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.
Department of Obstetrics and Gynecology, Northwestern University Medical School, Chicago, Illinois.
D A
DA
Ollendorff
J M
JM
Goldberg
G M
GM
Abu-Jawdeh
J R
JR
Lurain
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