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Obstet Gynecol. 2019 Jan;133(1):163-166. doi: 10.1097/AOG.0000000000003001.

Stage IV Gestational Choriocarcinoma Diagnosed in the Third Trimester.

Author information

1
Departments of Obstetrics and Gynecology and Pathology, Tufts Medical Center, Boston, Massachusetts.

Abstract

BACKGROUND:

Gestational trophoblastic neoplasia rarely occurs in term pregnancies. Stage IV choriocarcinoma treated with conventional chemotherapy can result in death as a result of hemorrhagic sequelae at tumor sites.

CASE:

A 30-year-old woman at 34 weeks of gestation presented with a persistent cough, worsening dyspnea, and vaginal bleeding. Chest radiograph demonstrated innumerable lung nodules, and quantitative β-hcg concentration exceeded 1.3 million milli-international units/mL. Cesarean delivery was performed for presumed abruption. Placental pathology demonstrated choriocarcinoma, and imaging confirmed stage IV disease with a World Health Organization score of 14. Remission was achieved after two courses of low-dose induction chemotherapy followed by 10 cycles of combination chemotherapy.

CONCLUSION:

Gestational trophoblastic neoplasia should be considered in a pregnant or postpartum woman presenting with atypical vaginal bleeding. Coexistent pulmonary or neurologic findings may suggest advanced disease.

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