Choriocarcinoma mimicking ectopic caesarean-scar pregnancy

Vaginal bleeding is one of the most common reasons for presentation to the early pregnancy unit. To aid in diagnosis, beta-human chorionic gonadotropin levels and ultrasound scan are commonly used. The most frequent diagnoses include miscarriage, ectopic pregnancy and cervical causes for bleeding; however, gestational trophoblastic disease (GTD) must always be ruled out. If left untreated, GTD can have fatal consequences. GTD is often associated with distinctive ultrasound findings, described as having a 'cystic' or 'snowstorm' appearance. However, it is important to consider GTD even in the absence of these features. Fewer than five cases of choriocarcinoma presenting as a caesarean-scar ectopic pregnancy have been reported. We described a rare but significant case of a patient with vaginal bleeding in early pregnancy, initially managed as a caesarean-scar ectopic pregnancy, with histology later confirming a diagnosis of choriocarcinoma.