Metastatic choriocarcinoma in amenorrheic woman following normal vaginal delivery

Gestational choriocarcinoma usually occurs following an intrauterine pregnancy. we report a case of metastatic choriocarcinoma to the left kidney and lungs with long term intermittent amenorrhea and vaginal bleeding after a normal vaginal delivery. a 43 year old rural woman presented with three years intermittent amenorrhea and vaginal bleeding following normal vaginal delivery. she also complained of gross hematuria and left flank pain and had a rising titer of serum β- hcg. pathologic examination of endometrial curettage specimen revealed choriocarcinoma. ultrasound revealed enlarged uterus involved by an irregular mass with heterogenous echo pattern and extensive myometrial invasion. a mass with similar echo pattern was also evident in the left kidney. computerized tomography confirmed the intrauterine mass and involvement of the left kidney. on chest x ray, metastatic nodules were seen in both lungs and in the left retrocardiac space. the patient underwent chemotherapy with ema-co regimen (etoposide, methotrexate, actinomycin d, cyclophosphamide, and vincristine/oncovine). during chemotherapy, she became pancytopenic and febrile. this condition was successfully managed with g-csf, leukovorin and antibiotics. the patient is now well and still under the chemotherapy. her serum β- hcg level has fell to 6 iu/ml.