Gestational choriocarcinoma in a postmenopausal woman. A case report and literature review

Abstract

Choriocarcinoma is the most common tumor of the gestational trophoblastic disease occuring usually in reproductive age related to antedecent gestational event (molar, physiological, ectopic pregnancy, elective or spontaneous abortion) either after one year or after many decades and rarely after the menopause. The main presenting clinical symptom is postmenopausal vaginal bleeding. It is an aggressive tumor with high potential rate to metastasize in various distant organs and is associated with considerable variation in prevalence wordwide. We describe a 51-year-old postmenopausal woman, who presented with heavy vaginal bleeding 27 years after her last pregnancy, 30 years after her last abortion and 3 years after her last menstrual period. Clinical examination,vaginal ultrasound scan, and computer tomography revealed an enlarged uterus at 16 weeks pregnant Gestational choriocarcinoma’s diagnosis depended on histological (preoperative endometrial curettage and postoperative uterus examination), immunochemistry findings and hCG elevated levels in serum. The intra and postoperative management was performed according to FIGO guidelines for gestational trophoblastic neoplasia. Early diagnosis and treatment have improved the survival rate. Currently due to the rarity of the tumor in postmenopause period, the difficult differential diagnosis of non gestational choriocarcinoma is of great importance. The presentation of one more case of gestational choriocarcinoma aims to enchance the scientific experience and improve the management.