Successful Management of High-Risk Gestational Choriocarcinoma with Choriocarcinoma Syndrome: A Case Report

Introduction: Choriocarcinoma is a rare and highly malignant gestational trophoblastic neoplasia that is treatable with timely and appropriate intervention. However, choriocarcinoma may lead to life-threatening complications, such as choriocarcinoma syndrome (CCS), a rare type of tumor lysis manifesting as hemorrhage at metastatic sites of advanced tumors. Case Description: This case involves a 30-year-old woman, gravida 3 para 0, with high-risk choriocarcinoma and a WHO score of 11, indicating high risk. Initial management comprised Etoposide, Methotrexate, Actinomycin D, Cyclophosphamide and Vincristine (EMA/CO) chemotherapy until multisystem complications arose, including the development of CCS which resulted in an abdominal compartment syndrome. An exploratory laparotomy led to a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Subsequent treatment involved Etoposide/Cisplatin (EP) chemotherapy to minimize toxicity before re-initiating EMA/CO, ultimately completing a total of 14 EMA/CO cycles. Discussion: To our knowledge, this is only the second case reported of CCS in a female patient, as most reported cases discuss testicular choriocarcinoma complicated by CCS in male patients. The patient's survival underscores the success of combining risk-based chemotherapy, surgery, and supportive care to achieve favorable outcomes in high-risk choriocarcinoma cases with rare, life-threatening complications in female patients. Furthermore, 2024 National Comprehensive Cancer Network guidelines suggest considering induction therapy with EP in tumors with WHO scores of greater than or equal to 12, but this case suggests that induction chemotherapy with EP may be a viable option for treating high-risk choriocarcinomas with WHO scores of less than 12 that are at risk for developing CCS.