Choriocarcinoma is a malignant and aggressive cancer 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 diseases (GTD).

Classification of GTDs

 Broadly, GTDs can be classified in the following:

 1. Hydatidiform Mole

    a. Complete Mole

    b. Partial Mole

2. Invasive Mole

3. Choriocarcinoma

4. Placental site trophoblastic tumor

 

Etiology/Epidemiology

It 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)

 Symptoms/Signs/Labs

     * increased quantitative β-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

 Pathology

 On light microscopy, there is malignant trophoblastic proliferation without hydropic villi.

 

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. Chemotherapy regimen include EMACO (etoposide, methotrexate, actinomycin D, cyclosphosphamide and oncovin).

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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