Mixed choriocarcinoma in a postmenopausal patient

Gestational trophoblastic disease rarely presents in patients beyond the reproductive years. To our knowledge, this is the first case of mixed trophoblastic disease in a postmenopausal woman. We present here a case of a 60-year-old woman with evidence of a pelvic mass and pulmonary metastasis. Surgery revealed an 8 × 6 × 6 cm multinodular uterine tumor involving the right adnexa. Histologic review was consistent with choriocarcinoma with intermediate trophoblastic features. Postoperative β-hCG was 381 561 mIU/ml. We conclude that maintaining a high index of suspicion facilitates the identification of postmenopausal patients with metastatic gestational trophoblastic disease. This case reconfirms the deceptive presentation of the "great masquerader".