Difference between revisions of "Choriocarcinoma"
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{{ Infobox diagnosis | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | | Name = {{PAGENAME}} | ||
| Image = Choriocarcinoma_-2-_very_high_mag.jpg | | Image = Choriocarcinoma_-2-_very_high_mag.jpg | ||
| Width = | | Width = | ||
| Caption = Choriocarcinoma. [[H&E stain]]. | | Caption = Choriocarcinoma. [[H&E stain]]. | ||
| Line 8: | Line 8: | ||
| LMDDx = [[mixed germ cell tumour]], [[invasive hydatidiform mole]], [[placental site trophoblastic tumour]] | | LMDDx = [[mixed germ cell tumour]], [[invasive hydatidiform mole]], [[placental site trophoblastic tumour]] | ||
| Stains = | | Stains = | ||
| IHC = beta-hCG | | IHC = beta-hCG +ve, CD10 +ve, p63 +ve, OCT3 -ve, GATA3 +ve, CK7 +ve | ||
| EM = | | EM = | ||
| Molecular = | | Molecular = | ||
| Line 14: | Line 14: | ||
| Gross = dark friable, hemorrhagic/necrotic-appearing mass with an invasive border | | Gross = dark friable, hemorrhagic/necrotic-appearing mass with an invasive border | ||
| Grossing = [[orchiectomy grossing]] | | Grossing = [[orchiectomy grossing]] | ||
| Staging = [[testicular cancer staging]] | |||
| Site = [[ovary]], [[testis]], [[uterus]] | | Site = [[ovary]], [[testis]], [[uterus]] | ||
| Assdx = [[complete hydatidiform mole]] | | Assdx = [[complete hydatidiform mole]] | ||
| Syndromes = | | Syndromes = | ||
| Clinicalhx = often preceded by [[pregnancy]] | | Clinicalhx = often preceded by [[pregnancy]] | ||
| Signs = | | Signs = testicular mass (male) | ||
| Symptoms = vaginal bleeding | | Symptoms = vaginal bleeding (female) | ||
| Prevalence = rare | | Prevalence = rare | ||
| Bloodwork = beta-hCG markedly elevated | | Bloodwork = beta-hCG markedly elevated (usu. >10,000 IU) | ||
| Rads = | | Rads = | ||
| Endoscopy = | | Endoscopy = | ||
| Prognosis = | | Prognosis = often poor | ||
| Other = | | Other = | ||
| ClinDDx = | | ClinDDx = | ||
| Tx = surgery and chemotherapy | |||
}} | }} | ||
'''Choriocarcinoma''' is a rare aggressive [[germ cell tumour]]. | '''Choriocarcinoma''' is a rare aggressive [[germ cell tumour]]. | ||
| Line 36: | Line 38: | ||
===Clinical=== | ===Clinical=== | ||
*High beta-hCG -- usually > 10,000 IU. | *High beta-hCG -- usually > 10,000 IU. | ||
*Vaginal bleeding. | **Median in one series of testicular choriocarcinoma ~ 200,000 IU.<ref name=pmid24145647>{{Cite journal | last1 = Alvarado-Cabrero | first1 = I. | last2 = Hernández-Toriz | first2 = N. | last3 = Paner | first3 = GP. | title = Clinicopathologic analysis of choriocarcinoma as a pure or predominant component of germ cell tumor of the testis. | journal = Am J Surg Pathol | volume = 38 | issue = 1 | pages = 111-8 | month = Jan | year = 2014 | doi = 10.1097/PAS.0b013e3182a2926e | PMID = 24145647 }}</ref> | ||
**Elevation may be seen in other (non-trophoblastic) tumours.<ref name=pmid7690985>{{Cite journal | last1 = Mann | first1 = K. | last2 = Saller | first2 = B. | last3 = Hoermann | first3 = R. | title = Clinical use of HCG and hCG beta determinations. | journal = Scand J Clin Lab Invest Suppl | volume = 216 | issue = | pages = 97-104 | month = | year = 1993 | doi = | PMID = 7690985 }}</ref> | |||
*Vaginal bleeding or testicular mass. | |||
*Occasionally thyrotoxicosis.<ref name=pmid8395487>{{Cite journal | last1 = O'Reilly | first1 = S. | last2 = Lyons | first2 = DJ. | last3 = Harrison | first3 = M. | last4 = Gaffney | first4 = E. | last5 = Cullen | first5 = M. | last6 = Clancy | first6 = L. | title = Thyrotoxicosis induced by choriocarcinoma a report of two cases. | journal = Ir Med J | volume = 86 | issue = 4 | pages = 124, 127 | month = | year = | doi = | PMID = 8395487 }}</ref> | *Occasionally thyrotoxicosis.<ref name=pmid8395487>{{Cite journal | last1 = O'Reilly | first1 = S. | last2 = Lyons | first2 = DJ. | last3 = Harrison | first3 = M. | last4 = Gaffney | first4 = E. | last5 = Cullen | first5 = M. | last6 = Clancy | first6 = L. | title = Thyrotoxicosis induced by choriocarcinoma a report of two cases. | journal = Ir Med J | volume = 86 | issue = 4 | pages = 124, 127 | month = | year = | doi = | PMID = 8395487 }}</ref> | ||
Note: | |||
*Beta-hCG is negative ~3 weeks after pregnancy.<ref name=pmid2436389 >{{Cite journal | last1 = Haenel | first1 = AF. | last2 = Hugentobler | first2 = W. | last3 = Brunner | first3 = S. | title = [The postpartum course of the HCG titer of maternal blood and its clinical relevance]. | journal = Z Geburtshilfe Perinatol | volume = 190 | issue = 6 | pages = 275-8 | month = | year = | doi = | PMID = 2436389 }}</ref> | |||
===Epidemiology=== | ===Epidemiology=== | ||
| Line 71: | Line 78: | ||
*[[Invasive hydatidiform mole]]. | *[[Invasive hydatidiform mole]]. | ||
*[[Placental site trophoblastic tumour]] (PSTT). | *[[Placental site trophoblastic tumour]] (PSTT). | ||
*[[Mixed germ cell tumour]] - esp. for testicular and ovarian tumours. | |||
===Images=== | ===Images=== | ||
====Case==== | |||
<gallery> | <gallery> | ||
Image: Choriocarcinoma - intermed mag.jpg | Choriocarcinoma - intermed. mag. (WC/Nephron) | Image: Choriocarcinoma - intermed mag.jpg | Choriocarcinoma - intermed. mag. (WC/Nephron) | ||
| Line 80: | Line 89: | ||
Image: Choriocarcinoma -2- very high mag.jpg | Choriocarcinoma - very high mag. (WC/Nephron) | Image: Choriocarcinoma -2- very high mag.jpg | Choriocarcinoma - very high mag. (WC/Nephron) | ||
</gallery> | </gallery> | ||
www | ====Case==== | ||
<gallery> | |||
Image: Choriocarcinoma to lung -- low mag.jpg | Choriocarcinoma - low mag. (WC) | |||
Image: Choriocarcinoma to lung -- intermed mag.jpg | Choriocarcinoma - intermed. mag. (WC) | |||
Image: Choriocarcinoma to lung -- high mag.jpg | Choriocarcinoma - high mag. (WC) | |||
Image: Choriocarcinoma to lung - alt -- high mag.jpg | Choriocarcinoma - high mag. (WC) | |||
Image: Choriocarcinoma to lung -- very high mag.jpg | Choriocarcinoma - very high mag. (WC) | |||
</gallery> | |||
====www==== | |||
*[http://www.webpathology.com/image.asp?n=5&Case=36 Choriocarcinoma - low mag. (webpathology.com)]. | *[http://www.webpathology.com/image.asp?n=5&Case=36 Choriocarcinoma - low mag. (webpathology.com)]. | ||
*[http://www.webpathology.com/image.asp?case=36&n=1 Choriocarcinoma (webpathology.com)]. | *[http://www.webpathology.com/image.asp?case=36&n=1 Choriocarcinoma (webpathology.com)]. | ||
| Line 90: | Line 107: | ||
[[ISUP]] consensus paper by Ulbright ''et al.'':<ref name=pmid24832161>{{cite journal |author=Ulbright TM, Tickoo SK, Berney DM, Srigley JR |title=Best practices recommendations in the application of immunohistochemistry in testicular tumors: report from the international society of urological pathology consensus conference |journal=Am. J. Surg. Pathol. |volume=38 |issue=8 |pages=e50–9 |year=2014 |month=August |pmid=24832161 |doi=10.1097/PAS.0000000000000233 |url=}}</ref> | [[ISUP]] consensus paper by Ulbright ''et al.'':<ref name=pmid24832161>{{cite journal |author=Ulbright TM, Tickoo SK, Berney DM, Srigley JR |title=Best practices recommendations in the application of immunohistochemistry in testicular tumors: report from the international society of urological pathology consensus conference |journal=Am. J. Surg. Pathol. |volume=38 |issue=8 |pages=e50–9 |year=2014 |month=August |pmid=24832161 |doi=10.1097/PAS.0000000000000233 |url=}}</ref> | ||
*Beta-hCG +ve. | *Beta-hCG +ve. | ||
*Glypican 3 +ve/-ve. | *[[Glypican 3]] +ve/-ve. | ||
*OCT3 -ve. | *OCT3 -ve. | ||
*AFP -ve. | *AFP -ve. | ||
Others: | Others: | ||
*p63 +ve.<ref name=pmid18318583>{{Cite journal | last1 = Mittal | first1 = K. | last2 = Soslow | first2 = R. | last3 = McCluggage | first3 = WG. | title = Application of immunohistochemistry to gynecologic pathology. | journal = Arch Pathol Lab Med | volume = 132 | issue = 3 | pages = 402-23 | month = Mar | year = 2008 | doi = 10.1043/1543-2165(2008)132[402:AOITGP]2.0.CO;2 | PMID = 18318583 }}</ref> | |||
**[[Placental site nodule]] and [[epithelioid trophoblastic tumour]] +ve. | |||
**[[Exaggerated placental site]] and [[placental site trophoblastic tumour]] -ve. | |||
*Ki-67 +ve -- typically >30%. | *Ki-67 +ve -- typically >30%. | ||
*CK7 +ve.<ref name=pmid25469347>{{Cite journal | last1 = Park | first1 = SY. | last2 = Lee | first2 = DE. | last3 = Park | first3 = HJ. | last4 = Kim | first4 = KC. | last5 = Kim | first5 = YH. | title = Retroperitoneal nongestational choriocarcinoma in a 25-year-old woman. | journal = Obstet Gynecol Sci | volume = 57 | issue = 6 | pages = 544-8 | month = Nov | year = 2014 | doi = 10.5468/ogs.2014.57.6.544 | PMID = 25469347 }}</ref><ref name=pmid22091297>{{Cite journal | last1 = Hemati | first1 = S. | last2 = Esnaashari | first2 = O. | last3 = Mohajeri | first3 = M. | last4 = Sarvizadeh | first4 = M. | title = Choriocarcinoma of the breast; a case report and review of literatures. | journal = J Res Med Sci | volume = 16 | issue = 5 | pages = 707-11 | month = May | year = 2011 | doi = | PMID = 22091297 }}</ref> | |||
*MUC-4 +ve.<ref name=pmid18059230>{{Cite journal | last1 = Mao | first1 = TL. | last2 = Kurman | first2 = RJ. | last3 = Huang | first3 = CC. | last4 = Lin | first4 = MC. | last5 = Shih | first5 = IeM. | title = Immunohistochemistry of choriocarcinoma: an aid in differential diagnosis and in elucidating pathogenesis. | journal = Am J Surg Pathol | volume = 31 | issue = 11 | pages = 1726-32 | month = Nov | year = 2007 | doi = 10.1097/PAS.0b013e318058a529 | PMID = 18059230 }}</ref> | *MUC-4 +ve.<ref name=pmid18059230>{{Cite journal | last1 = Mao | first1 = TL. | last2 = Kurman | first2 = RJ. | last3 = Huang | first3 = CC. | last4 = Lin | first4 = MC. | last5 = Shih | first5 = IeM. | title = Immunohistochemistry of choriocarcinoma: an aid in differential diagnosis and in elucidating pathogenesis. | journal = Am J Surg Pathol | volume = 31 | issue = 11 | pages = 1726-32 | month = Nov | year = 2007 | doi = 10.1097/PAS.0b013e318058a529 | PMID = 18059230 }}</ref> | ||
*CD10 +ve (10 +ve of 10 cases<ref name=pmid19145204>{{Cite journal | last1 = Kalhor | first1 = N. | last2 = Ramirez | first2 = PT. | last3 = Deavers | first3 = MT. | last4 = Malpica | first4 = A. | last5 = Silva | first5 = EG. | title = Immunohistochemical studies of trophoblastic tumors. | journal = Am J Surg Pathol | volume = 33 | issue = 4 | pages = 633-8 | month = Apr | year = 2009 | doi = 10.1097/PAS.0b013e318191f2eb | PMID = 19145204 }}</ref>). | |||
*[[GATA3]] +ve.<ref name=pmid26772394>{{cite journal |authors=Osman H, Cheng L, Ulbright TM, Idrees MT |title=The utility of CDX2, GATA3, and DOG1 in the diagnosis of testicular neoplasms: an immunohistochemical study of 109 cases |journal=Hum Pathol |volume=48 |issue= |pages=18–24 |date=February 2016 |pmid=26772394 |doi=10.1016/j.humpath.2015.09.028 |url=}}</ref> | |||
Notes: | Notes: | ||
Latest revision as of 19:00, 18 June 2024
| Choriocarcinoma | |
|---|---|
| Diagnosis in short | |
 Choriocarcinoma. H&E stain. | |
|
| |
| LM | cytotrophoblasts, syncytiotrophoblast (often wrapped around the cytotrophoblasts) - multinucleated, hemorrhage (very common), necrosis (common) |
| LM DDx | mixed germ cell tumour, invasive hydatidiform mole, placental site trophoblastic tumour |
| IHC | beta-hCG +ve, CD10 +ve, p63 +ve, OCT3 -ve, GATA3 +ve, CK7 +ve |
| Gross | dark friable, hemorrhagic/necrotic-appearing mass with an invasive border |
| Grossing notes | orchiectomy grossing |
| Staging | testicular cancer staging |
| Site | ovary, testis, uterus |
|
| |
| Associated Dx | complete hydatidiform mole |
| Clinical history | often preceded by pregnancy |
| Signs | testicular mass (male) |
| Symptoms | vaginal bleeding (female) |
| Prevalence | rare |
| Blood work | beta-hCG markedly elevated (usu. >10,000 IU) |
| Prognosis | often poor |
| Treatment | surgery and chemotherapy |
Choriocarcinoma is a rare aggressive germ cell tumour.
General
- Aggressive clinical course.
- Usually a mixed tumour, i.e. pure choriocarcinoma is rare, e.g. dysgerminoma + choriocarcinoma.
Clinical
- High beta-hCG -- usually > 10,000 IU.
- Vaginal bleeding or testicular mass.
- Occasionally thyrotoxicosis.[3]
Note:
- Beta-hCG is negative ~3 weeks after pregnancy.[4]
Epidemiology
- May be preceded by a complete hydatidiform mole.[5]
- More common in the far east.
- More common at extremes of fertile age (teens and 40-50 years).
Gross
- Dark, shaggy, focally hemorrhagic & friable/necrotic-appearing.
- Invasive border.
Microscopic
Features:
- Two cell populations:
- Cytotrophoblasts - key feature.
- Clear cytoplasm.
- Polygonal shaped cells in cords/masses.
- Distinct cell borders.
- Single uniform nucleus.
- Syncytiotrophoblasts - may be absent.[6]
- Large + many irreg. or lobular hyperchromatic nuclei.
- Eosinophilic vacuolated cytoplasm (contains hCG).
- +/-Hemorrhage - classically in the centre of the lesion.
- +/-Necrosis.
Notes:
- No chorionic villi should be present.
- If chorionic villi are present... it is likely a type of hydatidiform mole.
- The dual cell population may not be evident at first.
- Hemorrhage and marked nuclear pleomorphism are suggestive of the diagnosis.
DDx:
- Invasive hydatidiform mole.
- Placental site trophoblastic tumour (PSTT).
- Mixed germ cell tumour - esp. for testicular and ovarian tumours.
Images
Case
Choriocarcinoma - intermed. mag. (WC/Nephron)
Choriocarcinoma - high mag. (WC/Nephron)
Choriocarcinoma - very high mag. (WC/Nephron)
Choriocarcinoma - high mag. (WC/Nephron)
Choriocarcinoma - very high mag. (WC/Nephron)
Case
Choriocarcinoma - low mag. (WC)
Choriocarcinoma - intermed. mag. (WC)
Choriocarcinoma - high mag. (WC)
Choriocarcinoma - high mag. (WC)
Choriocarcinoma - very high mag. (WC)
www
- Choriocarcinoma - low mag. (webpathology.com).
- Choriocarcinoma (webpathology.com).
- Choriocarcinoma (webpathology.com).
- Choriocarcinoma (chestjournal.chestpubs.org).[7]
- Choriocarcinoma - uterus (med.jhmi.edu).
IHC
ISUP consensus paper by Ulbright et al.:[8]
- Beta-hCG +ve.
- Glypican 3 +ve/-ve.
- OCT3 -ve.
- AFP -ve.
Others:
- p63 +ve.[9]
- Ki-67 +ve -- typically >30%.
- CK7 +ve.[10][11]
- MUC-4 +ve.[12]
- CD10 +ve (10 +ve of 10 cases[13]).
- GATA3 +ve.[14]
Notes:
- Beta-hCG is classically said to be produced by syncytiotrophoblasts.[15]
See also
References
- ↑ Alvarado-Cabrero, I.; Hernández-Toriz, N.; Paner, GP. (Jan 2014). "Clinicopathologic analysis of choriocarcinoma as a pure or predominant component of germ cell tumor of the testis.". Am J Surg Pathol 38 (1): 111-8. doi:10.1097/PAS.0b013e3182a2926e. PMID 24145647.
- ↑ Mann, K.; Saller, B.; Hoermann, R. (1993). "Clinical use of HCG and hCG beta determinations.". Scand J Clin Lab Invest Suppl 216: 97-104. PMID 7690985.
- ↑ O'Reilly, S.; Lyons, DJ.; Harrison, M.; Gaffney, E.; Cullen, M.; Clancy, L.. "Thyrotoxicosis induced by choriocarcinoma a report of two cases.". Ir Med J 86 (4): 124, 127. PMID 8395487.
- ↑ Haenel, AF.; Hugentobler, W.; Brunner, S.. "[The postpartum course of the HCG titer of maternal blood and its clinical relevance].". Z Geburtshilfe Perinatol 190 (6): 275-8. PMID 2436389.
- ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 1110-1111. ISBN 0-7216-0187-1.
- ↑ URL: http://www.webpathology.com/image.asp?n=4&Case=36. Accessed on: 8 February 2011.
- ↑ Venkatram, S.; Muppuri, S.; Niazi, M.; Fuentes, GD. (Jul 2010). "A 24-year-old pregnant patient with diffuse alveolar hemorrhage.". Chest 138 (1): 220-3. doi:10.1378/chest.09-2688. PMID 20605823.
- ↑ Ulbright TM, Tickoo SK, Berney DM, Srigley JR (August 2014). "Best practices recommendations in the application of immunohistochemistry in testicular tumors: report from the international society of urological pathology consensus conference". Am. J. Surg. Pathol. 38 (8): e50–9. doi:10.1097/PAS.0000000000000233. PMID 24832161.
- ↑ Mittal, K.; Soslow, R.; McCluggage, WG. (Mar 2008). "Application of immunohistochemistry to gynecologic pathology.". Arch Pathol Lab Med 132 (3): 402-23. doi:10.1043/1543-2165(2008)132[402:AOITGP]2.0.CO;2. PMID 18318583.
- ↑ Park, SY.; Lee, DE.; Park, HJ.; Kim, KC.; Kim, YH. (Nov 2014). "Retroperitoneal nongestational choriocarcinoma in a 25-year-old woman.". Obstet Gynecol Sci 57 (6): 544-8. doi:10.5468/ogs.2014.57.6.544. PMID 25469347.
- ↑ Hemati, S.; Esnaashari, O.; Mohajeri, M.; Sarvizadeh, M. (May 2011). "Choriocarcinoma of the breast; a case report and review of literatures.". J Res Med Sci 16 (5): 707-11. PMID 22091297.
- ↑ Mao, TL.; Kurman, RJ.; Huang, CC.; Lin, MC.; Shih, IeM. (Nov 2007). "Immunohistochemistry of choriocarcinoma: an aid in differential diagnosis and in elucidating pathogenesis.". Am J Surg Pathol 31 (11): 1726-32. doi:10.1097/PAS.0b013e318058a529. PMID 18059230.
- ↑ Kalhor, N.; Ramirez, PT.; Deavers, MT.; Malpica, A.; Silva, EG. (Apr 2009). "Immunohistochemical studies of trophoblastic tumors.". Am J Surg Pathol 33 (4): 633-8. doi:10.1097/PAS.0b013e318191f2eb. PMID 19145204.
- ↑ Osman H, Cheng L, Ulbright TM, Idrees MT (February 2016). "The utility of CDX2, GATA3, and DOG1 in the diagnosis of testicular neoplasms: an immunohistochemical study of 109 cases". Hum Pathol 48: 18–24. doi:10.1016/j.humpath.2015.09.028. PMID 26772394.
- ↑ 15.0 15.1 Cole, LA. (2010). "Biological functions of hCG and hCG-related molecules.". Reprod Biol Endocrinol 8: 102. doi:10.1186/1477-7827-8-102. PMC 2936313. PMID 20735820. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2936313/.
- ↑ Kovalevskaya, G.; Genbacev, O.; Fisher, SJ.; Caceres, E.; O'Connor, JF. (Aug 2002). "Trophoblast origin of hCG isoforms: cytotrophoblasts are the primary source of choriocarcinoma-like hCG.". Mol Cell Endocrinol 194 (1-2): 147-55. PMID 12242037.