A Case of Metastatic Vulvar Choriocarcinoma Misdiagnosed as Vulvar Abscess: A Case Report.

Abstract

Background: Metastatic vulvar choriocarcinoma, a rare ectopic gestational trophoblastic neoplasia (GTN), often presents a diagnostic challenge due to its mimicry of other conditions, particularly in resource-limited settings. Its primary symptom is abnormal vaginal bleeding without a clear cause. Consequently, diagnosing and managing it poses difficulties for many low-resource health facilities, as evidenced by the current case. Case Presentation: We present the case of a 25-year-old, P2+2+2L2, who had a large painless, bleeding vulva mass for nearly 5 months. This followed a spontaneous abortion the month prior. The mass gradually increased in size and was accompanied by fever, pus discharge, and weight loss. Despite being treated at multiple health facilities for a vulvar abscess, there was no improvement. A diagnosis was finally made at a tertiary facility where elevated quantitative serum beta-human chorionic gonadotropin (hCG) (β-hCG) was noted. Due to uncontrollable vulva bleeding, she was referred to another tertiary facility for emergency radiotherapy. Following stabilization, chemotherapy was administered using the EMA-CO protocol. Conclusion: The report highlights the difficulty in diagnosing vulvar choriocarcinoma, underscoring the importance of a high index of suspicion. Clinical tests such as serum (β-hCG) and imaging studies are crucial for diagnosis. In resource-limited settings, a simple strip-based urine pregnancy test with serial dilutions can be sufficient for diagnosing and managing vulvar choriocarcinoma.