Successful Diagnosis and Treatment of Early Postpartum Choriocarcinoma

Background

Postpartum placental choriocarcinoma is a rare gestational trophoblastic tumor, with an incidence of approximately one in 50 000. Patients often present with persistent postpartum hemorrhage, which can lead to delayed diagnosis, hematogenous metastasis, and ultimately, a poor prognosis.

Case

A 35-year-old woman was admitted to the Emergency Department 39 days after a cesarean section due to persistent heavy vaginal bleeding. Initial evaluation revealed a serum β-human chorionic gonadotropin (β-hCG) level of 7868 mIU/mL, transvaginal ultrasound identified a vascularized uterine mass with myometrial invasion, and MRI suggested residual tissue implantation. Following exclusion of retained products of conception, postpartum choriocarcinoma was suspected. The patient underwent five cycles of FAV chemotherapy (fluorouracil + actinomycin D + vincristine), resulting in undetectable β-hCG levels and resolution of imaging findings after two cycles. Three additional consolidation cycles were administered, with complete remission confirmed at the final follow-up.

Conclusion

Pregnancy-related causes must always be ruled out in women of childbearing age who present with irregular vaginal bleeding, even during the postpartum and lactation periods. In patients with postpartum bleeding, vigilance should be heightened to rule out the possibility of a pregnancy-related Sertoli cell tumor.