Life-saving hysterectomy in choriocarcinoma: presentation of two cases.

Background: Choriocarcinoma is a malignant tumor of the placenta. Life-saving hysterectomy was performed in two cases with choriocarcinoma who had profuse vaginal bleeding. CASE 1: A 25-year-old, gravida 3, para 1, woman was referred to our emergency clinic with the diagnosis of choriocarcinoma and massive vaginal bleeding. She had been transfused seven units of blood at the hospital where she was first admitted. Pelvic examination demonstrated heavy vaginal bleeding and a uterus equivalent to the size of 14 weeks of gestation. Her beta-hCG level was 560,000 mIU/ml. Despite four units of blood transfusion, she had a pulse rate of 130/min, arterial pressure of 90/60 mm/Hg and HCT of 19%. An emergency hysterectomy with vertical incision was performed. CASE 2: A 54-year-old, gravida 3, para 3, woman was referred to our clinic with heavy bleeding with the diagnosis of choriocarcinoma. She was scanned to look for possible metastases and pulmonary metastasis was detected. Chemotherapy was planned but as sudden vaginal bleeding began she was referred to the Gynecology Department. At pelvic examination a soft uterus the size of 20 weeks of gestation was palpated. The beta-hCG level was 554,700 mIU/ml. Due to hemodynamic instability and continuous vaginal bleeding an emergency hysterectomy was performed.
Conclusion: Although chemotherapy is the cornerstone of treatment for choriocarcinoma, optimal treatment results may depend on the addition of surgery in selected circumstances. Hysterectomy is indicated in cases with life-threatening hemorrhage.