Hemoptysis as the first symptom in the diagnosis of metastatic choriocarcinoma in the third trimester of pregnancy: A case report

Choriocarcinoma is a rare neoplasm (1/40000 pregnancies). In the context of a viable pregnancy, the incidence is even lower (1/160000). A woman in her second pregnancy was admitted at 31 + 6 weeks of gestation with hemoptysis and abnormal vaginal bleeding. Numerous placental venous lakes, bilateral pulmonary nodules and a pleural effusion were found. Pleural fluid β-HCG levels were elevated and a brain-chest-abdominal-pelvic CT scan led to the diagnosis of a high-risk gestational trophoblastic neoplasm. A caesarean section at 32 + 1 weeks of gestation was performed. Six cycles of an EMA-CO chemotherapy regime were administered. β-HCG levels normalized after 3 cycles. Placental histopathology confirmed the presence of a gestational choriocarcinoma. Choriocarcinoma is a highly aggressive tumor. In high-risk tumors, combination chemotherapy is the first-line treatment, offering high remission rates. Treatment response is evaluated by monitoring blood β-HCG levels, which should be long-term. •Gestational choriocarcinoma is a rare trophoblastic neoplasm.•Abnormal vaginal bleeding in pregnancy is a common presentation.•Hemoptysis is the main symptom in the presence of lung metastases.•In high-risk groups, multi-agent chemotherapy is the first-line treatment.•Cure rates reach up to 95% in stage III high-risk groups.