The Choriocarcinoma

A 23-year-old woman has a progressive increase in her serum beta-human chorionic gonadotropin (beta-hCG) concentrations during an 8-week period. A hydatidiform mole is removed, but the beta-hCG concentration continues to increase. Which of the following is the most likely diagnosis?

Adrenal adenoma
Ectopic pregnancy
Pituitary insufficiency
A second noninvasive mole

Correct answer
correct answer: B

Steadily increasing beta-hCG concentration status post removal of hydatidiform mole is suggestive of malignant gestational trophoblastic disease (GTD). Choriocarcinoma (choice B) is a GTD that is commonly associated with increased beta-hCG concentrations and hydatidiform moles, making it the most likely diagnosis in this patient.
Adrenal adenoma (choice A) and pituitary insufficiency (choice D) are not commonly associated with either hydatidiform moles or increased concentrations of beta-hCG.

Ectopic pregnancy (choice C) or a second noninvasive mole (choice E) could be possible explanations for an increased beta-hCG concentration, but is much less likely than a malignant GTD in this clinical scenario.