A 22-year-old woman presents 3 months after suction evacuation of a molar pregnancy with vaginal bleeding. Serum β-hCG is 8500 mIU/mL (was undetectable 6 weeks ago). Chest X-ray shows 3 pulmonary nodules. Pelvic ultrasound reveals a heterogeneous intrauterine mass with increased vascularity. Which diagnosis is MOST likely?

• A Choriocarcinoma ✓
• B Recurrent complete hydatidiform mole
• C Placental site trophoblastic tumor
• D Invasive mole

Explanation

The presentation of rising β-hCG after plateau/normalization following molar evacuation, combined with pulmonary metastases, is characteristic of choriocarcinoma—the most malignant form of gestational trophoblastic neoplasia (GTN). Choriocarcinoma can arise from any gestational event and metastasizes hematogenously, most commonly to the lungs. It is highly chemosensitive, and single-agent methotrexate or actinomycin-D is curative for low-risk disease, while high-risk disease requires multi-agent regimens like EMA-CO.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.