Choriocarcinoma

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Choriocarcinoma
Classification and external resources

ICD-O: 9100-9101

Choriocarcinoma is a malignant and aggressive cancer, usually of the placenta. It is characterized by early hematogenous spread to the lungs. It belongs to the far end of the spectrum of gestational trophoblastic disease (GTD), a subset of germ cell tumors.

1 Pathology 2 Etiology/Epidemiology 3 Symptoms/Signs/Labs 4 Treatment 5 References 6 External links

[edit] Pathology

Characteristic feature is the identification of intimately related syncytiotrophoblast and cytotrophoblasts without formation of definite placental type villi.

Synctiotriphoblasts are large cells with bizarre nuclei and have a eosinophilic cytoplasm and often surround the cytotrophoblasts.

Cytotrophoblasts are polyhedral and regular cells. Have a clear/eosinophillic cytoplasm with hyperchromatic nuclei.

[edit] Etiology/Epidemiology

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)

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 of inherent resistance to anticancer drugs; patients have poor prognosis. Elements of choriocarcinoma in a mixed testicular tumor have no prognostic importance. ^[1]^[2]

[edit] Symptoms/Signs/Labs

increased quantitative Î²-hCG levels vaginal bleeding shortness of breath hemoptysis (coughing up blood) chest pain chest X-ray shows multiple infiltrates of various shapes in both lungs presents in males as a testicular neoplasm

[edit] Treatment

Choriocarcinoma is one of the tumors that is most sensitive to chemotherapy. The cure rate, even for metastatic choriocarcinoma, is around 90-95%. Virtually everyone without metastases can be cured however metastatic disease to the kidneys and/or brain is usually fatal. At present, treatment with single-agent methotrexate or actinomycin D is recommended for low-risk disease, while intense combination regimens including EMACO (etoposide, methotrexate, actinomycin D, cyclosphosphamide and oncovin) are recommended for intermediate or high-risk disease. ^[3]^[4]

Hysterectomy (surgical removal of the uterus) can also be offered^[5] to patients > 40 years of age or those desiring sterilization. It may be required for those with severe infection and uncontrolled bleeding.

[edit] References

^ DeVita VT, Lawrence TS, and Rosenberg SA. (editors), "Devita, Hellman & Rosenberg's Cancer: Principles & Practice of Oncology", Lippincott Williams & Wilkins, 8th ed., 2008. ^ Kufe D et al: Holland Frei Cancer Medicine, 5th ed. BC Decker, 2000. ^ Rustin GJ, Newlands ES, Begent RH, Dent J, Bagshawe KD (1989). "Weekly alternating etoposide, methotrexate, and actinomycin/vincristine and cyclophosphamide chemotherapy for the treatment of CNS metastases of choriocarcinoma". J. Clin. Oncol. 7 (7): 900â€“3. PMID 2472471. ^ Cancer Chemotherapy in Bertram G. Katzung, "Basic & Clinical Pharmacology", McGraw-Hill, 10th ed., 2007. ^ Lurain JR, Singh DK, Schink JC (2006). "Role of surgery in the management of high-risk gestational trophoblastic neoplasia". The Journal of reproductive medicine 51 (10): 773â€“6. PMID 17086805.