Incidental intraplacental gestational choriocarcinoma with positive fetomaternal haemorrhage quantitation: A case report

Intraplacental choriocarcinoma is a rare form of gestational choriocarcinoma arising within the placental parenchyma. Its true incidence is unknown as not all placentas are examined and it is often asymptomatic. It may present peripartum with features of vaginal bleeding or fetal death, post-partum with metastases, or be incidentally found on histopathological examination of the placenta. Fetomaternal haemorrhage results from choriocarcinoma invasion into the placental parenchyma, and can result in life-threatening fetal anaemia. It is an uncommon manifestation of intraplacental choriocarcinoma. We present a case of an asymptomatic primigravida women in her early 30 s who was admitted to hospital with fetomaternal haemorrhage. Serum human chorionic gonadotropin was normal and ultrasonography was reassuring. Following delivery, a focus of intraplacental choriocarcinoma with associated stromal invasion was found on placental examination. Imaging showed no evidence of metastasis. The patient was managed through serial hCG monitoring with contraception. This case demonstrates the importance of appropriate clinical referral of placentas and subsequent thorough histopathological examination of same.