Extra-gestational choriocarcinoma of colon - Diagnostic challenges and management issues

Choriocarcinoma is an unfrequently encountered malignant tumour arising from the placenta in the females and the gonads in males. Extra-gonadal or non-gestational choriocarcinoma are rare tumors which arise from sites which include the mediastinum, lung, stomach, cervix, ureter and pancreas. Primary choriocarcinoma arising from the rectum or the colon is extremely rare to encounter with very few cases reported till date. It is usually associated with poor prognosis. We present a case of 29 year old third gravida with known case of rheumatic heart disease who was referred to our rural tertiary care centre with a diagnosis of probable ruptured ectopic pregnancy which turned out to be a case extra gestational choriocarcinoma of the colon upon investigations. The patient was started with chemotherapy however she succumbed due to pulmonary embolism secondary to her high risk pregnancy due to rheumatic heart disease. This case highlights that though extra gestational choriocarcinoma is rare to encounter it is important for the clinicians to be vigilant for the same as it is often a misdiagnosed condition specially in the rural peripheral centres where there is lack of resources and investigations to confirm the diagnosis.