A metastatic intermediate trophoblastic tumor of unspecified subtype presenting as pneumothorax.

•Gestational trophoblastic neoplasia observed distant from antecedent pregnancy•Pneumothorax is a rare presentation of intermediate trophoblastic tumors.

Second trimester presentation of preeclampsia and choriocarcinoma in a primigravida with live birth.

Choriocarcinoma in the second trimester with a normal appearing live fetus is rare. A primigravida presented at 24 weeks' gestation with 5 days of worsening dyspnea and multiple widespread small lung nodules. Pelvic ultrasound revealed a normal intrauterine live singleton fetus with an extrauterine mass. Gestational hypertension progressed to preeclampsia with severe features and onset of vaginal bleeding. Cesarean delivery was undertaken with liveborn delivery and removal of an intrauterine mass confirmed to be choriocarcinoma. Postpartum treatment with multi-agent chemotherapy was initiated. The newborn thrived; the mother has no evidence of residual disease.