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Endgames Case report

Normal pregnancy or neoplasia?

BMJ 2008; 337 doi: (Published 30 October 2008) Cite this as: BMJ 2008;337:a2107
  1. Alexandre Rozenholc, resident, gynaecology and obstetrics,
  2. Patrick Petignat, consultant gynaecological oncologist
  1. 1Gynaecology and Obstetrics Department, Geneva University Hospitals, 1211 Geneva 14, Switzerland
  1. Correspondence to: P Petignat patrick.petignat{at}

    A 24 year old woman, gravida 1 para 1, presented with a request for contraception four months after delivery of a healthy baby and a normal placenta. She did not breastfeed, was asymptomatic, and did not have a return of menses (postpartum amenorrhea). A urinary pregnancy test was performed, which was positive. Transvaginal ultrasonography showed no intrauterine or extrauterine pregnancy; the endometrium was regular, 3 mm thick; and the ovaries were normal. The concentration of serum human chorionic gonadotrophin (hCG) was 92 713 IU/l (normal <5 IU/l), and one week later it was 117 056 IU/l. She underwent dilatation and curettage, and the pathological specimen showed no decidua or trophoblastic tissue. Hysteroscopy and laparoscopy showed a normal uterine cavity, tubes, and ovaries. A thoraco-abdominal computed tomography scan and magnetic resonance imaging of the brain showed no abnormality.


    • 1. What is your diagnosis?

    • 2. What are the prognostic factors?

    • 3. Which treatment do you recommend?


    Short answers

    • 1. The diagnosis is a gestational trophoblastic neoplasia, most likely a choriocarcinoma.

    • 2. Prognostic factors include age; type of pregnancy; time interval from the pregnancy; pre-treatment hCG concentration; tumour size, sites, and number of metastases; and previous chemotherapy.

    • 3. High risk patients (those with a FIGO (International Federation of …

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