Choriocarcinoma
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. | |
Specialty | Oncology |
Choriocarcinoma is a malignant,
Signs and symptoms
- increased quantitative chorionic gonadotropin (the "pregnancy hormone") levels
- vaginal bleeding
- shortness of breath
- hemoptysis (coughing up blood)
- chest pain
- chest X-rayshows 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 decreased thyroid-stimulating hormone (TSH) due to hyperthyroidism
Cause
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] and other organs.[6]
Pathology
Characteristic feature is the identification of intimately related
Syncytiotrophoblasts are large multi-nucleated cells with
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High magnification
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Very high magnification
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 rates, 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 (
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]
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Stage I choriocarcinoma
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Stage 2 choriocarcinoma
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Stage 3 choriocarcinoma
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Stage 4 choriocarcinoma
References
- ^ "choriocarcinoma" at Dorland's Medical Dictionary
- OCLC 192027662.
- OCLC 156944448.
- PMID 17954626.
- S2CID 20068680.
- PMID 28265226.
- PMID 25607129.
- PMID 30815369.
- PMID 2472471.
- OCLC 157011367.
- PMID 17086805.
- ISBN 9781604131666.
External links