Metastatic Choriocarcinoma after Full Term Pregnancy
Gestational choriocarcinoma is a highly vascular fast-growing cancer arising from placental trophoblastic cells that can metastasize hematogenously to the lungs, liver, brain, spleen, kidney, and vagina. Choriocarcinoma is part of the Gestational Trophoblastic Neoplasia (GTN) which includes in its spectrum Invasive mole, choriocarcinoma, Placental Site Trophoblastic Tumor (PSTT), and Epithelioid Trophoblastic Tumor (ETT). Gestational choriocarcinoma is a rare occurrence after a full-term pregnancy with an incidence of 1 in every 160.000 to 500.000 pregnancies as the incidence of GTN varies widely depending on geographic location. 50% of all Gestational Choriocarcinoma occur after Molar pregnancies, 25% develop after spontaneous abortion (miscarriages), induced abortion and ectopic pregnancies, and 25% after normal pregnancies.
In this case, we describe a 22-year old women status post uncomplicated Spontaneous Vaginal Delivery (SVD) after full-term pregnancy who presented with pleuritic chest pain 4 weeks after delivery, found to have significantly elevated serum quantitative Beta -hCG and imaging including Chest x-ray, CT scan of chest/abdomen/pelvis showed bilateral pulmonary nodules and splenic lesion consistent with metastatic disease. The patient was diagnosed with metastatic choriocarcinoma FIGO stage IV, WHO risk score 11, and started on combination chemotherapy (EMA-CO).