An Unusual Presentation of Choriocarcinoma Co-Existing with Pregnancy, Successful Delivery, and Treatment

Abstract

Choricarcinoma co-existing with pregnancy is rare often misdiagnosed with great potential for hemorrhagic complications and death. We present a case of a 34-year-old woman diagnosed with choriocarcinoma in her 3rd pregnancy with vaginal and pulmonary metastasis. Her first episode of vaginal bleeding was in the third trimester which was misdiagnosed. She had spontaneous vaginal delivery at 34 weeks of a healthy neonate. She was refered to gyneoncology unit of our hospital 5 weeks into puerperium from a nearby State hospital due to continouos vaginal bleeding and a growth from the postero-lateral wall of the lower third of the vagina. She had five courses of EMA-CO regimen. Her beta-human chorionic gonadotropin (hCG) has fallen from pretreatment value of 168,266 mIU/ml to <5 mIU/ml by the 5th course and the metastaic lesion regressed. She however developed WHO Stage III Oral Mucositis (with Oroesophageal Candidiasis) due to the side effects of chemotherapy which was co-managed successfully with the oral medicine specialist. She was subequently discharged home with follow-up visits. The quantitative beta-hCG has remained undetectable during her follow-up visits. Choriocarcinoma co-existing with pregnancy is rare, diagnosis often missed and confused with antepartum hemorrhage. Early and correct diagnosis can be life saving. High index of suspicion is needed to make the diagnosis. The role of chemotherapy and close follow-up with quantitative beta-hCG assays are key to survival.

Late diagnosis of intraplacental choriocarcinoma co-existing with fetomaternal haemorrhage causing fetal demise: A case report

“…Most choriocarcinomas arise as primary uterine tumours in women at the extremes of age, with the majority of trophoblastic tumours commonly metastasizing to the lungs. IC, however, may co-exist with or following abortion, ectopic pregnancy, hydatidiform mole or term gestation [ 5 ]. IC co-existing with an intrauterine gestation is exceedingly rare and carries a very high mortality rate of the mother and fetus, 62% and 65% respectively [ 5 ].…”

“…IC, however, may co-exist with or following abortion, ectopic pregnancy, hydatidiform mole or term gestation [ 5 ]. IC co-existing with an intrauterine gestation is exceedingly rare and carries a very high mortality rate of the mother and fetus, 62% and 65% respectively [ 5 ]. Due to the rarity of IC, the aetiology, pathogenesis, natural history and adequate therapy of IC are still unknown, and it is not surprising that the cases reported in the literature describe different outcomes.…”