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| ==Choriocarcinoma== | | ==Choriocarcinoma== |
| ===General===
| | {{Main|Choriocarcinoma}} |
| *Aggressive clinical course.
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| *Usually a mixed tumour, i.e. pure choriocarcinoma is rare, e.g. [[dysgerminoma]] + choriocarcinoma.
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| ====Clinical====
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| *High beta-hCG -- usually > 10,000 IU.
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| *Vaginal bleeding.
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| *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>
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| ====Epidemiology====
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| *May be preceded by a [[complete hydatidiform mole]].<ref name=Ref_PBoD1110-1>{{Ref PBoD|1110-1111}}</ref>
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| *More common in the far east.
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| *More common at extremes of fertile age (teens and 40-50 years).
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| ===Microscopic===
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| Features:
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| *Two cell populations:
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| #'''C'''ytotrophoblasts - '''key feature'''.
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| #*'''C'''lear cytoplasm.
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| #*Polygonal shaped cells in cords/masses.
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| #*Distinct cell borders.
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| #*Single uniform nucleus.
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| #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>
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| #*Large + many irreg. or lobular hyperchromatic nuclei.
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| #*Eosinophilic vacuolated cytoplasm (contains hCG).
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| *+/-Hemorrhage - classically in the centre of the lesion.
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| *+/-Necrosis.
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| Notes:
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| *No ''[[chorionic villi]]'' should be present.
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| **If chorionic villi are present... it is likely a type of [[hydatidiform mole]].
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| *The dual cell population may not be evident at first.
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| **Hemorrhage and marked nuclear pleomorphism are suggestive of the diagnosis.
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| DDx:
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| *[[Invasive hydatidiform mole]].
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| *[[Placental site trophoblastic tumour]] (PSTT).
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| ====Images====
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| www:
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| *[http://www.webpathology.com/image.asp?n=5&Case=36 Choriocarcinoma - low mag. (webpathology.com)].
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| *[http://www.webpathology.com/image.asp?case=36&n=1 Choriocarcinoma (webpathology.com)].
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| *[http://www.webpathology.com/image.asp?n=4&Case=36 Choriocarcinoma (webpathology.com)].
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| *[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>
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| *[http://oac.med.jhmi.edu/Pathology/Repro/Placenta/279B_Full.html Choriocarcinoma - uterus (med.jhmi.edu)].
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| <gallery>
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| Image:Choriocarcinoma_-2-_high_mag.jpg | Choriocarcinoma - high mag. (WC/Nephron)
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| Image:Choriocarcinoma_-2-_very_high_mag.jpg | Choriocarcinoma - very high mag. (WC/Nephron)
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| </gallery>
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| ===IHC===
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| *Beta-hCG +ve.
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| **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>
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| ***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.
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| *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>
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| *Ki-67 +ve -- typically >30%.
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| ==Teratoma== | | ==Teratoma== |