Primary tubal gestational choriocarcinoma: a case report with radiologic–pathologic correlation and comprehensive MRI findings

Abstract Background Primary extrauterine choriocarcinoma is a rare and aggressive malignancy. Its clinical presentation often overlaps with other gynecological conditions such as ectopic pregnancy or ovarian tumors, making diagnosis challenging. Imaging modalities, particularly ultrasound (US) and magnetic resonance imaging (MRI), are crucial for tracking tumor progression and differentiating it from other pathologies. This case report highlights the rapid growth of an adnexal mass and the critical role of contrast-enhanced MRI in diagnosis. Case presentation A 37-year-old female with a history of two lower-segment cesarean sections (LSCS) presented with abdominal pain and spotting per vaginum. An initial US showed a bulky uterus and normal adnexa. A month later, she presented with heavy menstrual bleeding and elevated β -hCG levels of 10,000 mIU/mL, raising concern for ectopic pregnancy and was referred to our institute. Imaging revealed a 5 × 5 × 6 cm left adnexal mass, bilateral multicystic ovaries and bulky uterus for which endometrial curettage for tissue sampling was performed. Patient was admitted and planned for surgical exploration after MRI pelvis. Repeat laboratory investigations showed significantly increased β -hCG levels (> 1,000,000 mIU/mL). MRI confirmed the presence of a heterogeneous enlarged adnexal mass (8 × 7 × 12 cm) with internal hemorrhage and necrosis. Exploratory laparotomy was performed, and histopathology confirmed tubal gestational choriocarcinoma. Conclusions This case illustrates the importance of imaging in diagnosing rapidly growing adnexal masses with elevated β-hCG. MRI provided essential details on the tumor extent, internal characteristics, vascularity and local invasion guiding timely surgical intervention.