A 37-year-old G5P005 woman presents to the emergency department with abnormal uterine bleeding for the past week and shortness of breath for the past two days. She has not had any prenatal care for the current pregnancy, and her earlier pregnancies have all been uncomplicated vaginal deliveries. She states that her last menstrual period was about 12 weeks ago. Past medical history is otherwise unremarkable. On physical examination, breath sounds are decreased bilaterally, and measurement of fundal height is consistent with a pregnancy of 30 weeks’ gestation. There is scant vaginal bleeding on speculum exam. B-HCG measures 22,000 mIU/mL. She is referred for further evaluation of choriocarcinoma.
Which of the following is the most common site of metastasis of choriocarcinoma?
- A) Heart
- B) Kidneys
- C) Lungs
- D) Pancreas
- E) Thyroid
Gestational choriocarcinoma consists of highly vascular, invasive, and anaplastic trophoblastic tissue made up of cytotrophoblasts and synctytiotrophoblasts without villi. Choriocarcinoma can follow a nonmolar or a molar pregnancy, where it is more common after a complete mole rather than a partial mole. Choriocarcinoma is the most aggressive histologic type of gestational trophoblastic neoplasia and is characterized by early vascular invasion and widespread metastases. The clinical presentation of choriocarcinoma depends upon extent of disease and location of metastases. One of the earliest signs of widespread disease is continued bleeding from various sites even after resolution of a pregnancy. Eighty percent of metastases are to the lungs, followed by vagina, central nervous system, and liver. Patients with pulmonary metastases have lesions identified on chest imaging and can present with cough, dyspnea, or signs of pulmonary hypertension.
Key Learning Point
Choriocarcinoma is characterized by early widespread metastases, most commonly to the lungs.
Dr. Ted O'Connell