A case of metastasis of choriocarcinoma to duodenum

A 30-year-old woman was admitted with tarry stools. Her HCGβ level was high; 140 ng/ml in the serum and 1340 IU/1 in the urine. Findings were as follows; a huge ulcerous lesion in the 2nd portion of the duodenum, multiple masses in the liver, and pneumothorax on the right side. The biopsy diagnosis of the duodenum and liver was choriocarcinoma. To control bleeding from the duodenum, gastrojejunostomy was performed. But her general condition did not take a favorable turn, and she died 50 days after the operation. Histological diagnosis by autopsy was pure choriocarcinoma. It had metastasized to the lung, liver, stomach, pancreas and left ovary, but no primary lesion was found in her genital tract. She had a history of labor one year earlier, and we diagnosed her condition as metastasis of gestational choriocarcinoma to the duodenum, probably originating in the uterus or placenta. Eight cases of choriocarcinoma in the duodenum were reported in the literature, but our case is the first one of metastasis of gestational choriocarcinoma to the duodenum.