Gestational choriocarcinoma

Gestational choriocarcinoma is a malignant trophoblastic tumour arising from any gestational event during pregnancy in the reproductive female. Women with gestational choriocarcinoma may present with abnormal vaginal bleeding, persistent markedly elevated βhCG, or a history of prior pregnancy. Most patients develop gestational choriocarcinoma shortly after gestational anomalies, but pathology may occur after a long latency of years. It may occur during pregnancy. Often, it happens after a growth of some sort in the womb (pregnancy, tumor, mole, cyst)^[1]

Diagnosis

Grossly, a red hemorrhagic mass is seen in the uterus, though it may vary in size. Often, diagnosis is presumptive, and based on clinical findings and the identification of a malignant trophoblast. One prevalent symptom is vaginal bleeding after a pregnancy, abortion, or hydatid mole.^[2] A pregnancy test will be positive even if there is no embryo/fetus.^[3]

Treatment

Chemotherapy is the treatment of choice. In certain cases, a hysterectomy and radiation are necessary.^[4]

Prognosis

At the time of diagnosis, more than 90% of patients already have lung metastases, though there are also less frequent metastases to the brain and liver. With chemotherapy, there is an 80% 5-year survival rate. Ultimately, death is related to liver and brain metastases.

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