Choriocarcinoma Explained

Choriocarcinoma
Field:Oncology

Choriocarcinoma is a malignant, trophoblastic cancer, usually of the placenta. It is characterized by early hematogenous spread to the lungs. It belongs to the malignant end of the spectrum in gestational trophoblastic disease (GTD). It is also classified as a germ cell tumor and may arise in the testis or ovary.

Signs and symptoms

Cause

Choriocarcinoma of the placenta during pregnancy is preceded by:

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

Choriocarcinomas can also occur in the ovaries[3] [4] and other organs.[5]

Pathology

Characteristic feature is the identification of intimately related syncytiotrophoblasts and cytotrophoblasts without formation of definite placental type villi. Since choriocarcinomas include syncytiotrophoblasts (beta-HCG producing cells), they cause elevated blood levels of beta-human chorionic gonadotropin.

Syncytiotrophoblasts are large multi-nucleated cells with eosinophilic cytoplasm. They often surround the cytotrophoblasts, reminiscent of their normal anatomical relationship in chorionic villi. Cytotrophoblasts are polyhedral, mononuclear cells with hyperchromatic nuclei and a clear or pale cytoplasm. Extensive hemorrhage is a common finding.

Treatment

Since gestational choriocarcinoma (which arises from a hydatidiform mole) contains paternal DNA (and thus paternal antigens), it is exquisitely sensitive to chemotherapy. The cure rate, even for metastatic gestational choriocarcinoma, is more than 90% when using chemotherapy for invasive mole and choriocarcinoma.[6]

As of 2019, treatment with either single-agent methotrexate or actinomycin-D is recommended for low-risk disease, while intense combination regimens including EMACO (etoposide, methotrexate, actinomycin D, cyclophosphamide and vincristine (Oncovin) are recommended for intermediate or high-risk disease.[7] [8] [9]

Hysterectomy (surgical removal of the uterus) can also be offered[10] to patients >40 years of age or those for whom sterilisation is not an obstacle. It may be required for those with severe infection and uncontrolled bleeding.

Choriocarcinoma arising in the testicle is rare, malignant and highly resistant to chemotherapy. The same is true of choriocarcinoma arising in the ovary. Testicular choriocarcinoma has the worst prognosis of all germ-cell cancers.[11]

Notes and References

  1. Book: Rosenberg S, DePinho RA, Weinberg RE, DeVita VT, Lawrence TS . DeVita, Hellman, and Rosenberg's Cancer: Principles & Practice of Oncology . Lippincott Williams & Wilkins . Hagerstwon, MD . 2008 . 978-0-7817-7207-5 . 192027662 .
  2. Book: Kufe D . Benedict RC, Holland JF . Cancer medicine . B.C. Decker . Hamilton, Ont . 2000 . 5th . 1-55009-113-1 . 156944448 .
  3. Gerson RF, Lee EY, Gorman E . Primary extrauterine ovarian choriocarcinoma mistaken for ectopic pregnancy: sonographic imaging findings . AJR. American Journal of Roentgenology . 189 . 5 . W280–W283 . November 2007 . 17954626 . 10.2214/AJR.05.0814 .
  4. Ozdemir I, Demirci F, Yucel O, Demirci E, Alper M . Pure ovarian choriocarcinoma: a difficult diagnosis of an unusual tumor presenting with acute abdomen in a 13-year-old girl . Acta Obstetricia et Gynecologica Scandinavica . 83 . 5 . 504–505 . May 2004 . 15059168 . 10.1111/j.0001-6349.2004.00092a.x . 20068680 . free .
  5. Snoj Z, Kocijancic I, Skof E . Primary pulmonary choriocarcinoma . Radiology and Oncology . 51 . 1 . 1–7 . March 2017 . 28265226 . 5330166 . 10.1515/raon-2016-0038 .
  6. Biscaro A, Braga A, Berkowitz RS . Diagnosis, classification and treatment of gestational trophoblastic neoplasia . Revista Brasileira de Ginecologia e Obstetricia . 37 . 1 . 42–51 . January 2015 . 25607129 . 10.1590/SO100-720320140005198 . free .
  7. Braga A, Mora P, de Melo AC, Nogueira-Rodrigues A, Amim-Junior J, Rezende-Filho J, Seckl MJ . Challenges in the diagnosis and treatment of gestational trophoblastic neoplasia worldwide . World Journal of Clinical Oncology . 10 . 2 . 28–37 . February 2019 . 30815369 . 6390119 . 10.5306/wjco.v10.i2.28 . free .
  8. Rustin GJ, Newlands ES, Begent RH, Dent J, Bagshawe KD . Weekly alternating etoposide, methotrexate, and actinomycin/vincristine and cyclophosphamide chemotherapy for the treatment of CNS metastases of choriocarcinoma . Journal of Clinical Oncology . 7 . 7 . 900–903 . July 1989 . 2472471 . 10.1200/JCO.1989.7.7.900 .
  9. Book: Cancer Chemotherapy . Katzung BG . Basic and clinical pharmacology . McGraw-Hill Medical Publishing Division . New York . 2006 . 0-07-145153-6 . 10th . 157011367.
  10. Lurain JR, Singh DK, Schink JC . Role of surgery in the management of high-risk gestational trophoblastic neoplasia . The Journal of Reproductive Medicine . 51 . 10 . 773–776 . October 2006 . 17086805 .
  11. Book: Testicular Cancer. Verville KM . 76. Infobase Publishing. 2009. 9781604131666 .