Third-Trimester Intraplacental Choriocarcinoma Presenting With Respiratory Failure and Hyperthyroidism
AuthorSubang, Maria Laarni L.
Staats, Paul N.
Lamos, Elizabeth M.
Munir, Kashif M.
JournalAACE Clinical Case Reports
MetadataShow full item record
AbstractObjective: Choriocarcinoma is an aggressive disease typically identified after a molar pregnancy. Diagnosis with a co-existing pregnancy is extremely rare. Only 35 cases have been reported from 1907 to 1995. We report a case of choriocarcinoma diagnosed during the third trimester of an intra-uterine pregnancy presenting with respiratory failure and biochemical hyperthyroidism. Methods: This is a case report of an intraplacental choriocarcinoma during the third trimester of pregnancy. We included a review of literature highlighting the rarity of this disease, diagnostic challenges, and treatment options. Results: A 34-year-old woman, 31 weeks pregnant, presented with dyspnea and hemoptysis for 2 weeks. Imaging showed bilateral pulmonary infiltrates, suggestive of pneumonia. Thyroid function tests checked due to tachycardia revealed hyperthyroidism, with thyroid-stimulating hormone of 0.02 μIU/mL (normal range, 0.5 to 4.5 μIU/mL) and free thyroxine of 4.8 ng/dL (normal range, 0.7 to 1.8 ng/dL). Serum human chorionic gonadotropin was elevated, at 1,433,740 mIU/mL. Respiratory failure ensued, requiring ventilatory support. Emergent cesarean section was done due to worsening clinical status. Histopathologic findings of the placenta were diagnostic of intraplacental choriocarcinoma. Chemotherapy was given; however, the patient developed acute cerebral hemorrhage and she eventually expired. Conclusion: Diagnosis of choriocarcinoma co-existing with intra-uterine pregnancy can be difficult, as initial symptoms can be mistaken for other diseases, such as pneumonia in this case. Biochemical hyperthyroidism during the third trimester in a patient with no history of thyroid disease is rare, and choriocarcinoma should be considered. A timely diagnosis is imperative, as early intervention with chemotherapy can be curative and potentially life-saving. Abbreviations: FIGO = International Federation of Gynecology and Obstetrics GTN = gestational throphoblastic neoplasia hCG = human chorionic gonadotropin T4 = free thyroxine TSH = thyroid-stimulating hormone WHO = World Health Organization
Identifier to cite or link to this itemhttp://hdl.handle.net/10713/18054