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Intraplacental Choriocarcinoma Presenting With Postpartum Hemorrhage Requiring Uterine Artery Embolization: A Case
Shiori Tsuge1, Kosuke Yoshida1, Mari Shirasaki1
1Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Intraplacental choriocarcinoma (ICC) is a rare gestational trophoblastic tumor that is often difficult to diagnose and is occasionally associated with fetomaternal hemorrhage (FMH). A 28-year-old woman presented with decreased fetal movements at 38 weeks of gestation. Due to a nonreassuring fetal heart rate pattern, an emergency cesarean section was performed. Severe neonatal anemia (3.2 g/dL) and markedly elevated maternal serum alpha-fetoprotein levels suggested FMH, despite normal maternal hemoglobin F levels. Initial placental pathology was unremarkable. Thirteen days postpartum, the patient developed massive vaginal bleeding requiring uterine artery embolization (UAE). Elevated serum β-hCG levels and multiple pulmonary nodules led to a clinical diagnosis of choriocarcinoma. Placental re-evaluation confirmed ICC. Chemotherapy with methotrexate, etoposide, and actinomycin D resulted in complete remission. In conclusion, ICC should be considered in cases of unexplained FMH or postpartum hemorrhage. UAE did not appear to impair the efficacy of subsequent chemotherapy in this case.
Intraplacental choriocarcinoma (ICC) is a rare gestational trophoblastic tumor that is often difficult to diagnose and is occasionally associated with fetomaternal hemorrhage (FMH). A 28-year-old woman presented with decreased fetal movements at 38 weeks of gestation. Due to a nonreassuring fetal heart rate pattern, an emergency cesarean section was performed. Severe neonatal anemia (3.2 g/dL) and markedly elevated maternal serum alpha-fetoprotein levels suggested FMH, despite normal maternal hemoglobin F levels. Initial placental pathology was unremarkable. Thirteen days postpartum, the patient developed massive vaginal bleeding requiring uterine artery embolization (UAE). Elevated serum β-hCG levels and multiple pulmonary nodules led to a clinical diagnosis of choriocarcinoma. Placental re-evaluation confirmed ICC. Chemotherapy with methotrexate, etoposide, and actinomycin D resulted in complete remission. In conclusion, ICC should be considered in cases of unexplained FMH or postpartum hemorrhage. UAE did not appear to impair the efficacy of subsequent chemotherapy in this case.