Metastatic extrauterine gestational choriocarcinoma of the cecum mimicking ruptured ectopic pregnancy: A case report.

BACKGROUND

Gestational choriocarcinoma (GC) is a rare but highly aggressive form of gestational trophoblastic neoplasia with a strong propensity for early hematogenous spread. Most cases arise within the uterus; extrauterine presentations are exceedingly uncommon and may mimic more common gynecologic conditions, contributing to diagnostic delay.

CASE: We report a 36-year-old gravida 6 para 4 who presented with markedly elevated β-hCG (455,501 mIU/mL) and no intrauterine pregnancy on ultrasound. She acutely decompensated with hemoperitoneum and was taken emergently to the operating room for presumed ruptured ectopic pregnancy. Laparoscopy revealed a peri-cecal mass grossly concerning for ectopic implantation, while the uterus, tubes, and ovaries appeared normal. Pathology demonstrated atypical trophoblastic proliferation in uterine curettage specimens and choriocarcinoma within the peritoneal mass. Staging imaging showed no additional metastatic disease. She was classified as FIGO stage IV, WHO score 10, and treated with multi-agent EMA-CO chemotherapy, achieving β-hCG normalization and sustained remission after five cycles.

CONCLUSION

Extrauterine abdominal gestational choriocarcinoma is an exceptionally rare entity that can closely resemble ruptured ectopic pregnancy. Markedly elevated β-hCG levels in the absence of an intrauterine gestation should prompt early consideration of gestational trophoblastic neoplasia. While chemotherapy remains the cornerstone of treatment, surgery may play an essential adjunctive role for hemostasis or resection of isolated chemoresistant disease. Early recognition and multidisciplinary management are critical, as timely initiation of risk-adapted chemotherapy yields excellent cure rates even in advanced-stage disease.