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Actinomycin D
9%
6/65
Cisplatin
Cytarabine
5%
3/65
Methotrexate
57%
37/65
Vincristine
Select Answer to see Preferred Response
The patient in this vignette presents with an elevated chorionic gonadotropin level, vaginal bleeding, cough, and pulmonary metastases suggestive of systemic choriocarcinoma following a spontaneous abortion. The first-line treatment for gestationally derived choriocarcinoma is methotrexate. Choriocarcinoma is a malignant tumor most commonly derived from trophoblastic tissue that belongs on the spectrum of gestational trophoblastic disease. Choriocarcinoma is known to metastasize early via hematogenous and lymphatic spread to the lungs and may present with increased chorionic gonadotropin levels, vaginal bleeding, shortness of breath, and hemoptysis. Single-agent methotrexate is recommended as a first-line treatment for systemic choriocarcinoma. Figure A demonstrates the characteristic appearance of pulmonary metastases in a patient with gestationally derived choriocarcinoma. Note the multiple hyperechoic lesions in both lung fields. Incorrect Answers: Answer 1: Actinomycin D is an antibiotic that also serves as an anti-tumor agent. It functions by intercalating between DNA base pairs and is primarily used to treat Ewing sarcoma, Wilms tumor, and rhabdomyosarcoma. It is occasionally used as part of a multi-drug regimen to treat choriocarcinoma but is not considered a first-line or single-agent therapy for this condition. Answer 2: Cisplatin is a DNA crosslinking anti-tumor agent that is used to treat several cancer types including testicular, ovarian, bladder, and lung cancer. It is not considered a first-line agent in the treatment of choriocarcinoma. Answer 3: Cytarabine is a pyrimidine analogue anti-tumor agent that is used to treat hematogenous cancers. It is not considered a first-line agent in the treatment of choriocarcinoma. Answer 5: Vincristine is an anti-tumor agent that functions by inhibiting microtubule formation. It is used to treat hematogenous and solid tumors. It is occasionally used as part of a multi-drug regimen to treat choriocarcinoma but is not considered a first-line or single-agent therapy for this condition. Bullet Summary: Methotrexate is the first-line systemic treatment for gestationally derived choriocarcinoma.
3.8
(5)
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