Primary Cervical Choriocarcinoma in a Nulligravida: A Rare Presentation of Low-Risk Gestational Trophoblastic Neoplasia (GTN) Managed with Fertility-Sparing Chemotherapy

Abstract

Background: Cervical gestational trophoblastic neoplasia (GTN) is a rare, aggressive manifestation that poses significant diagnostic challenges and a risk of life-threatening haemorrhage. Its management, particularly in young patients, requires a risk-adapted approach that prioritises fertility preservation alongside metabolic remission. Gestational trophoblastic neoplasia (GTN) pathologically originates from aberrant fertilisation and is classified as complete (no fetal tissue) or partial (abnormal fetal development) based on the presence of fetal elements. Case Presentation: A 23-year-old married nulligravida (G0P0) presented with intermittent abnormal uterine bleeding and generalised weakness. Initial evaluation revealed persistently elevated but declining serum β-hCG levels. Transvaginal ultrasonography (TVS) showed a bulky uterus with heterogeneous intrauterine contents and mild vascularity. An endometrial biopsy confirmed the diagnosis of choriocarcinoma, showing pleomorphic cytotrophoblastic and syncytiotrophoblastic cells with marked nuclear atypia and extensive haemorrhage. Management and Outcome: Based on the FIGO/WHO prognostic scoring system, the patient was categorised as having low-risk GTN. She was started on an 8-day multidose regimen of Methotrexate (50 mg) with Leucovorin rescue. The patient showed an excellent therapeutic response, with a progressive decline in β-hCG levels (from 53.35 mIU/ml to 28.24 mIU/ml) and stabilisation of haematological parameters. Currently, in her sixth cycle of chemotherapy, the patient remains clinically stable, with no acute treatment-related complications. Conclusion: This case underscores the efficacy of risk-adapted, single-agent chemotherapy in achieving metabolic remission for cervical choriocarcinoma while preserving reproductive potential. A multidisciplinary approach integrating histopathology, biochemical markers, and serial imaging is essential for early diagnosis and the prevention of disease progression in young women.