Persistently elevated quantitative hCG levels in a patient with gestational choriocarcinoma: A case report of simultaneous de-novo renal clear cell carcinoma and gestational choriocarcinoma

Background: Choriocarcinoma (CCA) is a rare form of gestational trophoblastic neoplasia. Early recognition and treatment are essential to reducing morbidity and mortality. We report the first case of concurrent CCA and renal cell carcinoma. Case: A 35-year-old female presented postpartum with heavy vaginal bleeding. She underwent a dilation and curettage and was diagnosed with CCA. The initial Human Chorionic Gonadotropin (hCG) level was greater than 225,000 mIU/mL. Multi-agent chemotherapy was initiated. The hCG plateaued and interval imaging revealed a persistent renal mass. A partial nephrectomy and hysterectomy were performed followed by complete remission. Conclusion: Treatment of multiple primary malignancies is challenging. Renal cell carcinoma may produce hCG, as in this case. Resection of ectopic non-trophoblastic neoplasms should be considered for persistently elevated hCG in CCA.