Caesarean scar choriocarcinoma: a case report and review of the literature

Abstract

ObjectiveTo report the clinical characteristics, pathologic findings and treatments of a patient with a Caesarean scar choriocarcinoma.Patient historyA 22-year-old woman had a diagnosis of primary gestational choriocarcinoma in a uterine Caesarean scar misdiagnosed as a normal Caesarean scar pregnancy. The patient underwent selective uterine artery embolization coupled with methotrexate arterial injection, along with dilatation and curettage of the uterine Caesarean scar. Finally, she received eight courses of multiagent chemotherapy. The reproductive function of the patient was preserved.ConclusionsPrimary gestational choriocarcinoma out of the uterine corpus is a rare disease. A Caesarean scar choriocarcinoma is an extremely unusual example of this entity because of its unique position. To the best of our knowledge, this is the first report of this phenomenon. Our experience and a literature review suggest that a clinical diagnosis of a primary gestational choriocarcinoma of the uterine Caesarean scar is difficult to make, and uterine artery embolization is beneficial to prevent massive bleeding before curettage.

Choriocarcinoma following scar pregnancy: a case report

“…In the case reported by Qian et al, HCG was above three lakhs. 5 Here it was not very high to befit a choriocarcinoma but cases of choriocarcinoma with very low values of HCG have been reported. 10,11 After a nonmolar pregnancy when there is a rising HCG the chance is more for a choriocarcinoma than other forms of trophoblastic neoplasia.…”

“…The case reported by Qian ZD et al was a choriocarcinoma in the scar which was mistakenly diagnosed as scar pregnancy. 5 She had a history of abortion four months prior. In that case after intra-arterial injection of methotrexate and uterine artery embolization, evacuation of products and packing of the deficient anterior uterine wall was done.…”

“…Literature review showed four cases of malignant gestational trophoblastic neoplasia in a scar. [5][6][7][8] The case reported by T Bekci et al was choriocarcinoma following a molar pregnancy in a scar for which hysterectomy was done. 8 The case report by Antonella V et al was a partial molar scar pregnancy which evolved into an invasive mole.…”

“…Different modalities of management are available but there is no consensus as to the best one. [5][6][7][8] Here failed evacuation was followed by a dose of systemic methotrexate. As HCG was rising scar ectopic was evacuated through a hysterotomy.…”

“…4 Choriocarcinoma developing in the lower uterus following a scar pregnancy is extremely rare. [5][6][7][8] Here is a case of choriocarcinoma which developed in lower uterus within five months of removal of a scar pregnancy.…”