Choriocarcinoma and
placental site trophoblastic tumor (PSTT) are rare varieties of
gestational trophoblastic disease (GTD). PSTT alone constitutes about 1-2% of all
trophoblastic tumors, which presents at early reproductive age and the serum beta-hCG level is much lower than
choriocarcinoma. This
tumor usually invades the myometrium and its depth of penetration is a prognostic factor. The first case report is regarding a 33-year-old woman with
vaginal bleeding 3 months after abortion. The ultrasound exhibited heterogeneous and hypervascular mass related to previous cesarean
scar. Serum beta-hCG level was 67 mIU/ml and
chemotherapy was administered. However, due to severe
vaginal bleeding and no regression in mass size, total abdominal
hysterectomy was performed. Histopathological examination and IHC staining confirmed PSTT from previous
cesarean section. The second case report is regarding a 33-year-old woman with cervicoisthmic
choriocarcinoma, which was mistaken as cesarean
scar pregnancy. The ultrasonography and elevated serum beta-hCG level suggested cesarean
scar pregnancy. The patient was treated with
methotrexate without any effect. Eventually, cervicoisthmic
choriocarcinoma was detected after
hysterectomy. A diagnostic error was made leading to possible uterus perforation along with incorrect
chemotherapy that resulted in a life-threatening condition. It is concluded that PSTT and
choriocarcinoma are the two important differential diagnoses of sustained elevated beta-hCG when imaging evidence is also suggestive. Although PSTT and cervicoisthmic
choriocarcinoma are rare, they do exist and are on the rise.