Choriocarcinoma with brain metastasis after term pregnancy

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RATIONALE: Although the incidence of postpartum choriocarcinoma is extremely low, careful postpartum placental examination, histopathological examination in patients with abnormalities, and blood β-human chorionic gonadotropin (HCG) monitoring in high-risk pregnant women are necessary for early diagnosis of postpartum choriocarcinoma and improvement in prognosis. PATIENT CONCERNS: A 32-year-old woman presented with the chief complaint of postpartum irregular vaginal bleeding for 45 days and coughing and hemoptysis for 7 days. DIAGNOSIS: Clinical findings when combined with her medical history and various physical examinations confirmed the diagnosis as postpartum choriocarcinoma with brain metastases (stage IV postpartum choriocarcinoma and a risk score of 16). INTERVENTIONS: The patient was administered three courses of multidrug chemotherapy (5-fluorouracil + actinomycin D) with intrathecal methotrexate injection. The 5-fluorouracil + actinomycin D maintenance chemotherapy regimen was continued for 4 cycles; whole brain radiotherapy was also administered. OUTCOMES: After the completion of chemotherapy and radiotherapy, the patient underwent regular follow-up examinations; no recurrence was noted for 17 months. LESSONS: Timely diagnosis of postpartum choriocarcinoma can significantly improve its prognosis. A stratified treatment should be administered according to the International Federation of Gynecology and Obstetrics staging and World Health Organization prognostic scoring systems. Blood β-HCG is a sensitive marker for evaluating therapeutic efficacy and follow-up after remission.