Hemostasis and life-saving by arterial embolization for a rupture of hepatic metastasis from choriocarcinoma after initiation of EMA/CO therapy: a case report and literature review.

Choriocarcinoma occurs in the uterus and various other organs, including liver, lungs, and brain. Depending on the site of onset, early identification is difficult due to non-specific or an asymptomatic presentation. Moreover, choriocarcinoma may be detected when the tumor grows considerably or ruptures. We encountered a case in which hepatic metastasis ruptured, leading to hemorrhagic shock. The rupture occurred after the initiation of etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine (EMA/CO) therapy for choriocarcinoma of unknown primary origin with multiple metastases in the liver, lungs, and peritoneal cavity. Hemostasis was achieved by hepatic artery embolization. EMA/CO therapy was resumed 10 days after the embolization. The patient was deemed to be in remission after 28 cycles, and the treatment was completed after 33 cycles. It may be necessary to consider emergency responses through multidisciplinary/inter-professional collaboration and appropriate length of hospitalization for patient observation. Furthermore, the possibility of lesion rupture due to tumor necrosis should be taken into account for large tumors and high serum human chorionic gonadotropin.