A CASE OF METASTATIC CHORIOCARCINOMA OF THE SMALL INTESTINE WITH MASSIVE ANAL BLEEDING

A 27-year-old woman was seen at the department of obstetrics and gynecology in our hospital because of anal bleeding after a normal delivery, and referred to the department of surgery in a shock state due to massive anal bleeding. With various imaging methods and endoscopic studies, bleeding from the jejunum was identified and an excision of the small intestine was performed. Postoperative pathological study offered the definite diagnosis of choriocarcinoma. The patient was transferred to the gynecological department for chemotherapy. Thereafter the patient had metastases to the brain and lung. It has been said that choriocarcinoma which develops during pregnancy and puerperal period occurs at a frequency of about one to tens of thousands. Choriocarcinoma reveals a hematogenic metastatic pattern starting in an early phase from its biological characters. In particular, the metastasis to the digestive tract presents difficulty in diagnosis, is often associated with multiple metastatic lesions, and has a poor prognosis in most cases. Metastatic choriocarcinoma of the small intestine is a very rare entity and only eight cases have been seen in the Japanese literature. The disease during pregnancy and puerperal period is sometimes discovered from some symptoms due to its metastatic lesion. When abnormal genital bleeding, anal bleeding, respiratory symptoms, and neurological symptoms are seen in such patient, a possibility of the disease must be kept in mind, though it rarely occurs.