doctors. 2nd ed. Moscow: Practical Medicine; 2019. 347 p. (in Russian)].
- Мещерякова Л.А., Гасанбекова З.А., Кузнецов В.В., Козаченко В.П., Алиев С.А., Чекалова М.А., Давыдова И.Ю., Мещеряков А.А. Ошибки в диагностике и лечении злокачественных трофобластических опухолей. Влияние на течение болезни и прогноз. Медицинский оппонент. 2019; 5(1): 31-6. [Meshcheryakova L.A., Gasanbekova Z.A., Kuznetsov V.V., Kozachenko V.P., Aliev S.A., Chekalova M.A., Davydova I.Yu., Meshcheryakov A.A. Errors in the diagnosis and treatment of malignant trophoblastic tumors. Effects on disease course and prognosis. Medical Opponent. 2019; 5(1): 31-6. (in Russian)].
Received 30.05.2024
Accepted 10.09.2024
About the Authors
Marina A. Chekalova, Dr. Med. Sci., Professor, Doctor of Ultrasound Diagnostics, Federal Scientific and Clinical Center for Specialized Types of Medical Care and Medical Technologies FMBA of Russia, +7(495)145-60-52, 115682 , Russia, Moscow, Orekhovy Boulevard str., 28, ch2me@yandex.ruLyudmila A. Meshcheryakova, Dr. Med. Sci., Professor, Oncologist, Yu.M. Lopukhin Federal Scientific and Clinical Center for Physical and Chemical Medicine FMBA of Russia, 119435, Russia, Moscow, Malaya Pirogovskaya str., 1-3, +7(499) 246-77-21.
Olga N. Streltsova, PhD, Radiologist, European Medical Center, 129090, Russia, Moscow, Shchepkin str., 35, +7(499)283-32-24.
Evgeniy Yu. Cherkasov, PhD, Head of Gynecological Department, Obstetrician-Gynecologist, Polyclinic No. 2 of the Medical Unit of the Ministry of Internal Affairs of Russia
in Moscow, 115054, Russia, Moscow, Zatsepa str., 38, +7(499)236-03-08.
Sergey N. Berdnikov, PhD, Head of the Department of Ultrasound Diagnostics, N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia, 115478, Russia, Moscow, Kashirskoe highway, 23, +7(499)444-24-24.
Ilona V. Torosyan, Ultrasound Diagnostics Doctor, N.N. Blokhin National Medical Research Center of Oncology, Ministry of Health of Russia,
115478, Russia, Moscow, Kashirskoe highway, 23, +7(499)444-24-24, intriga8686@yandex.ru
Corresponding author: Marina A. Chekalova, ch2me@yandex.ru
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