ABSTRACT
We report a case of a young female patient presenting with a high serum beta-HCG levels, amenorrhea, nausea and anemia which mimicked pregnancy followed by upper gastrointestinal bleeding. A gastric tumor was shown on endoscopy. Histopathologic evaluation revealed Primary Gastric Choriocarcinoma (PGC). The patient was treated with three cycles of standard nongestational choriocarcinoma chemotherapy. Tumor persistence was evidenced by CT Scans and high serum beta-HCG levels. The patient died approximately six months after diagnosis. Our case report suggest that PGC is a highly aggressive tumor that is often associated with liver and lungs metastasis without evidence of pelvic organ abnormality and is associated with some hormonal effects, such as amenorrhea, anemia, nausea and vomiting mimicking pregnancy in young adult female
Subject(s)
Choriocarcinoma, Non-gestational/diagnosis , Diagnostic Errors , Stomach Neoplasms/diagnosis , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Biomarkers, Tumor/blood , Bleomycin/administration & dosage , Choriocarcinoma, Non-gestational/drug therapy , Choriocarcinoma, Non-gestational/secondary , Chorionic Gonadotropin, beta Subunit, Human/blood , Cisplatin/administration & dosage , Etoposide/administration & dosage , Fatal Outcome , Female , Humans , Ifosfamide/administration & dosage , Liver Neoplasms/secondary , Lung Neoplasms/secondary , Methotrexate/administration & dosage , Paclitaxel/administration & dosage , Pregnancy , Pregnancy, Ectopic/diagnosis , Salvage Therapy , Stomach Neoplasms/drug therapy , Young AdultABSTRACT
Puerto Rico has implemented Health Care Reform legislation that shifted medically indigent and underserved persons from direct care by public sector institutions to managed care arrangements through the private sector. Our aim is to assess how previously underserved women with breast cancer have fared during the first three years of the Reform. Medical claims data were obtained on breast cancer cases in San Juan who were either enrolled in the capitated Reform plan or in a commercial policy offered by the same insurer. A set of indicators reflecting initial therapy, use of key services, and cumulative utilization rates of various medical procedures were constructed. Statistical tests were conducted to assess whether these indicators differed between Reform- and commercially-insured patients. Failure to reject null hypotheses of indicator differences were then used to judge Reform progress. We found some differences, but they were neither pervasive nor unidirectional. On balance, we conclude that previously underserved women are being treated for breast cancer roughly on par with other patients. This conclusion, however, is preliminary and subject to important qualifications.