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Stage IV Gestational Choriocarcinoma Diagnosed in the Third Trimester

Jorgensen, Kirsten, MD; Roychowdhury, Monika, MD; da Cunha, Grace, NP; Kim, Young Bae, MD; Schorge, John O., MD

doi: 10.1097/AOG.0000000000003001
Contents: Gynecologic Oncology: Case Report

BACKGROUND: Gestational trophoblastic neoplasia rarely occurs in term pregnancies. Stage IV choriocarcinoma treated with conventional chemotherapy can result in death as a result of hemorrhagic sequelae at tumor sites.

CASE: A 30-year-old woman at 34 weeks of gestation presented with a persistent cough, worsening dyspnea, and vaginal bleeding. Chest radiograph demonstrated innumerable lung nodules, and quantitative β-hcg concentration exceeded 1.3 million milli-international units/mL. Cesarean delivery was performed for presumed abruption. Placental pathology demonstrated choriocarcinoma, and imaging confirmed stage IV disease with a World Health Organization score of 14. Remission was achieved after two courses of low-dose induction chemotherapy followed by 10 cycles of combination chemotherapy.

CONCLUSION: Gestational trophoblastic neoplasia should be considered in a pregnant or postpartum woman presenting with atypical vaginal bleeding. Coexistent pulmonary or neurologic findings may suggest advanced disease.

Progressive dyspnea in the third trimester may indicate the presence of enlarging pulmonary metastases from gestational choriocarcinoma.

Departments of Obstetrics and Gynecology and Pathology, Tufts Medical Center, Boston, Massachusetts.

Corresponding author: Kirsten Jorgensen, MD, Department of Obstetrics and Gynecology, 800 Washington Street, Boston, MA 02111; email:

Financial Disclosure The authors did not report any potential conflicts of interest.

Dr. Schorge, Associate Editor (Gynecology) for Obstetrics & Gynecology, was not involved in the review or decision to publish this article.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews and author correspondence are available at

© 2018 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.