Dicle University, School of Medicine, Department of Radiology, Diyarbakir, Turkey

An aggressive malignant tumour called a choriocarcinoma is made up of sheets of anaplastic cytotrophoblast/syncytiotrophoblast cells. Since most occurrences of choriocarcinoma are of intra-uterine, gestational origin and typically manifest within the first year after pregnancy, it is typically seen in people who are in their reproductive years. A 58-year-old woman who had been experiencing vaginal bleeding in the previous months came to our clinic. There were 12414 mIU/mL of B-HCG in the serum. On the right anterior fundal wall of the corpus uteri, a pelvic ultrasound revealed a heterogeneous mass measuring 41 by 37 millimetres, to which colour Doppler imaging revealed enhanced blood flow. We present a case of postmenopausal uterine choriocarcinoma in this paper. The practitioner must be aware that postmenopausal vaginal haemorrhage can be caused by choriocarcinoma.

Keywords: Postmenopausal; Uterus; Choriocarcinoma

In 1 in 20,000 to 25,000 births in Western nations, choriocarcinoma, an aggressive malignant tumour made up of sheets of anaplastic cytotrophoblast syncytiotrophoblast cells, develops [1]. Most cases of choriocarcinoma have gestational and intrauterine origins. Usually, a previous molar pregnancy causes gestational choriocarcinoma, though occasionally a non-molar gestation may as well. The most typical choriocarcinoma symptom is vaginal haemorrhage [2]. Gestational choriocarcinoma is frequently seen in groups of people who are in reproductive age because the cancer commonly develops within the first year following pregnancy [1, 3]. In this report, we describe a case of uterine choriocarcinoma in a 58-year-old lady whose most recent pregnancy was a molar gestation, which occurred six years prior.

A 58-year-elderly person was confessed to our center with two discrete episodes of vaginal spotting in the former months. The patient went through menopause at 55 years old and didn't get hormonal treatment during this period. Every one of her conveyances were vaginal, straightforward, term pregnancies, her last pregnancy being quite a while back. The patient had a background marked by molar pregnancy at the age of 52, 3 years preceding the menopause. Following curettage for the molar pregnancy, she detailed that she was followed for 1 year and showed no indication of gestational trophoblastic sickness. She was a non-smoker and had gotten oral enemy of diabetic medications for type 2 diabetes mellitus for quite some time. She was physically dynamic.

In the actual assessment; her general condition was typical with no unusual discoveries. On pelvic assessment; the vulva and vagina were ordinary, the cervix was multiparous, the size of uterus was typical and no discernible adnexal mass was apparent. A pelvic ultrasound demonstrated the components of her uterus to be 97 × 52 mm with an endometrial thickness of 6 mm and a 41 × 37 mm heterogeneous mass on the right foremost fundal mass of the corpus uteri, to which blood stream was expanded on variety Doppler assessment. The serum B-HCG level was 12414 mIU/mL. Biochemical and hematological boundaries were inside typical cutoff points.

Upon pelvic attractive reverberation imaging, sagittal T2-weighted pictures uncovered a heterogeneous hypointense intramural uterine mass with unpredictable lobulated edges. The mass had insignificant space on the endometrial pit. Following difference organization, heterogeneous fringe improvement was seen with T1W pictures.Gestational trophoblastic neoplasia considered a hypothetical determination in view of the great upsides of b-HCG noticed. No metastatic sickness was found. Absolute stomach hysterectomy and respective salpingo-oophorectomy were performed. Perceptibly, hemorrhagic regions were seen on cut surfaces of the example.

Minute assessment uncovered infiltrative abnormal pleomorphic trophoblastic cells inside the myometrium. Immunohistochemical investigation showed that the growth cells were positive for Epitelial Layer Antigen, and the Ki-67 expansion record really depended on 30%. The neurotic conclusion was choriocarcinoma.During the first postoperative week, the B-HCG levels decreased to 1587 mIU/mL. The next step was to begin a multi-agent chemotherapy programme. After the first round of chemotherapy, the B-HCG levels dropped to 50 mIU/mL. Grade-four haematological toxicity started one week after the second chemotherapy session. The patient passed away as a result of sepsis and febrile neutropenia.

This patient had a past filled with a molar pregnancy while she was 52 years of age, encountered her menopause 3 years beforehand, and created choricarcinoma at 58 years old years old. The gamble of a hydatidiform mole expanded essentially with expanding maternal age. In writing announced that 27% of ladies matured 50 years and done with trophoblastic sickness created gestational trophoblastic neoplasia. In more youthful ladies, the frequency of gestational trophoblastic neoplasia is commonly 5% following trophoblastic illness [4].

Choriocarcinoma is for the most part seen in lady of a regenerative age in the span of a time of a precursor pregnancy, yet can likewise be seen in postmenopausal lady in uncommon cases, following a long idle period from past pregnancies. Desai et al. revealed a choriocarcinoma case in a 73-year-elderly person creating 38 years after pregnancy and 23 years after her last feminine period [2, 3].

Choriocarcinoma can be partitioned in two sorts: gestational or non-gestational. Gestational choriocarcinoma for the most part happens following a molar or non-molar pregnancy in lady of a conceptive age. Non-gestational choriocarcinoma can emerge from microorganism cells or the trophoblastic separation of endometrial carcinomas [2]. In our patient, preoperative endometrial examining looked like decidualization and no proof of endometrial adenocarcinoma was seen.

The most continuous side effect in uterine choriocarcinoma is unusual vaginal dying. High B-HCG levels and immunohistochemical tests for B-HCG may likewise be characteristic of choriocarcinoma. An early and right determination of choriocarcinoma is significant on the grounds that it is a chemosensitive growth with a decent guess even in cutting edge stages [5].

Chemotherapy regimens are chosen following the ID of high-and okay patients. Lurian et al. proposed multi-specialist EMACO regimens if a patient showed high gamble factors for the treatment of choriocarcinoma. High gamble factors included old age, a long time period record pregnancy, pre-treatment serum B-HCG levels, an enormous growth size, and the presence of metastases [5].

All in all, an exceptionally uncommon choriocarcinoma was obvious in a postmenopausal lady and ought to be viewed as in the differential finding of postmenopausal dying. A precise, early determination and therapy are significant in light of the fact that the choriocarcinoma is viewed as the most reparable gynecological malignant growth. Chemotherapy may every so often make fatalities due treatment-related entanglements.

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