Caesarean scar choriocarcinoma: a case report and review of the literature

Abstract

Objective: To report the clinical characteristics, pathologic findings and treatments of a patient with a Caesarean scar choriocarcinoma.

Patient history: A 22-year-old woman had a diagnosis of primary gestational choriocarcinoma in a uterine Caesarean scar misdiagnosed as a normal Caesarean scar pregnancy. The patient underwent selective uterine artery embolization coupled with methotrexate arterial injection, along with dilatation and curettage of the uterine Caesarean scar. Finally, she received eight courses of multiagent chemotherapy. The reproductive function of the patient was preserved.

Conclusions: Primary gestational choriocarcinoma out of the uterine corpus is a rare disease. A Caesarean scar choriocarcinoma is an extremely unusual example of this entity because of its unique position. To the best of our knowledge, this is the first report of this phenomenon. Our experience and a literature review suggest that a clinical diagnosis of a primary gestational choriocarcinoma of the uterine Caesarean scar is difficult to make, and uterine artery embolization is beneficial to prevent massive bleeding before curettage.

Figure 1

Transvaginal ultrasonography of the patient before (A) and after (B) dilation and curettage (D&C). The uterine cavity and cervical canal were empty. A mass implanted in the anterior wall of the uterine Caesarean scar (indicated by the arrow) embedded and surrounded by thin myometrium and separated from the endometrial cavity was visible on the retroverted uterus. Ultrasonography revealed that the mass was heterogeneous with a mixture of cystic and solid echogenicity. (A) Two days before D&C (longitudinal section). The size of the mass was 6.6 × 5.6 × 5.5 cm. RI = 0.38. (B) Five days after D&C (longitudinal section). The size of the mass was 4.7 × 5.7 × 4.5 cm. Abundant blood flow signals and low RI around the mass, RI = 0.29.

Figure 2

Histologic section of Caesarean scar choriocarcinoma. (A) Marked nuclear and cellular atypia and increased mitotic activity (H&E, ×400). (B) Immunohistochemical staining of tumour cells was positive for β-HCG (immunohistochemistry, ×400). (C) Ki-67 positive tumour cells (immunohistochemistry, ×200). (D) Human placental lactogen positive tumour cells (immunohistochemistry, ×200).