Gestational trophoblastic disease (GTD) is a spectrum of tumors that involve abnormal growth of cells commonly occurs in women of reproductive age. Choriocarcinoma a part of its spectrum, is a malignant form of GTD wherein it is more likely to grow quickly and metastasize to organs distant from the uterus. It is most great important to report these cases not only due to limitation of data but also as this presents a diagnostic and management dilemma. We describe an unusual chronology and presentation of clinical features and diagnostics that led to the diagnosis of a choriocarcinoma in the lungs of a 20 year old female in the Philippines. It is peculiar for a choriocarcinoma to grow into the lungs from a 4 year latency of a previous gestational event now presenting as a giant mass, with no evidence of any primary tumor. Pulmonary choriocarcinoma should be part of differential diagnosis of a young patient with a pleural effusion in a reproductive age. A multi-disciplinary approach is vital in patient’s presenting with pleural effusion with high index of suspicion of a GTD. Given a prolonged latency, metastatic choriocarcinoma originating from a previous molar pregnancy can be overlooked. The author finds the necessity to reclassify the current FIGO prognostication factor, giving more prognostic points in favor of choriocarcinoma presenting as giant or wherein an organ was entirely converted to a mass. It is also important to determine if the presenting choriocarcinoma in the lungs as either primary or metastatic, which presents as a dilemma in this case. It is imperative to give importance in the early diagnosis leading to early treatment of choriocarcinoma. For an Internist, great vigilance should be made in the follow-up for the detection of chorionic malignancy.