Choriocarcinoma following live birth: is it a delay in diagnosis or ignorance of the disease?

Objective: Molar pregnancies and choriocarcinomas are derived from villous trophoblast and placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT) are derived from extravillous trophoblast. Of all forms of gestational choriocarcinoma, placental choriocarcinoma is the most rare and is usually diagnosed in symptomatic patients with metastases. The incidental finding of a choriocarcinoma confined to the placenta with no evidence of dissemination to mother or infant is the least common scenario. Choriocarcinoma coexisting with or after a “normal” pregnancy has an incidence of one per 160,000 pregnancies. The authors report the first case diagnosed in their department. Case Report: A 34-year-old woman was diagnosed with abundant vaginal bleeding after term pregnancy at three months after the delivery of a healthy baby. Abdominal ultrasonography revealed an intracavitary uterine tumoral mass with signs of myometrial invasion to the uterine serosa. The pretreatment hCG level was 1,500,000 IU/Ml. Computed tomography scan showed a pelvic mass on the uterus that invaded the neighborhood organ, extending to posterior retro-peritoneal organ (large vessels), but excluded extrapelvic tumoral masses. Removal of the tumor was impossible due to its extension to the digestive system and the large vessel, necrosis, and hemorrhagic character, therefore the authors were limited to a biopsy of the tumor. Histopathological examination revealed uterine choriocarcinoma after four courses of chemotherapy, and the patient experienced severe hemorrhagic shock in the general surgery department during surgery due to acute intestinal obstruction. Conclusion: Although postpartum choriocarcinoma is extremely uncommon, there is a need for obstetricians to remain aware of this possibility in patients with postpartum vaginal bleeding with a healthy newborn. Early diagnosis by histopathological examination of the placenta, the precocity of the diagnosis influencing the prognosis, and tumor response to chemotherapy are important.

Choriocarcinoma; Term gestation; Villous trophoblast; Placental site trophoblastic tumor.

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