Rapid Progression of Molar Pregnancy to Choriocarcinoma With Pulmonary Metastases

Postmolar choriocarcinoma is a rare, highly malignant tumor of the placenta with characteristic histologic and clinical features. We present a case of a 31-year-old G3P2 female patient with evidence of a complete molar pregnancy indicated by symptoms of severe nausea and vomiting, a heterogenous, cystic mass on ultrasound, and human chorionic gonadotropin (hCG) levels above 900,000 IU/mL. Two days after the evacuation of the molar pregnancy, she developed symptomatic pulmonary metastases with markedly increased hCG levels and worsening symptoms. She was treated for pulmonary emboli and shortly started on EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) chemotherapy. However, due to persistently elevated hCG levels and rapid disease progression, she was ultimately referred to a tertiary trophoblastic disease center. She completed her chemotherapy regimen with subsequent return of her hCG levels to normal values and underwent a hysterectomy with complete removal of the tumor. While choriocarcinoma has an excellent prognosis, the accelerated progression and extreme hCG levels of this case highlight the need for further investigations into the management of molar pregnancy patients with high-risk features for gestational trophoblastic neoplasia (GTN), as well as the pathomechanism of this disease trajectory.