A 20 y.o. woman presents with a persistently high HCG after a miscarriage

This is her CXR

Why does she have a nodule in the R mid lung?

Our patient was biopsied and had choriocarcinoma of the lung .  This is in the spectrum of gestational trophoblastic disease,  disease occurring after a pregnancy or miscarriage.  She had a recent miscarriage and her HCG was still high because of tumor in the lung producing hcg. 

The molar pregnancy is the most common form of GTD

Gestational trophoblastic disease encompasses a group of conditions where abnormal cells develop in the tissue that would normally become placenta. The trophoblast, is the group of cells which surrounds the blastocyst and develops into the chorion and amnion.

Gestational trophoblastic disease includes a molar pregnancy which can be either partial or complete and this is the most common form of the disease. The partial molar pregnancy  usually has a fetus initially, is triploid, and the fetus dies within a few weeks.  Very rarely, a partial molar pregnancy develops with two maternal and one paternal set of chromosomes.  The fetus is growth restricted but may survive to term.  In the complete hydatidiform mole which is usually diploid and  46  XX there is no fetus and chorionic villi form a mass of vesicles .   Only 0.1% of women with partial hydatidiform moles develop a choriocarcinoma.   Malignant transformation is more likely in the complete molar pregnancy..  The chance of choriocarcinoma rises to 8% after a complete molar pregnancy.  There is even a risk of choriocarcinoma after a full-term pregnancy however it is much lower; at 1:50,000 after a term delivery.

vesicular lesions noted in a molar pregnancy

The molar pregnancy is referred to as hydatidiform derived from hydatisia (Greek “a drop of water”  and refers to the vesicular look of the contents and mole ( from Latin mola which means millstone/ false conception.  The term, refers tp the similar appearance of the cyst to hydatid cysts in Echinococcosis.

appearance of molar pregnancy on ct.

Cavaliere A, Ermito S, Dinatale A, Pedata R. Management of molar pregnancy. 2009 J Prenat Med. Jan-Mar;3(1):15-17.

Berkowitz R, Goldstein D. Chorionic tumors N Engl J Med. 1996;335:1740-9.

Benson C, Genest D, Bernstein M, et al. sonographic appearance of first trimester complete hydatidiform moles. J Ultrasound Obstet Gynecol. 2000;16:188-191.

molar pregnancy on us