Choriocarcinoma is the most aggressive, malignant form of
gestational trophoblastic disease and has varying incidence, increasing in patients older than 40 years. It usually develops after a malignant alteration in a
molar pregnancy, but rarely after an abortion or normal or
ectopic pregnancies. The most common localization is the uterus, but it can also be found rarely in the ovaries, fallopian tubes, vagina, vulva, cervix or pelvic region. A 38-year-old multiparous woman, with no complications in three previous labors and four
miscarriages, presented to her gynecologist one year after the last
miscarriage complaining of abnormal
vaginal bleeding. Clinical examinations showed normal ultrasound and histopathology findings. Blood analysis demonstrated moderate
anemia and low elevated serum b-
human chorionic gonadotropin. Due to profuse
hemorrhage and
anemia after the
curettage, the medical council decided that a total
hysterectomy should be performed. Macroscopic examination of the post-operative material showed regular morphology of the uterus, fallopian tubes and ovaries. However, a whitish brown lesion with a maximum diameter of 22 mm was noted in a longitudinal section of the cervix. Using standard histopathology and immunohistochemical analysis, a cervical gestational
choriocarcinoma was diagnosed. Knowledge of the characteristics of the
choriocarcinoma is very important for accurate diagnosis and treatment, especially when the
tumor is localized on the rare locations and where a high level of serum b-
human chorionic gonadotropin is absent.