Objectives Choriocarcinoma is a highly vascular tumor of the trophoblast with immense metastatic potential to the lung, liver, brain or vulva. Next to the lung, vulvo-vaginal metastasis comprises 30% of all metastatic incidences. Metastasis in this region is often misleading in its initial appearance. Here we present case of vaginal metastasis of choriocarcinoma which was misdiagnosed initially.

Methods 36 years old, referred to our emergency department at the beginning of January 2020 as suspected ectopic pregnancy on ultrasound and plateauing BHCG of 1012mIU/ml. had 5 weeks amenorrhea, no vaginal bleeding, her Last delivery was vaginally in august 2019. Was given methotrexate 2 doses, with no response, a diagnostic laparoscopy, and examination under anesthesia done, which found no ectopic pregnancy and a 5x3cm vaginal mass noticed. Biopsy taken showed choriocarcinoma. Started on combination chemotherapy, responded well her BHCG became <1, still under follow up.

Results Vaginal metastasis of trophoblastic tumor may occur even after vaginal delivery. This case was erroneously diagnosed as ectopic pregnancy and diagnosed during surgical intervention. Chemotherapy is the treatment of choice with a favorable prognosis. Regarding prognostic scoring, vaginal metastasis should be considered as a poor prognostic factor. Different studies in this context thus directly recommended combination chemotherapy as their first choice.

Conclusions While dealing with a case of vaginal mass with a history of antecedent pregnancy and rising BHCG, possibility of metastatic choriocarcinoma should be considered and investigate accordingly. Prompt diagnosis and early treatment with combination chemotherapy may thus save many lives.