A Case of Choriocarcinoma Disguised by a Cornual Fibroid

Document Type

Conference Proceeding

Publication Date

5-2026

Publication Title

Gynecologic Oncology

Abstract

Objectives Gestational trophoblastic neoplasia (GTN) is a rare condition in which malignant proliferation of trophoblastic tissue occurs after a pregnancy. Choriocarcinoma, an aggressive subtype of GTN, was often fatal before the use of chemotherapy. This study highlights the difficulties which can be encountered when diagnosis is delayed and response is not achieved with first line therapy. Methods The case involves a 27 year old woman who presented with one week of dyspnea and abdominal pain. She was 9 months postpartum from a term vaginal delivery with no interval pregnancies. Her serum human chorionic gonadotropic (hCG) was elevated at 301 mIU/mL and there was concern for an ectopic pregnancy. Ultrasound demonstrated a uterine cornual mass concerning for a leiomyoma. She underwent a diagnostic laparoscopy and was noted to have an abnormal, infiltrative growth in the left uterine cornua. Given the anticipated complexity of surgical resection, surgery was aborted, and she was treated with systemic methotrexate. Initially her hCG declined but then began to rise. Additional imaging demonstrated a pancreatic mass, lung metastases and enlarging left cornual uterine mass on CT. A multidisciplinary care conference was held and the decision was made to proceed with robotic-assisted surgery for removal of the uterine mass, given concern for GTN. Results At the time of surgery, significant enlargement and necrosis of the cornual uterine mass was noted. A biopsy of the lesion was evaluated by intraoperative frozen pathology and was concerning for high grade GTN. Given the extent of disease and involvement of a large portion of the uterus, hysterectomy was required for complete removal. Final pathology demonstrated choriocarcinoma, stage III, WHO score 6. She was initially treated with methotrexate therapy but did not respond. She transitioned to etoposide, methotrexate, dactinomycin, cyclophosphamide, vincristine (EMA/CO) due to failure of single agent therapy. She received 7 cycles of this multiagent regimen but her hCG started to rise again. She was transitioned to etoposide, cisplatin, methotrexate, and dactinomycin (EMA/EP) and received 6 cycles, with normalization of her hCG. It has now been one month since her last treatment and she is in remission. Conclusions This case illustrates two key points: the importance of a wide differential for elevated hCG and the difficulty that can be encountered when treating GTN. Choriocarcinoma is rare following a full term pregnancy and this patient was 9 months postpartum. This patient's diagnosis was especially difficult to recognize given that her cornual mass appeared consistent with a uterine leiomyoma on imaging and was infiltrating into the uterus when evaluated surgically. Following diagnosis, this case was more difficult than most to treat and required surgical resection and multiple systemic chemotherapy regimens to achieve remission. Recognition of this condition in a timely fashion is critical to improving outcomes in a disease that, without proper chemotherapy, can be fatal.

Volume

208

Issue

Suppl

First Page

s273

Last Page

s274

DOI

10.1016/j.ygyno.2026.01.487

ISSN

0090-8258

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