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Choriocarcinoma is a mostly very aggressive, malignant tumor that derives from syncytiotrophoblast cells and secretes beta human chorionic gonadotropin (beta-hCG). Choriocarcinoma is mostly gestational associated with pregnancy and there are rare non-gestational choriocarcinomas, independent of gestation and originated from germ cells mainly occurred extragenitally. Primary choriocarcinoma in the lung is very rare, and its association with kidney metastasis seems to be a literary rarity, as in a 43-year-old woman whose case history and the solving of the hormoneproducing tissue of unknown origin is reported here. Histopathological and molecular genetic diagnosis were made on the lobectomy and the nephrectomy specimen. Operative procedures (extirpations of the tumor tissue) and postoperative adjuvant chemo- and immune (antibodies against programmed cell death 1 [PD1] and its ligand [PDL1]) therapy were successfully applied. The patient is being followed up by imaging procedures and beta-hCG measurements.

Prematurity, which occurs in about 12% of pregnancies worldwide, continues to be one of the leading causes of perinatal morbidity and mortality worldwide. Preterm birth (PTB) can still be considered a syndrome with a variety of causes and underlying factors, which results in mostly unnoticed contraction of the uterus and changes in the cervix. Despite considerable effort aimed at decreasing the incidence of spontaneous PTB, PTB remains the leading cause of perinatal morbidity and mortality. In light of the available data, screening strategies for PTB are deficient. Approaches used to identify women considered by historical factors to be low risk for preterm delivery, as well as those at high risk for PTB, continue to evolve. Ultrasound evaluation of the cervix during pregnancy has been the focus of much research during the past decades. Cervical measurement by transvaginal sonography (TVS) has been shown to be a good predictive test for spontaneous PTB in high-and low-risk singleton pregnancy. Cervical shortening, which is often detected on ultrasound examination before it can be appreciated on physical examination, is one of the first steps in the processes leading to labor and can precede labor by several weeks. This is likewise true for funneling and loss of cervical gland area, which cannot be assessed with the physical examination. Therefore, all of these markers, especially if they are used together, can be useful to predict PTB and start adequate therapy as soon as possible to prevent spontaneous preterm delivery.

Spontaneous preterm birth remains a major cause of neonatal morbidity and mortality across the world. Hence, there is an urgent need to find and implement diagnostic methods and interventions that can reduce this public health treat. The ultrasonographic assessment of the cervix is one tool that can be utilized to identify women at increased risk who may be candidates for preventive interventions. There are three main characteristics of the cervix, which can be evaluated during the ultrasound examination of the cervix: cervical length (CL), funneling and cervical gland area. Cervical shortening is one of the first steps in the processes leading to labor and can precede labor by several weeks. Because shortening begins at the internal cervical os and progresses caudally, it is often detected on ultrasound examination before it can be appreciated on physical examination. This is equally true for funneling and cervical gland area (CGA), which cannot be assessed with the physical examination. Based on previous experiences, the timing and frequency of ultrasonographic assessment of the cervix is primarily based on the patient’s prior obstetric history (low-risk women are screened once at 18–24 weeks of gestation; high-risk population usually begins screening at about 16 weeks of gestation and the frequency depends on the measurement result). Classically the diagnosis of short cervix is defined when the CL is less than or equal to 25 mm at these gestational weeks, with the best prediction for PTB obtained at 16–24 weeks of gestation. The CL measurement, evaluation of funneling and CGA together increased the sensitivity of cervical screening for PTB and appeared to be powerful predictor of PTB before 32 weeks gestation. Generally, the importance of positive test is to try to recognize cervical changes on time, to plane the adequate therapy, to prepare for sufficient intrauterine transport, and to administered course of antenatal corticosteroid therapy to women at risk for PTB reduced the incidence and severity of respiratory distress syndrome (RDS) and mortality in offspring. Many interventions (bed rest, lifestyle intervention, cervical cerclage, pessary, progesteron, indomethacin, antibiotics, etc.) have been proposed in an attempt to prevent PTB depending on risk classification.

Background: Choriocarcinoma is a highly aggressive malignant tumor composed primarily of cytotrophoblast and syncytiotrophoblast cells without villi and is characterized by beta-human chorionic (beta-hCG) gonadotropin production. Although most cases are of gestational origin, rare non-gestational choriocarcinomas may arise from pluripotent germ cells in extragenital locations, independently of pregnancy. Primary pulmonary choriocarcinoma is extremely rare, and kidney metastasis has only exceptionally been reported in the literature. Case: We present the case of a 43-year-old patient with this unusual presentation. The diagnostic process began with a suspected implantation of unknown location and culminated in the final histopathological diagnosis based on lobectomy and nephrectomy specimens, including molecular genetic identification of the pulmonary tumor. Following thoracic and renal surgery, the patient received adjuvant chemotherapy and immunotherapy with anti-PD-1 monoclonal antibodies. Conclusion: This case highlighted the diagnostic challenges posed by primary pulmonary choriocarcinoma with renal metastasis, an exceptionally rare clinical entity. Ongoing follow-up includes regular imaging studies and beta-hCG monitoring.