Post-term gestational choriocarcinoma presenting with hemorrhagic brain and bilateral renal metastases: a rare case...

Gestational choriocarcinoma is a malignant subtype of gestational trophoblastic neoplasia (GTN) characterized by rapid hematogenous spread, commonly affecting the lungs, brain, liver, and pelvis. However, renal metastasis, particularly bilateral, further complicated by spontaneous retroperitoneal hemorrhage (SRH), is exceedingly rare and poses significant diagnostic and therapeutic challenges.

This case report describes a 33-year-old woman who presented with a 15-day history of progressive shortness of breath, vaginal bleeding, and flank pain, occurring 4 years after a term pregnancy. Investigations revealed severe anemia, markedly elevated beta-hCG, and metastatic lesions in the lungs, brain, and bilateral kidneys with significant retroperitoneal hemorrhage. Despite prompt resuscitation and initiation of EMA/CO chemotherapy, the patient's condition deteriorated rapidly due to hemorrhagic brain metastases, and she succumbed to intracranial complications resulting from hemorrhagic brain metastases.

This case illustrates the aggressive nature of choriocarcinoma, which can arise years after childbirth without uterine involvement. Bilateral renal metastases with SRH are uncommon, complicating diagnosis and treatment, whereas hemorrhagic brain lesions emphasize the disease's severity. Persistently high beta-hCG continues to be a crucial indicator for diagnosis.

This report highlights a rare case of gestational choriocarcinoma with extensive metastasis presenting years after a post-term pregnancy. Early suspicion and aggressive treatment are crucial, though prognosis is poor in advanced, treatment-resistant cases. Routine beta-hCG monitoring in postpartum women with unexplained symptoms may enable earlier detection and timely intervention.