Markedly elevated maternal serum alpha-fetoprotein associated with a normal fetus and choriocarcinoma of the placenta.
Determination of maternal serum alpha-fetoprotein (MSAFP) has become an important screening test for a variety of fetal and maternal abnormalities. A 33-year-old multiparous white woman had a markedly elevated MSAFP level (140 multiples of the median). Extensive antepartum work-up for fetal anomalies, fetal-maternal transfusion, or maternal etiology revealed no explanation. The patient subsequently delivered a healthy male infant. Pathologic examination of the placenta demonstrated a small, discrete area of choriocarcinoma. Computed tomography showed a solitary pulmonary metastasis. Because the patient did not desire future pregnancies, a total abdominal hysterectomy was performed, followed by four courses of EMA-CO chemotherapy. Her serum hCG levels subsequently became undetectable. Choriocarcinoma of the placenta must be considered in the differential diagnosis of an otherwise unexplained elevated MSAFP level.
Ollendorff
D A
DA
Department of Obstetrics and Gynecology, Northwestern University Medical School, Chicago, Illinois.
Goldberg
J M
JM
Abu-Jawdeh
G M
GM
Lurain
J R
JR
D000328:Adult; D002822:Choriocarcinoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008175:Lung Neoplasms / Q000556:secondary; D010922:Placenta Diseases / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D011247:Pregnancy; D011256:Pregnancy Outcome; D000509:alpha-Fetoproteins / Q000032:analysis*
D000509:alpha-Fetoproteins