Postmenopausal extragenital choriocarcinoma. A case report and review of the literature

A case is presented of extragenital abdominal choriocarcinoma without uterine lesion in a postmenopausal woman. Nineteen years after her antecedent pregnancy, a legal abortion, and thirteen years after her menopause, the patient was admitted to the hospital because of intermittent abdominal pain. Explorative laparotomy revealed a large tumour mass in the greater omentum, mesosigmoideum, peritoneal implants and metastatic growth to the serosal lining of the uterus and the wall of the stomach. Cytoreductive surgery was performed. The histopathological report showed an extrauterine, nongonadal pure choriocarcinoma. Immunoperoxidase stain was strongly positive for hCG and a raised serum beta-hCG level preoperatively confirmed the diagnosis. A polychemotherapy regimen was administered. However, after six months the beta-hCG levels increased rapidly. Liver, lung and mediastinal metastases were diagnosed. The patient's condition rapidly deteriorated and she expired one month later. The post mortem examination showed a far advanced extragonadal pure choriocarcinoma without any obvious primary origin. The implications for a possible origin of extragonadal nongestational choriocarcinoma are briefly discussed.