# Intestinal Metastasis of Choriocarcinoma: A Case Report of a Rare Cause of Gastrointestinal Bleeding

## TL;DR

A rare case of choriocarcinoma metastasizing to the intestine caused severe gastrointestinal bleeding in a patient with a history of molar pregnancy.

## Contribution

This case report highlights the rare occurrence of intestinal metastasis of choriocarcinoma and its diagnostic challenges.

## Key findings

- Choriocarcinoma can metastasize to the small intestine, causing life-threatening bleeding.
- Elevated hCG levels and histopathological analysis confirmed the diagnosis of metastatic choriocarcinoma.
- Atypical metastases can complicate diagnosis and lead to severe complications despite treatable primary disease.

## Abstract

Choriocarcinoma is widely known as an aggressive gestational trophoblastic disease characterized by rapid proliferation and early hematogenous spread. Gastrointestinal metastases, particularly to the small intestine, are rare but can lead to life-threatening complications such as ulceration, perforation, and massive bleeding. This case report describes intestinal metastasis of choriocarcinoma in a 30-year-old patient presenting with chronic hematochezia, progressive pallor, unintentional weight loss over three months, and left lower abdominal pain. Previously, the patient had a molar pregnancy, which was removed via dilation and curettage procedure, but no subsequent follow-up and examinations were conducted post-operation. Physical examination revealed conjunctival pallor and a palpable mass in the left lower quadrant, with rectal examination confirming active bleeding. Chest X-ray revealed multiple pulmonary nodules, and ultrasound revealed abdomen liver metastasis and irregular mass in the lower abdomen. The same mass was confirmed by CT scan of the abdomen. During hospitalization, the patient experienced recurrent GI bleeding, necessitating multiple blood transfusions. Colonoscopy identified an actively bleeding mass in the terminal ileum, and an abdominal CT scan confirmed a large abdominal mass. Extremely elevated levels of hCG (>1,000,000 mIU/mL) supported the diagnosis of metastatic gestational trophoblastic cancer with subsequent histopathological analysis confirmed metastatic choriocarcinoma. Given the persistent hemorrhage, surgical intervention was performed, but the patient developed postoperative sepsis and succumbed to the illness. Although choriocarcinoma is highly treatable with chemotherapy, atypical metastases to the gastrointestinal tract can complicate diagnosis and management, leading to severe complications. This case emphasizes the importance of considering choriocarcinoma in the differential diagnosis of unexplained GI bleeding in patients with a history of gestational trophoblastic disease.