Case report Gestational choriocarcinoma arising in a cornual pregnancy Pier Luigi Venturini MD a,* , Franco Gorlero MD a , Antonella Ferraiolo MD a , Mario Valenzano MD a , Ezio Fulcheri MD b a Department of Obstetrics and Gynecology, Istituto G. Gaslini, University of Genoa, Largo G. Gaslini 5, 16147 Genova, Italy b Department of Pathology, University of Genoa, 16147 Genova, Italy Accepted 10 June 2000 Abstract A of a case of cornual pregnancy associated with initial transformation to choriocarcinoma is reported. Appropriate monitoring of HCG titers following conservative management of ectopic pregnancy is important not only to diagnose persistent ectopic gestation, but to avoid missing trophoblastic disease, albeit rarely. # 2001 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Cornual pregnancy; Ectopic pregnancy; Choriocarcinoma 1. Introduction Gestational choriocarcinoma associated with ectopic pregnancy is an extremely rare event: its theoretic incidence is one in 5333 tubal pregnancies, or one in 1.6 million normal intrauterine pregnancies [1]. This report describes a case of cornual pregnancy asso- ciated with choriocarcinoma managed by conservative sur- gery followed by chemotherapy. 2. Case report A.F., a 31-year-old married woman was admitted to the Department of Obstetrics and Gynecology of Genoa Uni- versity because of complaints of heavy metrorrhagia and vague lower abdominal pain. She had undergone abdominal myomectomy of multiple ®broids elsewhere, 5 years earlier. On admission she was in good general health. Pelvic exam- ination revealed no pain in the adnexal regions, mild tender- ness was elicited by uterine palpation and blood was found in the vagina. She had had her last menses about 3 months before. b-HCG titers were positive at 13,380 mUI/ml. Ultrasound scans showed an empty uterus with a subserous 2 cm echogenic mass on the left side of the fundus that looked like a ®broid, which was compatible with the patient's history. Fig. 1). A thin endometrium, no echo-free space in the Douglas pouch, no adnexal masses and lastly, no presence of any corpus luteum on either ovary were observed. Transvaginal color-¯ow Doppler examination revealed no abnormal arteriovenous shunt ¯ow of either mass or myometrium, nor were there any `ring of ®re' signs, indicative of intense peritrophoblastic vascular activity. Hysterosonography performed by saline solution con- ®rmed the intramural echogenic mass which was separated from the uterine cavity by an apparently normal, 5 mm tissue. Laparoscopy and diagnostic curettage were per- formed in order to ®nd and treat the ectopic pregnancy and/or to remove intrauterine residual trophoblastic tissue. No blood was found in the pelvic cavity; the fallopian tubes and ovaries were bilaterally normal in appearance. Massive omental and intestinal adhesions due to previous myomect- omy were found. A mass of approximately 2 cm in diameter covered by normal myometrium and normal serosa located on the left side of the uterine fundus was observed. This mass, which was partially covered by adhesions, looked like a subserous myoma and was located in the area correspond- ing to the uterine mass described by previous sonography. A small amount of endometrial tissue was found by diagnostic curettage. b-HCG levels increased from 13,380 mUI/ml to 19,990 over the three postoperative days. Histological examination identi®ed neither chorionic villi nor fetal parts and the endometrium showed typical changes due to hyperproges- teronism. Laparotomy was performed. After removing the adhe- sions, the uterine mass observed by sonography and by laparoscopy was gently cut by means of a small incision. European Journal of Obstetrics & Gynecology and Reproductive Biology 96 2001) 116±118 * Corresponding author. Tel.: 39-010-3742373; fax: 39-010-5636382. 0301-2115/01/$ ± see front matter # 2001 Elsevier Science Ireland Ltd. All rights reserved. PII:S0301-211500)00412-7