A stormy course of choriocarcinoma following a healthy term pregnancy: A case report
Keywords:
Choriocarcinoma, Gestational trophoblastic neoplasia, Postpartum hemorrhage, Brain metastasis, β-hCGAbstract
Background: Gestational trophoblastic diseases (GTDs) most commonly follow molar pregnancies or non-molar miscarriages. The occurrence of choriocarcinoma following a normal term pregnancy is extremely rare and often presents late with metastatic disease, leading to diagnostic delay and poor outcomes.
Case Presentation: We report a 22-year-old primiparous woman who presented four months after a healthy term pregnancy delivered by lower-segment cesarean section. She developed sudden-onset headache, vomiting, and visual disturbances. Neuroimaging revealed multiple intracerebral hemorrhages with a? 5*4cm large parenchymal lesion. Urine pregnancy test was positive and serum β-hCG was markedly elevated (2,25,000 mIU/mL), with no evidence of intrauterine pathology on pelvic ultrasonography. Despite aggressive resuscitation, the patient deteriorated rapidly due to malignant cerebral edema and succumbed to absent brainstem reflexes before definitive oncologic treatment could be initiated due to delayed presentation.
Conclusion: Postpartum choriocarcinoma following a normal term pregnancy is rare but highly aggressive. A high index of suspicion is essential in postpartum women presenting with cerebral/lung metastases or irregular vaginal bleeding. Early diagnosis and prompt chemotherapy can dramatically improve survival.
