| Choriocarcinoma | |
|---|---|
 | |
| Micrograph of choriocarcinoma showing both of the components necessary for the diagnosis –cytotrophoblasts andsyncytiotrophoblasts. The syncytiotrophoblasts are multinucleated and have a dark stainingcytoplasm. The cytotrophoblasts are mononuclear and have a pale staining cytoplasm.H&E stain. | |
| Specialty | Oncology |
Choriocarcinoma is a malignant,trophoblastic[1]cancer, usually of theplacenta. It is characterized by early hematogenous spread to the lungs. It belongs to the malignant end of the spectrum ingestational trophoblastic disease (GTD). It is also classified as agerm cell tumor and may arise in thetestis orovary.
Choriocarcinoma of theplacenta during pregnancy is preceded by:
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 adulttestis is rare. Pure choriocarcinoma of the testis represents the most aggressive pathologic variant of germ cell tumors in adults, characteristically with early hematogenous and lymphaticmetastatic 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] and other organs.[6]
Characteristic feature is the identification of intimately relatedsyncytiotrophoblasts andcytotrophoblasts without formation of definite placental type villi. Since choriocarcinomas include syncytiotrophoblasts (beta-HCG producing cells), they cause elevated blood levels ofbeta-human chorionic gonadotropin.
Syncytiotrophoblasts are large multi-nucleated cells witheosinophiliccytoplasm. They often surround the cytotrophoblasts, reminiscent of their normal anatomical relationship inchorionic villi. Cytotrophoblasts are polyhedral, mononuclear cells with hyperchromatic nuclei and a clear or pale cytoplasm. Extensivehemorrhage is a common finding.
Sincegestational choriocarcinoma (which arises from a hydatidiform mole) contains paternal DNA (and thus paternal antigens), it is exquisitely sensitive tochemotherapy. The cure rate, even for metastatic gestational choriocarcinoma, is more than 90% when using chemotherapy for invasive mole and choriocarcinoma.[7]
As of 2019, treatment with either single-agent methotrexate or actinomycin-D is recommended for low-risk disease, while intense combination regimens including EMACO (etoposide,methotrexate,actinomycin D,cyclophosphamide andvincristine (Oncovin) are recommended for intermediate or high-risk disease.[8][9][10]
Hysterectomy (surgical removal of the uterus) can also be offered[11] 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.[12]
