Choriocarcinoma

Snapshot

• A 28-year-old woman presents to the emergency department after coughing blood. Her symptom is associated with progressively worsening shortness of breath. She has a past medical history of bilateral theca-lutein ovarian cysts. A radiagraph of the chest demonstrates multiple radiopaque pulmonary lesions. Laboratory studies are remarkable for highly elevated β-hCG.

Introduction

• Overview
  • a type of gestational trophoblastic neoplasia 
    • made up of cytotrophoblasts and syncytiotrophoblasts without villi 
    • most commonly of placental origin
    • most commonly spreads to the lungs, leading to shortness of breath and hemoptysis
    • can follow a molar pregnancy or can arise from the ovaries and testes as a germ cell tumor
• Epidemiology
  • incidence
    • extremely rare (<1% of ovarian tumors)
• Associated conditions
  • theca-lutein ovarian cysts
• molar pregnancy (more common after a complete than a partial mole)

Presentation

• Symptoms
  • shortness of breath and hemoptysis
    • suggests metastasis to the lung
• Physical exam
• pelvic mass

Imaging

• Radiography of the chest
  • indication
    • to evaluate cause of shortness of breath or hemoptysis
  • findings
• “cannonball” metastases 

Studies

• Serum labs
  • ↑ β-hCG
• Histology 
  • trophoblasts and cytotrophoblasts with syncytiotrophoblast
  • central hemorrhage with necrosis
• cytologic atypia

Differential

• Dysgerminoma
  • differentiating factors
• associated with elevated lactic acid dehydrogenase (LDH)

Treatment

• Medical
  • chemotherapy 
    • indication
      • mainstay of treatment
        • highly sensitive to chemotherapy
    • medications
• methotrexate 

Complications

• Hemorrhage
  • secondary to its high vascularity