Introduction/Background Gestational choriocarcinoma is a malignant tumor arising from trophoblastic cells with the lung and the vagina as its common sites of metastasis. Skin metastasis is known to be extremely unusual.1 This paper outlines the case of a 45-year-old multigravida who manifested with occasional nonproductive cough; multiple cutaneous lesions in left flank, right triceps area, upper back, and infraumbilical areas associated with neurologic symptoms, two years after undergoing hysterectomy for a molar pregnancy. Skin biopsy of the left flank masses showed metastatic gestational choriocarcinoma; and she had elevated B-hCG (309,245 mIU/mL), and lung, brain, liver, and right adrenal metastases on imaging studies. She achieved remission after treatment with Etoposide Cisplatin induction chemotherapy, high-dose EMACO with concurrent whole brain irradiation, and ten cycles of EMACO. Seven months after treatment, she remains alive and well, with ongoing regular follow-ups. The importance of keeping a high index of suspicion in patients with a prior molar pregnancy who only have clinical presentations referable to metastatic sites to avoid delay in the diagnosis and treatment; as well as the curability of widespread disease with aggressive combined treatment modalities, is emphasized herein (figure 1 and 2).
Conclusion Cutaneous metastases in gestational CC is infrequent and one of its diverse atypical clinical manifestations that has the potential to delay diagnosis and affect the clinical outcome. It is also associated with disseminated disease. Nevertheless, remission through aggressive multi-modal therapeutic strategies like Etoposide-Cisplatin induction chemotherapy, high-dose EMACO with concurrent whole brain irradiation, and regular EMACO is still possible for Stage IV multi-metastatic gestational CC patients who have late presentations and already have advanced disease, as documented in the index case. Prompt identification and vigorous treatment as keys to ensure better prognosis in gestational CC is stressed.
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