Choriocarcinoma

• Definition
  • A highly malignant gestational trophoblastic disease characterized by invasive, highly vascular, and anaplastic trophoblastic tissue without villi.
  • Has the tendency to metastasize to the lungs, vagina, CNS, liver, pelvis, GI tract, and kidneys
• Etiology: Choriocarcinoma is preceded by:
  • Hydatidiform mole
  • Spontaneous abortion or ectopic pregnancy
• Pathophysiology
  • Malignant transformation of cytotrophoblastic and syncytiotrophoblastic tissue
  • Destructive growth into myometrium without chorionic villi → risk of hemorrhage and early metastasis (lung, vagina, brain, liver)
• Clinical features: depend on disease extension and metastases location
  • Postpartum vaginal bleeding and inadequate uterine regression after delivery
  • Additional symptoms according to the site of metastasis e.g.:
    • Dyspnea, cough, or hemoptysis from metastases in the lungs
    • Seizures, headaches from metastases in the brain
    • Visible vascular lesions from metastases to the vagina
  • β-hCG-mediated endocrine conditions (e.g., hyperthyroidism, theca lutein cysts)
• Diagnostics
  • β-HCG levels: very high (initial test of choice)
  • Chest x-ray
    • Asses for lung metastases
    • “Cannonball metastases” (hematogenous spread → multiple nodules in the lung)

• Comparison of choriocarcinoma, hydatidiform mole, and teratoma

  Feature	Choriocarcinoma	Hydatidiform Mole	Teratoma
  Nature	Malignant	Premalignant	Benign (usually)
  Origin	Trophoblasts (often from molar pregnancy)	Trophoblasts (from abnormal fertilization)	Germ cells
  Karyotype	Aneuploid (often derived from mole)	46,XX (Complete) or 69,XXX/XXY (Partial)	46,XX
  Key Histo	Anaplastic trophoblasts, NO villi	Hydropic (swollen) villi	Mature tissue (hair, teeth, etc.)
  β-hCG	Massively ↑ (>100k)	Massively ↑ (>100k, Complete)	Normal
  Key Sx	Lung mets (hemoptysis, dyspnea)	Uterine size > dates, preeclampsia <20wks	Asymptomatic or ovarian torsion
  Ultrasound	Solid uterine mass	”Snowstorm” appearance (Complete)	Cyst with calcifications/fat
  Treatment	Chemotherapy (Methotrexate)	Suction Curettage	Surgical Removal (Cystectomy)

  Link to original