title: Postpartum choriocarcinoma presentation, management and survival.
abstract: OBJECTIVE
  To determine the clinical presentation and outcome of postpartum choriocarcinoma.
  
  
  METHODS
  Case note review of patients with choriocarcinoma treated at the Sheffield Trophoblastic Disease Centre.
  
  
  RESULTS
  Thirty-five patients were identified between 1977 and 2005. Mean age was 27 years (range, 21-37). Thirty-three patients complained of persistent postpartum hemorrhage, and in 3 cases there were other symptoms. Two patients presented with nongynecologic symptoms. Mean time until diagnosis was 7 weeks postpartum (range, 0-60), with a mean delay from onset of symptoms to treatment of 7 weeks (maximum, 19). Twenty patients had metastatic disease, but this did not correlate with delay in diagnosis. The mean International Federation of Gynecology and Obstetrics score was 10. Multidrug regimens were used in most patients; however, 8 low-risk patients had a complete response with methotrexate alone. The mean survival was 7.8 years (range, 1-21). Two patients died from disease.
  
  
  CONCLUSIONS
  Postpartum choriocarcinoma presents mainly with vaginal bleeding, and there is often a delay in diagnosis despite being under the care of gynecologists. In the small numbers that present with nongynecologic symptoms there is a rapid awareness of the possibility of gestational trophoblastic neoplasia; nevertheless, the outcome may be fatal, especially in the presence of symptomatic brain metastases.
authors.affiliation: Department of Gynaecological Oncology, Royal Hallamshire Hospital, Sheffield, UK.
authors.forename: David
authors.initials: D
authors.lastname: Nugent
authors.forename: Ayman
authors.initials: A
authors.lastname: Hassadia
authors.forename: Jan
authors.initials: J
authors.lastname: Everard
authors.forename: Barry W
authors.initials: BW
authors.lastname: Hancock
authors.forename: John A
authors.initials: JA
authors.lastname: Tidy
mesh_terms: D000328:Adult; D002822:Choriocarcinoma / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000628:therapy; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008499:Medical Records; D009362:Neoplasm Metastasis; D011247:Pregnancy; D011644:Puerperal Disorders / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000628:therapy; D012189:Retrospective Studies; D016019:Survival Analysis; D014594:Uterine Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000628:therapy