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Ann Thorac Surg. 2019 Jan 24. pii: S0003-4975(19)30108-0. doi: 10.1016/j.athoracsur.2018.12.038. [Epub ahead of print]

Short Tandem Repeats Define A Gestational Origin For Metastatic Choriocarcinoma.

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Division of Thoracic Surgery, Department of Surgery.
Department of Pathology, Yale University School of Medicine, New Haven, CT.
Division of Thoracic Surgery, Department of Surgery. Electronic address:


We present the case of a healthy female patient with a history of placenta accreta, who was transferred from an outside hospital with the chief complaint of shortness of breath and a large spontaneous hemothorax requiring surgical exploration. Resection of a large, bleeding lower lobe mass identified metastatic gestational choriocarcinoma, a previously unreported cause of spontaneous hemothorax and an equally rare consequence of placenta accreta. The identification of novel genomic features associated with gestational choriocarcinoma allowed for confirmation of this subtype, which has clinical implications for surveillance and prognosis following treatment with adjuvant therapy. Spontaneous hemothorax is an uncommon problem most often associated with pneumothorax, an underlying arterial-venous malformation, or an undiagnosed malignancy. The management of spontaneous hemothorax may include chest tube drainage, vessel embolization, operative evacuation, and in some cases the need for lung resection to obtain hemostasis. Although the finding of metastatic disease from a gynecological malignancy is not unusual, the presentation of spontaneous hemothorax as a result of a metastatic tumor rupture into the pleural space is a rare phenomenon.

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