Difference between revisions of "Choriocarcinoma"

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Choriocarcinoma (view source)

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#redirect [[Germ cell tumours#Choriocarcinoma]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Choriocarcinoma_-2-_very_high_mag.jpg
| Width      =
| Caption    = Choriocarcinoma. [[H&E stain]].
| Micro      = cytotrophoblasts, syncytiotrophoblast (often wrapped around the cytotrophoblasts) - multinucleated, hemorrhage (very common), necrosis (common)
| Subtypes  =
| LMDDx      = [[mixed germ cell tumour]], [[invasive hydatidiform mole]], [[placental site trophoblastic tumour]]
| Stains    =
| IHC        = beta-hCG
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[ovary]], [[testis]], [[uterus]]
| Assdx      = [[complete hydatidiform mole]]
| Syndromes  =
| Clinicalhx = often preceded by [[pregnancy]]
| Signs      =
| Symptoms  = vaginal bleeding
| Prevalence = rare
| Bloodwork  = beta-hCG markedly elevated
| Rads      =
| Endoscopy  =
| Prognosis  =
| Other      =
| ClinDDx    =
}}
'''Choriocarcinoma''' is a rare aggressive [[germ cell tumour]].
 
==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.<ref name=pmid8395487>{{Cite journal  | last1 = O'Reilly | first1 = S. | last2 = Lyons | first2 = DJ. | last3 = Harrison | first3 = M. | last4 = Gaffney | first4 = E. | last5 = Cullen | first5 = M. | last6 = Clancy | first6 = L. | title = Thyrotoxicosis induced by choriocarcinoma a report of two cases. | journal = Ir Med J | volume = 86 | issue = 4 | pages = 124, 127 | month =  | year =  | doi =  | PMID = 8395487 }}</ref>
 
===Epidemiology===
*May be preceded by a [[complete hydatidiform mole]].<ref name=Ref_PBoD1110-1>{{Ref PBoD|1110-1111}}</ref>
*More common in the far east.
*More common at extremes of fertile age (teens and 40-50 years).
 
==Microscopic==
Features:
*Two cell populations:
#'''C'''ytotrophoblasts - '''key feature'''.
#*'''C'''lear cytoplasm.
#*Polygonal shaped cells in cords/masses.
#*Distinct cell borders.
#*Single uniform nucleus.
#Syncytiotrophoblasts - may be absent.<ref>URL: [http://www.webpathology.com/image.asp?n=4&Case=36 http://www.webpathology.com/image.asp?n=4&Case=36]. Accessed on: 8 February 2011.</ref>
#*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.
**If chorionic villi are present... it is likely a type of [[hydatidiform mole]].
*The dual cell population may not be evident at first.
**Hemorrhage and marked nuclear pleomorphism are suggestive of the diagnosis.
 
DDx:
*[[Invasive hydatidiform mole]].
*[[Placental site trophoblastic tumour]] (PSTT).
 
===Images===
www:
*[http://www.webpathology.com/image.asp?n=5&Case=36 Choriocarcinoma - low mag. (webpathology.com)].
*[http://www.webpathology.com/image.asp?case=36&n=1 Choriocarcinoma (webpathology.com)].
*[http://www.webpathology.com/image.asp?n=4&Case=36 Choriocarcinoma (webpathology.com)].
*[http://chestjournal.chestpubs.org/content/138/1/220.full Choriocarcinoma (chestjournal.chestpubs.org)].<ref>{{Cite journal  | last1 = Venkatram | first1 = S. | last2 = Muppuri | first2 = S. | last3 = Niazi | first3 = M. | last4 = Fuentes | first4 = GD. | title = A 24-year-old pregnant patient with diffuse alveolar hemorrhage. | journal = Chest | volume = 138 | issue = 1 | pages = 220-3 | month = Jul | year = 2010 | doi = 10.1378/chest.09-2688 | PMID = 20605823 }}</ref>
*[http://oac.med.jhmi.edu/Pathology/Repro/Placenta/279B_Full.html Choriocarcinoma - uterus (med.jhmi.edu)].
<gallery>
Image:Choriocarcinoma_-2-_high_mag.jpg | Choriocarcinoma - high mag. (WC/Nephron)
Image:Choriocarcinoma_-2-_very_high_mag.jpg | Choriocarcinoma - very high mag. (WC/Nephron)
</gallery>
==IHC==
*Beta-hCG +ve.
**Classically said to be produced by syncytiotrophoblasts.<ref name=pmid20735820>{{Cite journal  | last1 = Cole | first1 = LA. | title = Biological functions of hCG and hCG-related molecules. | journal = Reprod Biol Endocrinol | volume = 8 | issue =  | pages = 102 | month =  | year = 2010 | doi = 10.1186/1477-7827-8-102 | PMID = 20735820 | PMC = 2936313 | URL = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2936313/ }}</ref>
***Cytotrophoblasts also produce some<ref name=pmid20735820/><ref name=pmid12242037>{{Cite journal  | last1 = Kovalevskaya | first1 = G. | last2 = Genbacev | first2 = O. | last3 = Fisher | first3 = SJ. | last4 = Caceres | first4 = E. | last5 = O'Connor | first5 = JF. | title = Trophoblast origin of hCG isoforms: cytotrophoblasts are the primary source of choriocarcinoma-like hCG. | journal = Mol Cell Endocrinol | volume = 194 | issue = 1-2 | pages = 147-55 | month = Aug | year = 2002 | doi =  | PMID = 12242037 }}</ref> - usu. no staining.
*MUC-4 +ve.<ref name=pmid18059230>{{Cite journal  | last1 = Mao | first1 = TL. | last2 = Kurman | first2 = RJ. | last3 = Huang | first3 = CC. | last4 = Lin | first4 = MC. | last5 = Shih | first5 = IeM. | title = Immunohistochemistry of choriocarcinoma: an aid in differential diagnosis and in elucidating pathogenesis. | journal = Am J Surg Pathol | volume = 31 | issue = 11 | pages = 1726-32 | month = Nov | year = 2007 | doi = 10.1097/PAS.0b013e318058a529 | PMID = 18059230 }}</ref>
*Ki-67 +ve -- typically >30%.
 
==See also==
*[[Germ cell tumours]].
*[[Ovarian tumours]].
*[[Gynecologic pathology]]
 
==References==
{{Reflist|2}}


[[Category:Diagnosis]]
[[Category:Diagnosis]]
[[Category:Germ cell tumours]]
[[Category:Gentiourinary pathology]]
[[Category:Gynecologic pathology]]
Michael
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