Introduction/Background Choriocarcinoma following a term pregnancy is an uncommon disease with an estimated occurrence of 1 per 160,000 pregnancies. The interval between delivery and treatment is an important prognosis factor. We present a case of a placental choriocarcinoma with no metastases in a full-term intrauterine pregnancy. A first curettage because of abnormal persistent bleeding did not reveal the true diagnosis of choriocarcinoma.
Methodology A 34-year-old patient, gravity 3, miscarriage 1, parity 2 presented an episode of abnormal vaginal bleeding 6 weeks after term delivery. First curettage was performed without abnormal histopatholgical findings. Due to the persistence of bleeding second curettage was done 4 weeks after the first one. Pathologic report was Choriocarcinoma and it was possible to review the original material that confirmed the diagnosis. Ultrasound revealed an intracavitary uterine tumoral mass with strong Doppler signal (figure 1). Stage 1 was confirmed by MNR (figure 2), pretreatment human chorionic gonadotropin (HCG) level was 92.770 mUI / ml and FIGO risk factor score was 6.
The treatment was Methotrexate (MTX)50 mg by intramuscular injection and Calcium folinate after each injection. During chemotherapy, the HCG measured once per week was decreasing to become negative after 6 weeks. After a new increase of HCG levels in the third month of negativity, an early uterine relapse was suspected and confirmed by CTscan and PET-CT.
Results Hysterectomy was performed with double salpinguectomy and right oophorectomy due to the presence of ovarian cyst. HCG levels became negative three weeks after. Patient is asymptomatic without any abnormality in image or laboratory tests 3 years after the diagnosis.
Conclusion Although posterm delivery choriocarcinoma incidence is very low, postpartum placental histopathological examination and HCG monitoring in case of abnormal bleeding are necessary for early diagnosis an d improvement in prognosis.
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