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Fetopathology and developmental pathology of the embryo and fetus
Marta Ježová, Josef Feit et al.
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Gestational choriocarcinoma
Introduction

Malignant tumor derived from trophoblast.

Etiology, pathogenesis

50% cases of choriocarcioma arise in complete mole, 25% follow normal term pregnancy, 25% follow spontaneous abortion. Extremely rare are cases arising in ectopic pregnancy.

Clinical signs
  • abnormal bleeding from uterine cavity in women of reproductive age
  • there is a latent period from 1 month up to 2 years from the antecedent pregnancy
  • hCG level is always elevated
  • metastasatic disease with involvement of the lungs, brain and vagina occurs very early
  • in 20% the primary in uterus undergoes complete necrosis and only metastastatic foci are detected then
  • metastatic disease may be the first clinical symptom  —  brain hemorrhage, hemoptysis
  • incidence: 1 : 25 000 of recognized pregnancies (5 women per year in the Czech republic)
  • therapy: chemotherapy; choriocarcinoma was the first solid neoplasm which was succesfully treated by chemoteraphy
  • prognosis:
    • excellent (5-year survival exceding 90% in metastatic disease)
    • fertility can be saved in most cases; hysterectomy is an exceptional therapeutic procedure
Macroscopic appearance

Hemorrhagic nodule in the uterine cavity.

Pictures

Choriocarcinoma, uterus: Choriocarcinoma of the uterus, Macro, autopsy (71342)

Brain hemorrhage, metastasis of choriocarcinoma: Choriocarcinoma, metastases to the brain, Macro, autopsy (71315)

Histology
  • dimorphic pattern
  • neoplastic cytotrophoblastic and syncytiotrophoblastic cells with prominent atypia
  • no chorionic villi
  • areas of bleeding and necrosis
  • epithelial tumor (cytokeratin stains are positive)