Upper Gastrointestinal Bleeding from non-gestational Primary Gastric Choriocarcinoma

Background: Upper gastrointestinal bleeding from non-gestational primary gastric choriocarcinoma is extremely rare. Non-gestational primary gastric choriocarcinoma is an aggressive β-human chorionic gonadotropin–producing malignancy and it accounts for less than 1% of all gastric cancers. A 37-year-old woman with primary non-gestational gastric choriocarcinoma with hepatic metastasis presented with unintentional weight loss, gastrointestinal bleeding, abdominal pain, early satiety, and a disproportionately elevated serum β-human chorionic gonadotropin (β-hCG) level of 74,906 IU/L. On clinical examination, a palpable epigastric mass was noted. Initial clinical diagnosis of gastric malignancy was made, and upper gastrointestinal endoscopy revealed a malignant-appearing gastric lesion. Contrast enhanced Computed tomography of the abdomen demonstrated a large ulceroinfiltrative, malignant-looking gastric mucosal lesion at the antrum. Histopathological examination of the endoscopic biopsy specimen confirmed choriocarcinoma. Immunohistochemistry has shown diffused positive tissue staining for B-hCG. Due to the aggressive nature and rapid progression of the disease, the patient died within one month after diagnosis. Early recognition, speedy diagnosis and prompt multidisciplinary management are essential.

Keywords: Non-gestational primary gastric choriocarcinoma, β-human chorionic gonadotropin (β-hCG), gastrointestinal bleeding.