BACKGROUND:

Cervical pregnancy is an extremely rare site, with an incidence of 1 in 9000 deliveries. The association with choriocarcinoma is even rarer. The most common location of choriocarcinoma is the uterus; it can be found in the salpingeum, vagina, vulva, cervix or pelvic region. Chemotherapy is highly effective in treating patients with choriocarcinoma, with cure rates of 100% in low-risk conditions and 80 to 90% in high-risk.

OBJECTIVE:

To determine the extent of disease and contribute to medical knowledge of the timely diagnosis and correct multidisciplinary treatment of choriocarcinoma in an extremely rare presentation.

CLINICAL CASE:

36-year-old female patient with complete abortion at 5.4 weeks of gestation, with no evidence of intrauterine pregnancy. She was treated with vaginal misoprostol and, subsequently, contraceptives for two months. The patient continued with scant transvaginal bleeding and diffuse pelvic pain. Abdomino-pelvic axial tomography showed a 15 cm tumor in the uterus at the level of the isthmus. The adnexa, liver and retroperitoneum were normal; chorionic gonadotrophin hormone beta fraction (β-hGC) was found to be 225,000 mIU/mL. Given the clinical diagnosis of isthmic-cervical pregnancy, satisfied parity with a history of salpingoclasia and probable choriocarcinoma, a simple abdominal hysterectomy was performed without complications. She received chemotherapy with methotrexate and etoposide for 8 weeks. At the conclusion of the chemotherapy scheme the β-hGC was found to be: 1.28 mIUI/mL.

CONCLUSIONS:

Cervical choriocarcinoma is rare; its location endangers the life of patients due to the high risk of hemorrhage, despite having good prognosis and adequate response to chemotherapy.