Choriocarcinoma metastatic to the kidney in amenorrheic woman following normal vaginal delivery

Gestational choriocarcinoma usually occurs following an intrauterine pregnancy. We report a case of metastatic choriocarcinoma to the left kidney and lungs with long term intermittent amenorrhea and vaginal bleeding after a normal vaginal delivery.A 43 year old rural woman presented with three years intermittent amenorrhea and vaginal bleeding following normal vaginal delivery. She also complained of gross hematuria and left flank pain and had a rising titer of serum β- hCG. Pathologic examination of endometrial curettage specimen revealed choriocarcinoma. Ultrasound revealed enlarged uterus involved by an irregular mass with heterogenous echo pattern and extensive myometrial invasion. A mass with similar echo pattern was also evident in the left kidney. Computerized tomography confirmed the intrauterine mass and involvement of the left kidney. On chest X ray, metastatic nodules were seen in both lungs and in the left retrocardiac space. The patient underwent chemotherapy with EMA-CO regimen (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine/oncovine). During chemotherapy, she became pancytopenic and febrile. This condition was successfully managed with G-CSF, leukovorin and antibiotics. The patient is now well and still under the chemotherapy. Her serum β- hCG level has fell to 6 IU/ml.