Incidental Placental Choriocarcinoma in a Term Pregnancy: A Case Report

Introduction:

Gestational choriocarcinoma occurs in 1 in 40,000 pregnancies. Of all forms of gestational choriocarcinoma, placental choriocarcinoma is the most rare. Maternal choriocarcinoma is usually diagnosed in symptomatic patients with metastases. The incidental finding of a choriocarcinoma confined to the placenta with no evidence of dissemination to the mother, or infant is the least common scenario.

Case Presentation:

The patient is an 18 year-old African American Gravida 1 Para 0 at her 39th weeks of gestation who presented to a hospital in the St. Louis area in early labor. After rupture of membranes, light meconium was noted. The patient subsequently delivered a viable female infant vaginally, weighing 3641 g, with Apgar scores of 9 and 9 at 1 and 5 minutes. Her pregnancy course was complicated by gestational hypertension during the third trimester. She was treated with magnesium sulfate during labor for possible pre-eclampsia due to elevated blood pressure intrapartum. Her blood pressure was normal after delivery, and her post partum course was unremarkable.

The placenta appeared to be grossly normal with a 3 vessel cord at the time of delivery. Because of the patient's history of gestational hypertension, the placenta was sent to pathology and placental choriocarcinoma was diagnosed (Figure 1 & Figure 2). She was then referred to and followed closely by the Gynecologic Oncology service. Her serum beta human chorionic gonadotropin (hCG) dropped from 3070 mIU/ml to less than 2 mIU/ml six weeks post partum. No chemotherapy was initiated. She had also undergone multiple studies such as chest x-ray and computed tomography (CT) scan which all ruled out metastasis during the one year post partum period. The infant was followed by the pediatric service. To date, both mother and baby have been disease free for eight years.

Conclusion

[HIDE]It is not a routine practice to send a placenta for pathological evaluation following a normal spontaneous delivery. However, a number of cases, like ours, reported incidental findings of placental choriocarcinoma in asymptomatic mothers and infants with no evidence of metastases. In the majority of these cases, the placenta was sent to pathology due to other pregnancy complications such as intrauterine growth restriction, pre-eclampsia, maternal fetal hemorrhage, and in our case, gestational hypertension.

It is our belief that the incidence of placental choriocarcinoma may actually be higher than reported. It is also well established that early detection and treatment of gestational trophoblastic disease improves treatment outcome. The obstetrician, pathologist and pediatrician should have an increased awareness of placental choriocarcinoma and its manifestations. Clinical suspicion and any gross placental anomaly should mandate a thorough pathological examination of the placenta.
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