P0657 - Metastatic Choriocarcinoma With Small Bowel Invasion as a Rare Cause of Gastrointestinal Bleeding

Grecia Santaella Mendez, MD¹, Devika Gandhi, MD², Andrei Tong, BA², Nour Parsa, MD^1
1Loma Linda University Health, Loma Linda, CA; ²Loma Linda University, Loma Linda, CA

Introduction: Choriocarcinoma is a rare and aggressive trophoblastic tumor with capacity for hematogenous spread, known to metastasize to the lungs, liver, and central nervous system. It is rare to develop metastasis to the intestines. We describe the case of a 22 year old female with non-gestational choriocarcinoma with small bowel metastasis causing a gastrointestinal bleed.

Case Description/Methods: The patient initially presented with intracranial hemorrhage requiring craniectomy and her course was complicated by hemodynamically significant gastrointestinal bleeding with both hematochezia and melena. After multiple colonoscopies, VCE and push enteroscopy, there was suspicion for the bleeding to be secondary to a bleeding small bowel metastatic lesion. The main concerning factor in the setting of the patient’s clinical scenario was the increased risk for bleeding during rapid tumor involution in the setting of her multiple metastases. Ultimately, tissue histology from prior brain biopsy confirmed diagnosis of metastatic choriocarcinoma and the patient was started on chemotherapy with etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine (EMA-CO). In this case the decision to start chemotherapy first versus attempt surgical intervention proved a good outcome for the patient. She displayed consistent improvement in bHCG levels with each cycle of chemotherapy and blood transfusions needed due to bleeding became less frequent. She didn’t require further endoscopic intervention throughout her stay after being started on chemotherapy.

Discussion: Despite a prolonged hospitalization with multiple additional neurosurgeries, splenic mass rupture and embolization with acquired asplenia, and tracheostomy and gastrostomy placement, the patient has been doing well since completing chemotherapy with removal of tracheostomy and gastrostomy, normalization of bHCG, and continued improvement in functional status with outpatient physical therapy.


Disclosures:


Grecia Santaella Mendez, MD¹, Devika Gandhi, MD², Andrei Tong, BA², Nour Parsa, MD¹. P0657 - Metastatic Choriocarcinoma With Small Bowel Invasion as a Rare Cause of Gastrointestinal Bleeding, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.