Choriocarcinoma

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Choriocarcinoma is a rare aggressive germ cell tumour.

Choriocarcinoma
Diagnosis in short

Choriocarcinoma. H&E stain.

LM cytotrophoblasts, syncytiotrophoblast (often wrapped around the cytotrophoblasts) - multinucleated, hemorrhage (very common), necrosis (common)
LM DDx mixed germ cell tumour, invasive hydatidiform mole, placental site trophoblastic tumour
IHC beta-hCG
Gross dark friable, hemorrhagic/necrotic-appearing mass with an invasive border
Site ovary, testis, uterus

Associated Dx complete hydatidiform mole
Clinical history often preceded by pregnancy
Symptoms vaginal bleeding
Prevalence rare
Blood work beta-hCG markedly elevated

General

  • Aggressive clinical course.
  • Usually a mixed tumour, i.e. pure choriocarcinoma is rare, e.g. dysgerminoma + choriocarcinoma.

Clinical

  • High beta-hCG -- usually > 10,000 IU.
  • Vaginal bleeding.
  • Occasionally thyrotoxicosis.[1]

Epidemiology

Gross

  • Dark, shaggy, focally hemorrhagic & friable/necrotic-appearing.
  • Invasive border.

Microscopic

Features:

  • Two cell populations:
  1. Cytotrophoblasts - key feature.
    • Clear cytoplasm.
    • Polygonal shaped cells in cords/masses.
    • Distinct cell borders.
    • Single uniform nucleus.
  2. Syncytiotrophoblasts - may be absent.[3]
    • Large + many irreg. or lobular hyperchromatic nuclei.
    • Eosinophilic vacuolated cytoplasm (contains hCG).
  • +/-Hemorrhage - classically in the centre of the lesion.
  • +/-Necrosis.

Notes:

  • No chorionic villi should be present.
  • The dual cell population may not be evident at first.
    • Hemorrhage and marked nuclear pleomorphism are suggestive of the diagnosis.

DDx:

Images

www:

IHC

  • Beta-hCG +ve.
    • Classically said to be produced by syncytiotrophoblasts.[5]
      • Cytotrophoblasts also produce some[5][6] - usu. no staining.
  • MUC-4 +ve.[7]
  • Ki-67 +ve -- typically >30%.

See also

References

  1. O'Reilly, S.; Lyons, DJ.; Harrison, M.; Gaffney, E.; Cullen, M.; Clancy, L.. "Thyrotoxicosis induced by choriocarcinoma a report of two cases.". Ir Med J 86 (4): 124, 127. PMID 8395487.
  2. Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1110-1111. ISBN 0-7216-0187-1.
  3. URL: http://www.webpathology.com/image.asp?n=4&Case=36. Accessed on: 8 February 2011.
  4. Venkatram, S.; Muppuri, S.; Niazi, M.; Fuentes, GD. (Jul 2010). "A 24-year-old pregnant patient with diffuse alveolar hemorrhage.". Chest 138 (1): 220-3. doi:10.1378/chest.09-2688. PMID 20605823.
  5. 5.0 5.1 Cole, LA. (2010). "Biological functions of hCG and hCG-related molecules.". Reprod Biol Endocrinol 8: 102. doi:10.1186/1477-7827-8-102. PMC 2936313. PMID 20735820. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2936313/.
  6. Kovalevskaya, G.; Genbacev, O.; Fisher, SJ.; Caceres, E.; O'Connor, JF. (Aug 2002). "Trophoblast origin of hCG isoforms: cytotrophoblasts are the primary source of choriocarcinoma-like hCG.". Mol Cell Endocrinol 194 (1-2): 147-55. PMID 12242037.
  7. Mao, TL.; Kurman, RJ.; Huang, CC.; Lin, MC.; Shih, IeM. (Nov 2007). "Immunohistochemistry of choriocarcinoma: an aid in differential diagnosis and in elucidating pathogenesis.". Am J Surg Pathol 31 (11): 1726-32. doi:10.1097/PAS.0b013e318058a529. PMID 18059230.