RARE CLINICAL CASE OF CHORIOCARCINOMA WITH MULTIPLE METASTASES AND A FAVORABLE OUTCOME: DIAGNOSTIC CHALLENGES.

BACKGROUND

The incidence of gestational trophoblastic neoplasia (GTN) in the United States and a number of developed countries is estimated at approximately 110-120 cases per 100,000 pregnancies, with choriocarcinoma among the malignant forms of GTN characterized by the most aggressive course and rapid metastasis. The presented clinical case demonstrates the difficulties of early diagnosis of GTN following pregnancy termination. Minimal ultrasound changes and atypically low β-hCG levels in the early stages masked the onset of pathological trophoblastic proliferation. The disease, initially confined to the reproductive system, spread to the lungs, brain, and liver. The case underscores the need for regular dynamic monitoring of β-hCG levels and early morphological verification after any pregnancy termination.

AIM: To describe a rare case of choriocarcinoma with multiple metastases and a favorable outcome, to evaluate the effectiveness of treatment, and to analyze factors influencing the accuracy and timeliness of diagnosis in suspected GTN.

METHODS

An analysis was conducted of a rare clinical case of malignant gestational trophoblastic neoplasia. The patient underwent comprehensive clinical and laboratory examination, including determination of β-hCG levels by electrochemiluminescence immunoassay (ECLIA), general clinical blood tests, ultrasound examination (Voluson S10), computed tomography (Siemens SOMATOM go.Now), and histological examination of surgical material by standard methods. Staging was performed according to the FIGO anatomical classification.

CONCLUSION

The described case shows that atypical clinical and ultrasound manifestations, along with non-typical β-hCG dynamics, significantly complicate the early diagnosis of GTN, increasing the risk of diagnostic errors and delayed verification. The absence of regular β-hCG monitoring and morphological confirmation after pregnancy termination contributes to the development of advanced forms of choriocarcinoma with life-threatening complications. A combination of surgical interventions with polychemotherapy and radiation therapy ensured sustained remission even at advanced stages, confirming the high chemosensitivity of choriocarcinoma.