737 Gestational trophoblastic tumour: choriocarcinoma

Introduction/Background Choriocarcinoma is a rare malignancy that arises from placental trophoblastic tissue. Approximately 50% of choriocarcinomas follow molar pregnancies, and the remainder occur after spontaneous abortions or ectopic pregnancies. It belongs to the malignant end of the spectrum in gestational trophoblastic disease (GTD). While the disease used to be fatal in the majority of cases, currently, most cases can be cured by chemotherapy. Methodology Case report Results We report a rare case of a 42-year-old female patient admitted with a one-month history of vaginal bleeding. The patient has given birth twice vaginally, the latest was 13 months ago. She reports a history of spontaneous miscarriage at home one month ago, with an imprecise last menstrual period (LMP) and no evidence of intrauterine pregnancy. The b-hCG level was 10,257 with an empty uterus on pelvic ultrasound, no fluid accumulation or lateral uterine mass. The patient underwent a brain CT scan following a severe headache, which revealed a brain metastasis. A thoracoabdominal CT scan was performed, showing a 19mm lung metastasis, three hepatic metastatic lesions, and a 6cm metastasis in the middle-splenic region. The case was discussed with the reference center for trophoblastic diseases in Lyon, who confirmed that even in the absence of anatomopathological evidence, the diagnosis of metastatic postpartum choriocarcinoma (attributed to the recent childbirth rather than the miscarriage) is established (FIGO score 15). Care was continued in the specialized center. The response was excellent, and the patient was subsequently discharged after 6 cycles of chemotherapy, and a 10-year follow-up was arranged. Conclusion This report highlights that he diagnosis of choriocarcinoma might be proven challenging even for experienced clinicians. Consideration should be given, as to whether or not a tissue biopsy is needed before starting treatment. The overall prognosis is very good if a prompt diagnosis is made, and care is provided correctly. Disclosures All authors declare that they have no conflicts of interest.