Choriocarcinoma and Variants



Choriocarcinoma and Variants


Steven S. Shen, MD, PhD

Jae Y. Ro, MD, PhD










This photomicrograph shows the features of CC with large areas of hemorrhage and necrosis, and 2 types of cells, i.e., syncytiotrophoblasts image and cytotrophoblasts image.






CC shows close spatial relationship of cytotrophoblasts image with clear cytoplasm and multinucleated syncytiotrophoblasts image with abundant eosinophilic cytoplasm and smudged nuclei.


TERMINOLOGY


Abbreviations



  • Choriocarcinoma (CC)


Synonyms



  • Trophoblastic tumor


Definitions



  • Germ cell tumor composed of admixture of mononucleate cytotrophoblastic and multinucleate syncytiotrophoblastic cells


  • Monophasic choriocarcinoma (rare, lacks syncytiotrophoblasts)


  • Placental site trophoblastic tumor (extremely rare; tumor of intermediate trophoblasts)


CLINICAL ISSUES


Epidemiology



  • Incidence



    • Pure choriocarcinoma accounts for < 1% of germ cell tumors


    • Usually mixed with other germ cell tumor components (8% of mixed germ cell tumors)


  • Age



    • 25-30 years


Presentation



  • Testicular mass (often small)


  • Symptoms due to hematogenous metastasis (hemoptysis, central nervous system dysfunction, hematemesis, melena, hypotension, anemia)



    • May present with metastasis with subsequent detection of primary


  • May have gynecomastia or hyperthyroidism


Laboratory Tests



  • Patients typically have very high circulating human chorionic gonadotropin (hCG) (usually > 100,000 mIU/mL)


Treatment



  • Radical orchiectomy and systemic chemotherapy


Prognosis



  • Worse prognosis than other germ cell tumors, if pure


  • Level of hCG correlates with prognosis, reflecting tumor burden


IMAGE FINDINGS


General Features



  • Similar to other nonseminomatous germ cell tumors, but mass is usually small or inapparent in pure CC


MACROSCOPIC FEATURES


General Features



  • For pure tumors



    • Hemorrhagic and necrotic mass with blood clot; illdefined gray to tan tissue at periphery


    • Primary site may be totally regressed with “burntout” focus


Size



  • Variable (may be quite small)


MICROSCOPIC PATHOLOGY


Key Descriptors

Jul 7, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Choriocarcinoma and Variants
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