A rare case of a gestational and metastatic choriocarcinoma

Abstract

Gestational choriocarcinoma is a malignant and rare trophoblastic tumor. It belongs to the group of gestational trophoblastic diseases (GTD) whose common denominator is hypersecretion of the gonadotrophic chorionic hormone. It is a highly malignant tumor made from the juxtaposition of cytotrophoblast and syncytiotrophoblast cells with complete disappearance of chorionic villi. It is most often metastatic and is followed in most cases by a hydatiform mole, but may also occur after spontaneous abortion or normal pregnancy. We present a case of a 50-year-old Moroccan patient, G2P2, admitted to the gynecological emergency department for vaginal bleeding and dyspnea. Speculum examination showed an invasive vaginal lesion. Thoracic-abdominal-pelvic CT showed bilateral pulmonary nodules and cystic lesions in the uterus and vagina. Through a vaginal biopsy, the diagnosis of choriocarcinoma was confirmed. Taking into account the usually very chemo-sensitive character of these diseases, EMA-CO type chemotherapy (Etoposide, Methotrexate and Actinomycin D alternating at weekly intervals with Vincristine and Cyclophosphamide) has been introduced. The patient received 8 cycles of EMA-CO including 2 cycles after normalization of β-hCG. The evolution was very favorable and regular controle was scheduled.

Keywords

• choriocarcinoma
• vaginal metastases
• pulmonary metastases
• chemotherapy