Du Zeqing, Su Luyang, Zhao Sufen, Wang Shizhao
Department of Obstetrics and Gynecology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
Physical Examination Center, Hebei General Hospital, Shijiazhuang, China.
Cancer Rep (Hoboken). 2025 Sep;8(9):e70328. doi: 10.1002/cnr2.70328.
Postpartum placental choriocarcinoma is a rare gestational trophoblastic tumor, with an incidence of approximately one in 50 000. Patients often present with persistent postpartum hemorrhage, which can lead to delayed diagnosis, hematogenous metastasis, and ultimately, a poor prognosis.
A 35-year-old woman was admitted to the Emergency Department 39 days after a cesarean section due to persistent heavy vaginal bleeding. Initial evaluation revealed a serum β-human chorionic gonadotropin (β-hCG) level of 7868 mIU/mL, transvaginal ultrasound identified a vascularized uterine mass with myometrial invasion, and MRI suggested residual tissue implantation. Following exclusion of retained products of conception, postpartum choriocarcinoma was suspected. The patient underwent five cycles of FAV chemotherapy (fluorouracil + actinomycin D + vincristine), resulting in undetectable β-hCG levels and resolution of imaging findings after two cycles. Three additional consolidation cycles were administered, with complete remission confirmed at the final follow-up.
Pregnancy-related causes must always be ruled out in women of childbearing age who present with irregular vaginal bleeding, even during the postpartum and lactation periods. In patients with postpartum bleeding, vigilance should be heightened to rule out the possibility of a pregnancy-related Sertoli cell tumor.
产后胎盘绒毛膜癌是一种罕见的妊娠滋养细胞肿瘤，发病率约为五万分之一。患者常出现持续性产后出血，这可能导致诊断延迟、血行转移，并最终导致预后不良。
一名35岁女性在剖宫产术后39天因持续性大量阴道出血入住急诊科。初步评估显示血清β-人绒毛膜促性腺激素（β-hCG）水平为7868 mIU/mL，经阴道超声检查发现一个有肌层浸润的血管化子宫肿块，MRI提示有残留组织植入。在排除妊娠物残留后，怀疑为产后绒毛膜癌。该患者接受了五个周期的FAV化疗（氟尿嘧啶+放线菌素D+长春新碱），两个周期后β-hCG水平检测不到，影像学检查结果消失。又进行了三个巩固周期的化疗，最终随访确认完全缓解。
对于出现不规则阴道出血的育龄女性，即使在产后和哺乳期，也必须始终排除与妊娠相关的原因。对于产后出血的患者，应提高警惕，排除与妊娠相关的支持细胞瘤的可能性。
