Normal pregnancy or neoplasia?BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a2107 (Published 30 October 2008) Cite this as: BMJ 2008;337:a2107
- Alexandre Rozenholc, resident, gynaecology and obstetrics,
- Patrick Petignat, consultant gynaecological oncologist
- 1Gynaecology and Obstetrics Department, Geneva University Hospitals, 1211 Geneva 14, Switzerland
- Correspondence to: P Petignat
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?
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 …