From Benign to Lethal: A Case of Aggressive Choriocarcinoma With Systemic Metastases

Choriocarcinoma is a rare and aggressive gestational trophoblastic neoplasm that often arises after a molar pregnancy or miscarriage and is characterized by rapid metastatic potential. Diagnosis is typically based on clinical presentation, history of antecedent pregnancy, markedly elevated β-hCG levels, and supportive imaging and histopathologic findings. Early recognition and prompt initiation of multi-agent chemotherapy are crucial, as they markedly improve survival, with remission achievable even in advanced disease. We report the case of a 24-year-old woman who presented with persistent vaginal bleeding, severe pelvic pain, and progressive dyspnea one month after a molar pregnancy treated with dilation and curettage. Examination revealed pallor and mild abdominal tenderness. Laboratory studies showed a β-hCG level >250,000 mIU/mL (reference range: 0-5 mIU/mL) and profound anemia with a hemoglobin of 2 g/dL (reference range: 12-15.3 g/dL). Contrast-enhanced abdominal and pelvic computed tomography demonstrated metastatic lesions in the liver and gastrointestinal tract, while chest CT revealed multiple pulmonary nodules consistent with metastases. The patient was promptly initiated on multi-agent chemotherapy, resulting in normalization of β-hCG levels after several treatment cycles. This case highlights the importance of vigilant follow-up in patients with molar pregnancies and persistently elevated β-hCG, as timely diagnosis and treatment can lead to curative outcomes despite widespread metastasis.