Vol.2, No.4, 69-72 (2013) Modern Chemotherapy http://dx.doi.org/10.4236/mc.2013.24009 Uterine choriocarcinoma: A gynaecological masquerader case report and review of the literature Eguzo Kelechi 1 , Chisara C. Umezurike 1* , Emmanuel Akwuruoha 2 1 Nigerian Christian Hospital, Aba, Nigeria; * Corresponding Author: umeztochi@hotmail.com 2 Abia State University Teaching Hospital, Aba, Nigeria Received 9 July 2013; revised 15 August 2013; accepted 1 September 2013 Copyright © 2013 Eguzo Kelechi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Choriocarcinoma is a rare clinical condition, and its diagnosis may be difficult, es- pecially in resource-limited settings. Case Pre- sentation: A 38-year old para 2 woman is with a 4-month history of intractable vaginal bleeding and offensive vaginal discharge, but without antecedent pregnancy. She had previously been managed at various tertiary medical institutions where several pelvic ultrasound scans and even histology of endometrial curette could not clinch the diagnosis. The diagnosis of choriocarcino- ma was made by a serial strip-based pregnancy testing, which was still positive at 1:200 dilu- tions. She was treated with chemotherapy in- volving Adriamycin, Cyclophosphamide, Meth- otrexate and Folinic acid. Conclusion: The di- agnosis of choriocarcinoma may be difficult especially when it develops ab initio without preceding abortion, molar or term pregnancy. In settings where serum hCG assay may be not available, the simple strip-based pregnancy test in dilution could be helpful in its diagnosis and treatment monitoring. Keywords: Choriocarcinoma; Chemotherapy; Human Chorionic Gonadotropin; Resource-Limited Settings 1. INTRODUCTION According to the World Health Organization Science Group in 1983 [1] on histopathological and clinical termin- ology, gestational choriocarcinoma is a carcinoma arising from the trophoblastic epithelium that shows both cyto- trophoblastic and syncytiotrophoblastic element. It may arise from conceptions that give rise to a live birth, a still birth, and abortion at any stage, an ectopic pregnancy or a hydatidiform mole, or it may arise from ab initio. Gestational trophoblastic diseases (GTD) comprise a variety of biologically interrelated conditions which form a clinical spectrum consisting of four distinct clinical pathological entities namely, molar pregnancy, invasive mole, placental site trophoblastic tumours, and chorio- carcinoma [2-4]. Serum human chorionic gonadotropin (h’CG) assay has remained the main stay of diagnosis, prognosis and monitoring of the condition. The purpose of this report is to illustrate how difficult the diagnosis of choriocarcinoma could be and to show how a simple and “technology free” pregnancy test could still be relevant in its diagnosis and treatment in resource- poor settings. 2. CASE PRESENTATION A 38-year old para-2 Nigerian woman was presented in our centre with 4 months history of intractable vaginal bleeding. The bleeding was said to be heavy and was associated with passage of big blood clots. It was associ- ated with offensive vaginal discharge, weight loss, fever and antecedent menorrhagia. It was not however associ- ated with any history of amenorrhea, termination of preg- nancy, lower abdominal swelling, post-coital or contact bleeding. Her last confinement was four years prior to presentation. There was no history of cough, hemoptysis, jaundice, unusual behaviour, convulsion, urinary or gas- tro-intestinal symptoms. Prior to her presentation at our center, the patient had been managed at the various terti- ary hospitals (both in northern and south-eastern Nigeria), where various abdominal ultra-sound scan report sus- pected uterine fibroids, cervical cancer and endometrial cancer respectively. A histopathological report from one of the centres queried chronic endometritis. There was no definite diagnosis, but she had been transfused with many units of blood. Initial evaluation revealed severe anaemia, with high grade fever, tachycardia (120 beats/minute) and low Copyright © 2013 SciRes. OPEN ACCESS