Gestational choriocarcinoma following an ectopic pregnancy: A diagnostic dilemma in low-resource settings

Gestational choriocarcinoma is a highly aggressive form of gestational trophoblastic neoplasia that follows an ectopic pregnancy in fewer than 1.5 cases per million births. In low-resource settings, diagnosis is frequently delayed due to a lack of standardized postoperative surveillance and clinical presentations that mimic other conditions. A 34-year-old woman presented with hemodynamic instability and a beta-human chorionic gonadotropin (β-hCG) level of 304,000 IU/L, one month after undergoing surgery for a cornual ectopic pregnancy. Ultrasound revealed a 14.8-cm hypervascular uterine fundal mass and massive hemoperitoneum. An emergency exploratory laparotomy was performed, revealing 4 L of hemoperitoneum and an extensive infiltration of placental tissue on the small bowel, omentum, and fundus of the uterus, which histopathological analysis confirmed as gestational choriocarcinoma infiltrating the regional omental fat. Delayed recognition of gestational trophoblastic neoplasia following ectopic pregnancy surgery remains a significant risk in resource-constrained settings due to inadequate postoperative β-hCG surveillance. Routine β-hCG monitoring and prompt ultrasound evaluation are essential for early detection and emergency decision-making. At the same time, persistent postpregnancy symptoms with markedly elevated β-hCG warrant urgent suspicion for GTN and histopathological confirmation.