Metastatic choriocarcinoma in amenorrheic woman following normal vaginal delivery

Abstract

Gestational choriocarcinoma usually occurs following an intrauterine pregnancy. We report a case of metastatic choriocarcinoma to the left kidney and lungs with long term intermittent amenorrhea and vaginal bleeding after a normal vaginal delivery. A 43 year old rural woman presented with three years intermittent amenorrhea and vaginal bleeding following normal vaginal delivery. She also complained of gross hematuria and left flank pain and had a rising titer of serum β- hCG. Pathologic examination of endometrial curettage specimen revealed choriocarcinoma. Ultrasound revealed enlarged uterus involved by an irregular mass with heterogenous echo pattern and extensive myometrial invasion. A mass with similar echo pattern was also evident in the left kidney.Computerized tomography confirmed the intrauterine mass and involvement of the left kidney. On chest X ray, metastatic nodules were seen in both lungs and in the left retrocardiac space. The patient underwent chemotherapy with EMA-CO regimen (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine/oncovine). During chemotherapy, she became pancytopenic and febrile. This condition was successfully managed with G-CSF, leukovorin and antibiotics. The patient is now well and still under the chemotherapy. Her serum β- hCG level has fell to 6 IU/ml.