Snapshot A 36-year-old woman presents to the emergency department after coughing up blood. She reported some progressively worsening shortness of breath and on the day of presentation had an episode of hemoptysis. She has a past medical history of a complete molar pregnancy, where she underwent a dilation and curettage to evacuate the hydatidiform mole. A radiagraph of the chest demonstrates multiple radiopaque pulmonary lesions. Laboratory studies are remarkable for highly elevated β-hCG. Introduction Overview a type of gestational trophoblastic neoplasia login to view 4 more bullets Epidemiology Incidence extremely rare (< 1% of ovarian tumors) ETIOLOGY Associated conditions theca-lutein ovarian cysts molar pregnancy (more common after a complete than a partial mole) Presentation Symptoms shortness of breath and hemoptysis login to view 1 more bullet Physical exam pelvic mass Imaging Radiography of the chest indication login to view 1 more bullet findings login to view 1 more bullet Studies Serum labs ↑ β-hCG Histology trophoblasts and cytotrophoblasts with syncytiotrophoblast central hemorrhage with necrosis cytologic atypia Differential Dysgerminoma differentiating factors login to view 1 more bullet Treatment Medical chemotherapy login to view 3 more bullets Complications Hemorrhage secondary to its high vascularity