A 24-year-old woman presents 8 months after delivery of a normal baby with hemoptysis, irregular vaginal bleeding, and hCG of 95,000 IU/L. Chest CT shows multiple pulmonary nodules. Brain MRI is negative. What is the most likely diagnosis and WHO risk score category?

• A Placental site trophoblastic tumour, low-risk
• B Epithelioid trophoblastic tumour, intermediate-risk
• C Invasive mole with lung metastases, low-risk
• D Choriocarcinoma, likely high-risk GTN (WHO score ≥7) ✓

Explanation

Choriocarcinoma typically occurs after any pregnancy (including term deliveries) and is characterised by very high hCG, haematogenous metastases (lungs most common), and absence of chorionic villi histologically. Pulmonary metastases with hCG 95,000 IU/L, 8 months after a term pregnancy, and the clinical picture are classic for choriocarcinoma. Multiple pulmonary nodules and very high hCG place this in high-risk GTN (WHO score ≥7), requiring EMA-CO or similar multi-agent chemotherapy.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.