NECROSIS OF MYOMETRIAL CHORIOCARCINOMA WITH FULMINATING SEPSIS COMPLICATING CHEMOTHERAPY FOR TROPHOBLASTIC TUMOR

We report a patient who developed metastatic gestational choriocarcino ma following delivery of a normal, healthy child that, however, was an emic and required blood transfusion. The patient developed secondary p ostpartum hemorrhage over a period of several weeks and required curet tage and myometrial contractants to control the bleeding. At the time of diagnosis the patient had extensive pulmonary metastases and ultras ound showed full penetration of the myometrium by tumor. Immediately f ollowing the second course of chemotherapy with etoposide, methotrexat e, and actinomycin D, alternating with cyclophosphamide and vincristin e, the patient developed sepsis associated with a uteroperitoneal fist ula and required hysterectomy. The sepsis was associated with dissemin ated intravascular coagulopathy and adult respiratory distress syndrom e. However, the patient's tumor was exquisitely sensitive to chemother apy and with good intensive care unit support and chemotherapy she sur vived without residual scar except for the loss of reproductive functi on. There are two lessons to be learned from these events: (1) The syn drome of secondary postpartum hemorrhage with a fetus that is anemic s pells a diagnosis of choriocarcinoma; and (2) color Doppler flow vagin al ultrasound performed at the time of presentation of trophoblastic t umors may be useful to show full penetration of the myometrium by tumo r which may be a warning of possible scar rupture in a subsequent preg nancy. a 1998 Academic Press.