Unusual Presentation of a Metastatic Choriocarcinoma: A Case Report of Non-Gestational Choriocarcinoma Presenting as Advanced Colorectal Cancer

Case: A 51-year-old perimenopausal female presented with persistent vaginal bleeding, elevated human chorionic gonadotropin (hCG), and colonic and liver masses. Her initial diagnosis was felt to be metastatic colorectal cancer. Given that her hCG was rising, her pathology was re-reviewed and felt to be consistent with choriocarcinoma. To date, she received three cycles of EMA-CO chemotherapy with resultant drop in hCG. Conclusion: This patient’s presentation and subsequent diagnosis with metastatic choriocarcinoma highlight the importance of evaluating a gynecologic complaint noted in the context of a diagnosis of advanced cancer. Although the initial presentation with anemia in the setting of colorectal and liver masses painted a clinical picture raising concern for metastatic colorectal cancer, the significantly elevated hCG level found in the investigation of irregular bleeding requires additional evaluation. This case report emphasizes the importance of considering a diagnosis of choriocarcinoma even in patients with remote or unclear history of pregnancy.