| Choriocarcinoma |
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Micrograph of choriocarcinoma showing both of the components necessary for the diagnosis - cytotrophoblasts and syncytiotrophoblasts. The syncytiotrophoblasts are multinucleated and have a dark staining cytoplasm. The cytotrophoblasts are mononuclear and have a pale staining cytoplasm. H&E stain.
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| Classification and external resources |
| ICD-10 |
C58 |
| ICD-9 |
181 |
| ICD-O |
M9100/3-9101 |
| DiseasesDB |
2602 |
| MedlinePlus |
001496 |
| MeSH |
D002822 |
Choriocarcinoma is a malignant, trophoblastic[1] cancer, usually of the placenta. It is characterized by "early hematogenous spread" to the lungs. It belongs to the malignant end of the spectrum in gestational trophoblastic disease (GTD). It is also classified as a germ cell tumor and may arise in the testis or ovary.
Contents
- 1 Pathology
- 2 Etiology/Epidemiology
- 3 Symptoms/Signs/Labs
- 4 Treatment
- 5 Additional images
- 6 References
- 7 External links
Pathology
Characteristic feature is the identification of intimately related syncytiotrophoblasts and cytotrophoblasts without formation of definite placental type villi. Since choriocarcinomas include syncytiotrophoblasts (beta-HCG producing cells), they cause elevated blood levels of beta-human chorionic gonadotropin.
Syncytiotrophoblasts are large multi-nucleated cells with eosinophilic cytoplasm. They often surround the cytotrophoblasts, reminiscent of their normal anatomical relationship in chorionic villi. Cytotrophoblasts are polyhedral, mononuclear cells with hyperchromatic nuclei and a clear or pale cytoplasm. Extensive hemorrhage is a common finding.
Etiology/Epidemiology
Choriocarcinoma of the placenta during pregnancy is preceded by:
- hydatidiform mole (50% of cases)
- spontaneous abortion (20% of cases)
- ectopic pregnancy (2% of cases)
- normal term pregnancy (20-30% of cases)
- hyperemesis gravidarum
Rarely, choriocarcinoma occurs in primary locations other than the placenta; very rarely, it occurs in testicles. Although trophoblastic components are common components of mixed germ cell tumors, pure choriocarcinoma of the adult testis is rare. Pure choriocarcinoma of the testis represents the most aggressive pathologic variant of germ cell tumors in adults, characteristically with early hematogenous and lymphatic metastatic spread. Because of early spread and inherent resistance to anticancer drugs, patients have poor prognosis. Elements of choriocarcinoma in a mixed testicular tumor have no prognostic importance.[2][3]
Choriocarcinomas can also occur in the ovaries.[4][5]
Symptoms/Signs/Labs
- increased quantitative chorionic gonadotropin (the "pregnancy hormone") levels
- vaginal bleeding
- shortness of breath
- hemoptysis (coughing up blood)
- chest pain
- chest X-ray shows multiple infiltrates of various shapes in both lungs
- presents in males as a testicular cancer, sometimes with skin hyperpigmentation (from excess chorionic gonadotropin cross reacting with the alpha MSH receptor), gynecomastia, and weight loss (from excess chorionic gonadotropin cross reacting with the LH, FSH, and TSH receptor) in males
- can present with increased thyroid-stimulating hormone (TSH)
Treatment
Since gestational choriocarcinoma (which arises from a hydatidiform mole) contains paternal DNA (and thus paternal antigens), it is exquisitely sensitive to chemotherapy. The cure rate, even for metastatic gestational choriocarcinoma, is around 90-95%.
At present, treatment with single-agent methotrexate is recommended for low-risk disease, while intense combination regimens including EMACO (etoposide, methotrexate, actinomycin D, cyclosphosphamide and vincristine (Oncovin) are recommended for intermediate or high-risk disease.[6][7]
Hysterectomy (surgical removal of the uterus) can also be offered[8] to patients > 40 years of age or those for whom sterilisation is not an obstacle. It may be required for those with severe infection and uncontrolled bleeding.
Choriocarcinoma arising in the testicle is rare, malignant and highly resistant to chemotherapy. The same is true of choriocarcinoma arising in the ovary. Testicular choriocarcinoma has the worst prognosis of all germ-cell cancers.[9]
Additional images
References
- ^ "choriocarcinoma" at Dorland's Medical Dictionary
- ^ Rosenberg S, DePinho RA, Weinberg RE, DeVita VT, Lawrence TS (2008). DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-7207-9. OCLC 192027662.
- ^ Kufe D (2000). Benedict RC, Holland JF, ed. Cancer medicine (5th ed.). Hamilton, Ont: B.C. Decker. ISBN 1-55009-113-1. OCLC 156944448.
- ^ Gerson RF, Lee EY, Gorman E (November 2007). "Primary extrauterine ovarian choriocarcinoma mistaken for ectopic pregnancy: sonographic imaging findings". AJR Am J Roentgenol 189 (5): W280–3. doi:10.2214/AJR.05.0814. PMID 17954626.
- ^ Ozdemir I, Demirci F, Yucel O, Demirci E, Alper M (May 2004). "Pure ovarian choriocarcinoma: a difficult diagnosis of an unusual tumor presenting with acute abdomen in a 13-year-old girl". Acta Obstet Gynecol Scand 83 (5): 504–5. doi:10.1111/j.0001-6349.2004.00092a.x. PMID 15059168.
- ^ Rustin GJ, Newlands ES, Begent RH, Dent J, Bagshawe KD (1989). "Weekly alternating etoposide, methotrexate, and actinomycin/vincristine and cyclophosphamide chemotherapy for the treatment of CNS metastases of choriocarcinoma". J. Clin. Oncol. 7 (7): 900–3. PMID 2472471.
- ^ Katzung, Bertram G. (2006). "Cancer Chemotherapy". Basic and clinical pharmacology (10th ed.). New York: McGraw-Hill Medical Publishing Division. ISBN 0-07-145153-6. OCLC 157011367.
- ^ Lurain JR, Singh DK, Schink JC (2006). "Role of surgery in the management of high-risk gestational trophoblastic neoplasia". The Journal of reproductive medicine 51 (10): 773–6. PMID 17086805.
- ^ Verville, Kathleen M. (2009). Testicular Cancer. Infobase Publishing. p. 76. ISBN 9781604131666.
External links
- MyMolarPregnancy.com Information, personal stories, and support groups for women who have been diagnosed with molar pregnancy or choriocarcinoma.
- 00976 at CHORUS
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Germ cell tumors (ICD-O 9060–9119) (C45–C49/D17–D21, 171/214–215)
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| Germinomatous |
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| Nongerminomatous |
- Embryonal carcinoma
- Endodermal sinus tumor/Yolk sac tumor
- Teratoma: Fetus in fetu
- Dermoid cyst
- Struma ovarii
- Strumal carcinoid
- Trophoblastic neoplasm: Gestational trophoblastic disease
- Choriocarcinoma
- Placental site trophoblastic tumor
- Polyembryoma
- Gonadoblastoma
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Index of reproductive medicine
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| Description |
- Anatomy
- Physiology
- Development
- sex determination and differentiation
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| Disease |
- Infections
- Congenital
- Neoplasms and cancer
- male
- female
- gonadal
- germ cell
- Other
- Symptoms and signs
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| Treatment |
- Procedures
- Drugs
- benign prostatic hypertrophy
- erectile dysfunction and premature ejaculation
- sexual dysfunction
- infection
- hormones
- androgens
- estrogens
- progestogens
- GnRH
- prolactin
- Assisted reproduction
- Birth control
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Tumors: female urogenital neoplasia (C51–C58/D25–D28, 179–184/218–221)
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| Adnexa |
| Ovaries |
Glandular and epithelial/
surface epithelial-
stromal tumor |
| CMS: |
- Ovarian serous cystadenoma
- Mucinous cystadenoma
- Cystadenocarcinoma
- Papillary serous cystadenocarcinoma
- Krukenberg tumor
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- Endometrioid tumor
- Clear-cell ovarian carcinoma
- Brenner tumour
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| Sex cord-gonadal stromal |
- Leydig cell tumour
- Sertoli cell tumour
- Sertoli-Leydig cell tumour
- Thecoma
- Granulosa cell tumour
- Luteoma
- Sex cord tumour with annular tubules
- Steroid cell tumor (NOS)
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| Germ cell |
- Dysgerminoma
- Nongerminomatous
- Embryonal carcinoma
- Endodermal sinus tumor
- Gonadoblastoma
- Teratoma/Struma ovarii
- Choriocarcinoma
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| Fibroma |
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| Fallopian tube |
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| Uterus |
| Myometrium |
- Uterine fibroids/leiomyoma
- Leiomyosarcoma
- Adenomyoma
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| Endometrium |
- Endometrioid tumor
- Uterine papillary serous carcinoma
- Clear cell carcinoma
- Endometrial intraepithelial neoplasia
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| Cervix |
- Cervical intraepithelial neoplasia
- SCC
- Glassy cell carcinoma
- Villoglandular adenocarcinoma
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| Placenta |
- Choriocarcinoma
- Gestational trophoblastic disease
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| General |
- Uterine sarcoma
- Mixed Müllerian tumor
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| Vagina |
- SCC
- Botryoid rhabdomyosarcoma
- Clear cell adenocarcinoma of the vagina
- Vaginal intraepithelial neoplasia
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| Vulva |
- SCC
- Melanoma
- Papillary hidradenoma
- Extramammary Paget's disease
- Vulvar intraepithelial neoplasia
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Index of reproductive medicine
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| Description |
- Anatomy
- Physiology
- Development
- sex determination and differentiation
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| Disease |
- Infections
- Congenital
- Neoplasms and cancer
- male
- female
- gonadal
- germ cell
- Other
- Symptoms and signs
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| Treatment |
- Procedures
- Drugs
- benign prostatic hypertrophy
- erectile dysfunction and premature ejaculation
- sexual dysfunction
- infection
- hormones
- androgens
- estrogens
- progestogens
- GnRH
- prolactin
- Assisted reproduction
- Birth control
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- Tumors: male urogenital neoplasia (C60–C63/D29, 185–187/222)
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| Internal |
| Testicles |
Sex cord-
gonadal stromal |
- Sertoli-Leydig cell tumour
- Sertoli cell tumour
- Leydig cell tumour
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| Germ cell |
| G |
- Seminoma
- Spermatocytic seminoma
- Intratubular germ cell neoplasia
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| NG |
- Embryonal carcinoma
- Endodermal sinus tumor
- Gonadoblastoma
- Teratoma
- Choriocarcinoma
- Embryoma
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| Prostate |
- Adenocarcinoma
- High-grade prostatic intraepithelial neoplasia
- Small-cell carcinoma
- Transitional cell carcinoma
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| External |
| Penis |
- Carcinoma
- Extramammary Paget's disease
- Bowen's disease
- Bowenoid papulosis
- Erythroplasia of Queyrat
- Hirsuties coronae glandis
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Index of reproductive medicine
|
|
| Description |
- Anatomy
- Physiology
- Development
- sex determination and differentiation
|
|
| Disease |
- Infections
- Congenital
- Neoplasms and cancer
- male
- female
- gonadal
- germ cell
- Other
- Symptoms and signs
|
|
| Treatment |
- Procedures
- Drugs
- benign prostatic hypertrophy
- erectile dysfunction and premature ejaculation
- sexual dysfunction
- infection
- hormones
- androgens
- estrogens
- progestogens
- GnRH
- prolactin
- Assisted reproduction
- Birth control
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