Rare presentation of aggressive choriocarcinoma in a 22-year-old female with splenic rupture after uncomplicated term pregnancy during extended puerperium: A case report

Abstract

Choriocarcinoma (CC) is a rare, highly malignant pregnancy-related trophoblastic neoplasm that often presents with distant metastases. We present a rare case of a 22-year-old female who developed aggressive choriocarcinoma following an uncomplicated term pregnancy. The patient initially presented with severe headache, vomiting, and blurred vision. Imaging studies revealed venous infarct, thrombus in the superior sagittal sinus, and subdural hemorrhage. Subsequently, the patient developed sudden abdominal pain, with CT scans revealing splenic rupture, multiple organ lesions, and possible metastases. Despite an initial diagnosis of splenic rupture, a positive pregnancy test and high β-hCG levels led to the suspicion of choriocarcinoma. The patient was diagnosed with FIGO stage 4 choriocarcinoma, with splenic and brain metastasis. Histopathological examination confirmed metastatic deposits of choriocarcinoma in the spleen. The patient received combination chemotherapy (EMA-CO), but follow-up was lost due to treatment at another facility. This case highlights the aggressive nature of choriocarcinoma, its rare presentation, and the need for early suspicion and intervention in cases of unexplained post-partum complications.