The online version of this article (doi:10.1186/1752-1947-8-117) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
All the authors have read and approved the final version of this manuscript. RD, EG, CC and PS were involved in writing the manuscript. RD and ZMB compiled the final draft of the manuscript. PS revised the manuscript critically and was a major contributor in writing the manuscript. JJ provided the radiological input for the case and prepared the images. EG, CC, JJ, MS and PS were involved in the clinical care of the patient. PS is the corresponding author.
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.
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.
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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McGrath S, Harding V, Lim AK, Burfitt N, Seckl MJ, Savage P: Embolization of uterine arteriovenous malformations in patients with gestational trophoblastic tumors: a review of patients at Charing Cross Hospital, 2000-2009. J Reprod Med. 2012, 57: 319-324. PubMed
Savage P, Williams J, Wong SL, Short D, Casalboni S, Catalano K, Seckl M: The demographics of molar pregnancies in England and Wales from 2000-2009. J Reprod Med. 2010, 55: 341-345. PubMed
Sita-Lumsden A, Short D, Lindsay I, Sebire NJ, Adjogatse D, Seckl MJ, Savage PM: Treatment outcomes for 618 women with gestational trophoblastic tumours following a molar pregnancy at the Charing Cross Hospital, 2000-2009. Br J Cancer. 2012, 107: 1810-1814. 10.1038/bjc.2012.462. CrossRefPubMedPubMedCentral
Berndt S, Perrier d'Hauterive S, Blacher S, Péqueux C, Lorquet S, Munaut C, Applanat M, Hervé MA, Lamandé N, Corvol P, van den Brûle F, Frankenne F, Poutanen M, Huhtaniemi I, Geenen V, Noël A, Foidart JM: Angiogenic activity of human chorionic gonadotropin through LH receptor activation on endothelial and epithelial cells of the endometrium. FASEB J. 2006, 20: 2630-2632. 10.1096/fj.06-5885fje. CrossRefPubMed
Choi SH, Goo JM, Kim HC, Im JG: Pulmonary arteriovenous fistulas developed after chemotherapy of metastatic choriocarcinoma. Am J Roentgenol. 2003, 181: 1544-1546. 10.2214/ajr.181.6.1811544. CrossRef
FIGO Committee on Gynecologic Oncology: Current FIGO staging for cancer of the vagina, fallopian tube, ovary, and gestational trophoblastic neoplasia. Int J Gynaecol Obstet. 2009, 105: 3-4. CrossRef
- Haemoptysis from a pulmonary arteriovenous malformation in a post molar pregnancy gestational trophoblast tumour patient managed by radiological embolisation: a case report
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