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#541 Gestational trophoblastic tumour: choriocarcinoma
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  1. Yasmine El Gharbi,
  2. Sassi Boughizene and
  3. Ines Ben Salem
  1. University Hospital Farhat Hached, Sousse, Tunisia

Abstract

Introduction/Background Choriocarcinoma is a rare malignancy that arises from placental trophoblastic tissue. Approximately 50% of choriocarcinomas follow molar pregnancies, and the remainder occur after spontaneous abortions or ectopic or intrauterine pregnancies. It is characterized by early hematogenous spread to the lungs. It belongs to the malignant end of the spectrum in gestational trophoblastic disease. While the disease used to be fatal in the majority of cases, currently, most cases can be cured by chemotherapy.

Results We report a rare case of a 42-year-old female patient admitted with a one-month history of vaginal bleeding. The patient has given birth twice vaginally, the latest was 13 months ago. She reports a history of spontaneous miscarriage at home one month ago, with an imprecise last menstrual period (LMP) and no evidence of intrauterine pregnancy.

The b-hCG level was 10,257 with an empty uterus on pelvic ultrasound, no fluid accumulation or lateral uterine mass. The patient underwent a brain CT scan following an episode of severe headache, which revealed a brain metastasis. A thoracoabdominal CT scan was performed, showing a lung metastasis, three hepatic metastatic lesions, and a 6cm splenic metastasis.

The case was discussed with the reference center for trophoblastic diseases in Lyon, who confirmed that even in the absence of anatomopathological evidence, the diagnosis of postpartum choriocarcinoma (attributed to the recent childbirth rather than the miscarriage) is established (FIGO score 15). Care was continued in the specialized center with multi-agent chemotherapy. The response was excellent, and the patient was subsequently discharged after 6 cycles of chemotherapy, and a 10-year follow-up was arranged.

Conclusion The overall prognosis is very good if a prompt diagnosis is made, and care is provided in a center with experience in the management of these cases.

Disclosures This report highlights that he diagnosis of choriocarcinoma might be proven challenging even for experienced clinicians. However, combining the gynecological history, elevated b-hCG levels and USS findings, usually leads to the diagnosis. Consideration should be given, as to whether or not a tissue biopsy is needed before starting treatment.

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