Primary choriocarcinoma of the cervix mimicking a cervical pregnancy

E. Brătilă, C.P. Brătilă, D.E. Comandaşu, M.M. Cîrstoiu, C. Berceanu, S. Vlădăreanu, G.E. Lupușoru, C. Lupușoru, C. Mehedințu

Rezumat: Introduction. Gestational trophoblastic neoplasia (GTN) represents a generic term that includes invasive mole (IM), choriocarcinoma (CCA), placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT). Case report. In this paper we report the case of a 40-yearold woman, gesta 2, para 2, presenting with a cervical well vascularized mass causing vaginal bleeding two years after the delivery of her second baby at term by caesarean section. The cervical CCA suspicion diagnosis was established based on imaging aspect - transvaginal ultrasound showing a parenchymatous area that protrudes into the cervical canal with intense peripheral vascular network and contrast-enhanced MRI describing an expansive bulky, round-oval, well defined mass with a long necrotic pedicle and extensive central area of necrosis. For the differential diagnosis it was recommended the dosage of serum βHCG, which showed a very high value of 63291 mUI/mL. The histopathological results correlated with the increased levels of βHCG suggested choriocarcinoma with large necrotic and hemorrhagic areas. Accurate positive diagnosis of CCA was realized through immunohistochemistry evaluation (IHC), the AE1-AE3 markers, βHCG, HPL, MUC4 and Ki-67 diffusely positive in tumor cells. A trachelectomy was performed, followed by abdominal uterine cerclage, in order to preserve the patient’s ability to carry a future pregnancy until term.Discussions. Usually, the diagnosis of a primary extrauterine CCA is difficult because of the non-specific clinical presentation that can mimic other conditions. Conclusions. Primary cervical choriocarcinoma is an extremely rare condition that should be considered in the differential diagnosis of a cervical mass with profuse bleeding particularly due to intense vascularity, especially in young women. Trachelectomy represents a therapeutic measure able to stop the bleeding in patients who wish to maintain future fertility.
Cuvinte cheie: primary cervical choriocarcinoma, gestational trophoblastic neoplasia, cervical mass, vaginal bleeding.