Choriocarcinoma in the Cervix: Case Report of a Challenging Differential Diagnosis

Primary cervical choriocarcinoma in abortion curettage tissue is extremely rare and represents a diagnostic challenge. It is a serious condition that requires prompt and targeted therapeutic management. This case report describes the diagnostic evaluation, taking into account relevant differential diagnoses and highlighting the importance of a comprehensive diagnostic work-up to resolve these complex cases.

A 43-year-old woman presented with recurrent vaginal bleeding, an elevated β-HCG of 1165 mU/mL, and sonographic suspicion of an incomplete abortion with an ectopic pregnancy in the cervix. Dilation and curettage were performed. Histological analysis raised the suspicion of a gestational choriocarcinoma of the cervix. In contrast, an external specialist referral suggested a somatic carcinoma with germ cell differentiation due to an abnormal p53 pattern, which subsequently led to a change in the management. The patient underwent a total hysterectomy and bilateral salpingo-oophorectomy together with bilateral iliac lymphadenectomy. In the final molecular workup, nonmaternal DNA was identified in the tumor tissue. A TP53 mutation could not be detected. In summary, these findings confirmed a gestational choriocarcinoma of the cervix. Follow-up 28 months after completion of chemotherapy revealed no evidence of recurrence.

Cervical gestational choriocarcinoma requires thorough molecular investigation, as accurate diagnosis is pivotal for optimal management.