Background: Gestational choriocarcinoma associated with ectopic pregnancy is an extremely infrequent event. Primary abdominal gestational choriocarcinoma has not been previously described.
Case: A pregnant woman presented to the emergency room with 6 days of vaginal spotting. Her last menstrual period suggested a gestation at 6 4/7 weeks. Transvaginal sonogram showed a hemoperitoneum with no intrauterine pregnancy. The serum human chorionic gonadotropin level was noted to be 317,735 mIU/mL. A 20 x 20-mm friable, bleeding mass on the left anterior abdominal wall was laparoscopically resected. Gestational choriocarcinoma was identified on histopathologic review. International Federation of Gynecology and Obstetrics stage IV:4 was assigned, and the patient achieved clinical remission with combination chemotherapy.
Conclusion: Primary abdominal gestational choriocarcinoma can present with findings similar to a ruptured ectopic pregnancy; it should be treated by surgical excision and chemotherapy.