Atypical presentation of choriocarcinoma: A report of two cases

Background: Choriocarcinoma is a gestational trophoblastic tumor commonly seen in the reproductive-age group. It is an aggressive tumor with high malignant potential and responds well to chemotherapy. Lungs and vagina are the most common sites for metastasis, and brain involvement is seen in 20–25% of cases. It usually presents within 6 months to 1 year following a molar or normal pregnancy. Case descriptions: We are presenting two interesting cases of choriocarcinoma who reported with atypical symptoms. Case 1: A 47-year-old P3L3 reported with abnormal uterine bleeding and cough with expectoration. Suction and evacuation suggested choriocarcinoma, and she was started on EMACO regimen of chemotherapy in view of lung metastasis. Case 2: A 23-year-old P1L1 presented with irregular vaginal bleeding for 15 days, 2 months following delivery. She developed left-sided hemiparesis, diagnosed as choriocarcinoma with brain metastasis and started on chemotherapy with etoposide, methotrexate, actinomycin D, cyclosphosphamide, and vincristine (oncovin) (EMACO) regimen. Both the cases had a prior history of molar pregnancy but failed to follow-up after the evacuation. Conclusion: Women with prior history of molar pregnancy need to be counseled to follow-up with serum beta-human chorionic gonadotropin (β-hCG) following evacuation. Choriocarcinoma is an aggressive tumor that can present with atypical symptoms such as abnormal uterine bleeding in postpartum period or perimenopausal age. Early diagnosis and treatment with or without metastasis have excellent prognosis. Clinical significance: Choriocarcinoma can present with atypical symptoms, especially in postpartum period and perimenopausal age. Clinicians need to have an index of suspicion of choriocarcinoma in treating women with atypical features.