Case Report Occult choriocarcinoma discovered by positron emission tomography/computed tomography imaging following a successful pregnancy T. Michael Numnum a, T , Charles A. Leath III a , J. Michael Straughn Jr. a , Michael G. Conner b , Mack N. Barnes III a a Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 619 19th Street South, OHB 340, Birmingham, AL 35294, USA b Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294, USA Received 29 November 2004 Available online 17 March 2005 Abstract Background. Positron emission tomography (PET) is commonly used to detect occult or recurrent malignancy, including tumors of the female genital tract. Recently, there have been reports of PET scans used in patients with Gestational Trophoblastic Disease (GTD). Case. A 22-year-old female presented with vaginal bleeding and elevated h-hCG 7 months after a spontaneous vaginal delivery of a healthy infant. She had a history of molar pregnancy and persistent GTD requiring multi-agent chemotherapy. Metastatic evaluation with computed tomography and magnetic resonance imaging showed no evidence of GTD. A positron emission tomography/computed tomography (PET/CT) scan revealed a focus of metabolic activity in the left pelvis. The patient underwent an exploratory laparotomy that revealed metastatic choriocarcinoma in the left broad ligament. Conclusion. PET/CT may be useful in the evaluation of occult choriocarcinoma when conventional imaging fails to identify metastatic disease. D 2005 Elsevier Inc. All rights reserved. Choriocarcinoma is a rare tumor occurring in women of reproductive age and is one form of gestational trophoblas- tic disease (GTD). The evaluation of choriocarcinoma involves a combination of clinical, radiographic, and labo- ratory studies. Physical examination may document lesions on the vulva or vagina, while computed tomography (CT) and/or magnetic resonance imaging (MRI) are convention- ally used to evaluate the location and extent of metastatic disease. h-human chorionic gonadotropin (h-hCG) is utilized to monitor the presence of disease and response to treatment. The primary treatment of GTD is surgical evacuation followed by chemotherapy in those patients who are high risk based on the WHO risk scoring system [1]. Some patients with choriocarcinoma may benefit from surgical resection of disease if sites of metastasis can be identified and surgically resected. This case report describes the use of positron emission tomography/computed tomog- raphy (PET/CT) in the evaluation of occult choriocarcinoma where standard imaging modalities did not detect metastatic disease. Case A 22-year-old black female para 1-0-2-1 presented to our institution with a 3-day history of vaginal bleeding and abdominal cramping. Her past medical history was signifi- cant for a partial molar pregnancy diagnosed by dilation and curettage at the age of 16. Following uterine evacuation, the patient had persistently elevated h-hCG titers and was treated with single agent methotrexate and then actinomycin D. The patient had plateauing h-hCG titers and was 0090-8258/$ - see front matter D 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.ygyno.2005.01.049 T Corresponding author. Fax: +1 205 975 6411. E-mail address: mnumnum@hotmail.com (T.M. Numnum). Gynecologic Oncology 97 (2005) 713 – 715 www.elsevier.com/locate/ygyno