An Interesting Case of Choriocarcinoma: Early Diagnosis & Timely Treatment
An Interesting Case of Choriocarcinoma: Early Diagnosis & Timely Treatment
Dr. Hema Jajoo
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2 min read
Doctor
Dr. Hema Jajoo
Clinic / Hospital
Matricare Clinic
Patient Age
33
Gender
Female
Patient's Initial Condition
Symptoms / Health Concerns
Persistent bleeding per vaginum following medical termination of an unintended pregnancy; intrauterine mass with progressively rising beta-hCG.
Duration of Symptoms
Approximately 2 months
Previous Treatments
Patient had taken medical termination pills at approximately 6 weeks of pregnancy without prior ultrasound. She initially received treatment in her village after persistent bleeding.
Diagnosis
Final Diagnosis
Choriocarcinoma (Gestational Trophoblastic Neoplasia) with metastatic involvement of the lungs, liver, vagina and peritoneal cavity; classified as Stage II, high-risk GTN based on the reported staging and prognostic assessment.
Tests / Scans / Investigations
Ultrasound, serial serum beta-hCG, diagnostic hysteroscopy, biopsy with histopathology, MRI of abdomen and pelvis, and chest imaging. Initial ultrasound showed a 7 cm intrauterine mass with beta-hCG 10,678 mIU/mL; repeat evaluation showed approximately 9 cm mass and beta-hCG 72,680 mIU/mL.
Treatment Details
Diagnostic hysteroscopy with removal of approximately 25 g of abnormal intrauterine tissue and biopsy. Following confirmation of choriocarcinoma and staging, the patient was referred to a medical oncologist and started on systemic treatment.
Duration: Ongoing; patient is currently undergoing oncology treatment with close follow-up.
Advanced Techniques Used
Diagnostic hysteroscopy, hysteroscopic tissue sampling, histopathological examination, MRI-based staging, chest imaging and serial quantitative beta-hCG monitoring.
Results & Recovery
Patient Improvements
The underlying cause of persistent bleeding was identified and choriocarcinoma was confirmed. Metastatic disease was detected through staging investigations, allowing prompt referral to oncology and initiation of treatment. The patient remains under close follow-up with serial serum beta-hCG and imaging to monitor treatment response.
Final Outcome
Choriocarcinoma confirmed with metastatic disease. Patient has been referred to a medical oncologist and started treatment.
Returned to Normal Activities: Yes
Case Highlights
What Makes This Case Unique
Persistent bleeding following medical termination of pregnancy, with progressively increasing uterine mass and beta-hCG levels, ultimately diagnosed as choriocarcinoma with metastatic disease.
Complex / Rare Factors
Choriocarcinoma with metastatic involvement of the lungs, liver, vagina, and peritoneal cavity
Most Significant Benefit
Timely hysteroscopy, biopsy, diagnosis, staging, and referral to a medical oncology team enabled appropriate treatment to be initiated.
Conclusion
This case highlights the importance of evaluating persistent bleeding after medical termination of pregnancy. Ultrasound, quantitative beta-hCG testing, appropriate follow-up, and timely biopsy can help identify serious conditions such as choriocarcinoma. The patient has been referred to a medical oncologist and is receiving treatment with close imaging and serum beta-hCG follow-up.