Choriocarcinoma in a patient with human immunodeficiency virus: case presentation and review of the literature

A 26-year-old woman with choriocarcinoma and acquired immunodeficiency syndrome initially presented with hydatidiform mole and was treated with dilation and curettage. Because of persistent elevation of serum beta human chorionic gonadotropin, the patient was treated with combination chemotherapy with etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine (EMACO) for high-risk gestational trophoblastic tumor. The patient s initial stage was IIc. The serum beta human chorionic gonadotropin level returned to normal. Fourteen months later, the gonadotropin level again increased. The patient was treated with uterine curettage followed by vaginal hysterectomy. Despite further chemotherapy (with methotrexate and leucovorin, then oral etoposide), she died following metastasis of the tumor to the brain. Only four other cases of human immunodeficiency virus (HIV) infection with choriocarcinoma have been reported. There is no evidence to date that gestational trophoblastic disease is more prevalent in patients with acquired immunodeficiency syndrome. HIV infection and other immunodeficiency states, however, can influence the course of treatment and outcome in these patients. The low CD4 count in HIV infection may lead to a poor outcome despite chemotherapy.