Choriocarcinoma

After a term vaginal delivery, this patient has abnormal vaginal bleeding, an enlarged uterus, a vascular vaginal lesion, and a positive urine pregnancy test, a presentation consistent with gestational trophoblastic neoplasia (GTN). Choriocarcinoma is the most aggressive form of GTN, and metastasis to the lungs, vagina, central nervous system, or liver often occurs. Abnormal vaginal bleeding is common and can be from either metastatic disease (eg, vaginal lesion) or the primary tumor itself (eg, enlarged uterus).

GTN is a type of neoplasm that results from malignant transformation of the chorionic villi or trophoblast. Although GTN is typically a sequela of a hydatidiform mole, it can follow any type of pregnancy, including a normal term delivery, spontaneous abortion, or ectopic pregnancy. Another risk is maternal age >40.

In patients with suspected GTN, initial evaluation includes a quantitative β-hCG; thyroid, renal, and hepatic function panels; pelvic ultrasound; and chest x-ray. Treatment options include chemotherapy (typically methotrexate) and hysterectomy. After treatment, β-hCG levels are used as a marker for disease remission or progression.

Patients with an incomplete abortion have vaginal bleeding and a positive pregnancy test. However, there is also associated cervical dilation, and products of conception are frequently visible at the cervical os, neither of which is seen in this patient.