Mrs. Praveen Bansal (Female, 42 years)
The patient had a history of vaginal bleeding for which hysterectomy (removal of uterus) was done and a histopathological diagnosis of choriocarcinoma (a type of cancer) was made. After diagnosis, she was referred to our hospital.
On examination, she was found to have weakness of the right arm. On further investigation, she was found to have involvement of brain by the disease. β(HCG) levels in the blood were raised (indicative of choriocarcinoma). She was diagnosed as a case of metastatic choriocarcinoma to the brain.
Choriocarcinoma is a type of germ cell tumor seen in women. It has two unique features. It is a fast growing aggressive disease and dangerous if not treated adequately. On the other hand, it is a highly chemotherapy sensitive tumor and curable even if it has spread to other parts of the body, if adequate treatment is given.
Prognosis of the case was explained and in view of the danger involved of bleeding in brain due to the tumor, radiotherapy to brain was started immediately. She responded very well. After radiotherapy she was planned for chemotherapy.
During chemotherapy, she suddenly developed watery discharge from vagina. On examination, she was found to have vesico vaginal fistula, due to which urine was coming from the vagina. This happens due to necrosis of tumor at bladder site due to the chemotherapy. Patient was reassured that it will be repaired after treatment was completed. Till then, it was handled conservatively.
She received 6 Cycles of chemotherapy (EMACO) without much toxicity. Her blood β(HCG) levels came to normal. She was evaluated and no active disease was found. Her fistula was repaired surgically and thus the problem of vaginal discharge was taken care of.
She has been on follow-up for more than a year and is completely disease free.