Abstract
Choriocarcinoma is a disease associated with uncontrollable proliferation and malignant change of cells of the placenta and belongs to the malignant end of the spectrum in gestational trophoblastic disease. These tumours are usually developed after molar pregnancies, and their incidence after full-term pregnancies is extremely rare.We present a very rare case of a 30-year-old lady, admitted with a five-month history of vaginal bleeding after a normal pregnancy. The human chorionic gonadotropin (hCG) was at a level of 209,566. A pelvic ultrasound scan revealed an endometrial thickness of 6 cm and the presence of an intra-uterine mass measuring 56 × 50 × 45 mm. After discussion with the regional gestational trophoblastic disease centre, we proceeded to a surgical evacuation of the uterus, which confirmed a post-partum choriocarcinoma (International Federation of Gynaecology and Obstetrics (FIGO) score 9). Care was continued in the specialised centre with multi-agent chemotherapy. The response was excellent, and the patient was subsequently discharged after 10 cycles of chemotherapy, and a 10-year follow-up was arranged.Choriocarcinomas after full-term pregnancies are a rare entity. Even when they happen, they are usually associated with pregnancy complications in the ante-natal period. The prognosis is usually very good, provided that prompt diagnosis and referral to a specialised centre are made. Low-risk patients are usually treated with methotrexate monotherapy, whereas high-risk women would normally require multi-agent chemotherapy. The diagnosis of choriocarcinoma might be proven challenging even for experienced clinicians. Women should be informed that the prognosis is usually excellent, provided that they receive the right treatment.
Highlights
Gestational trophoblastic disease (GTD) envelops a variety of diseases, from the pre-malignant conditions of complete hydatiform mole (CHM) and partial hydatiform mole (PHM), to malignant invasive mole, choriocarcinoma (CC) and more rarely, placental site trophoblastic tumour (PSTT) or epithelioid trophoblastic tumour (ETT)
The incidence of CC after a full-term pregnancy is reported in some literature to be as rare as one in 160,000 [3]
Consideration should be given, as to whether or not a tissue biopsy is needed before starting treatment
Summary
Gestational trophoblastic disease (GTD) envelops a variety of diseases, from the pre-malignant conditions of complete hydatiform mole (CHM) and partial hydatiform mole (PHM), to malignant invasive mole, choriocarcinoma (CC) and more rarely, placental site trophoblastic tumour (PSTT) or epithelioid trophoblastic tumour (ETT). A 30-year-old G1P1 female presented to a district general hospital with a five-month history of heavy postpartum bleeding She reported having passed large clots in the preceding few days, prompting attendance at the accident and emergency department. Her general practitioner had inserted a Mirena IUS (Bayer HealthCare Pharmaceuticals Inc., Turku, Finland) at 12 weeks post-partum, which failed to cease the bleeding. Histology demonstrated macroscopically a sac weighing 40.6 g, with no obvious vesicles nor fetal parts It was comprised of large areas of haemorrhage with some necrosis and viable cells. She responded very well to chemotherapy and was advised that she could try to conceive again after one year.
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