Choriocarcinoma at a First Trimester
Masaharu Fukunaga. Jikei University Daisan Hospital, Tokyo, Japan
Background: The number of cases of choriocarcinoma (CC) with antecedent pregnancy of hydatidiform mole has been decreasing. Choriocarcinoma in situ (CCIS) (intraplacental CC), a neoplastic trophoblastic proliferation localized in the placenta, is a very rare condition and is usually diagnosed after or around a term delivery. CCIS and CC with lung metastases at a first trimester have been rarely studied.
Design: Clinicopathologic analyses were done on four cases of CCIS and a case of CC with lung metastases at a first trimester. The origin of CC and the significance of CC at early gestational stage were discussed.
Results: The patients ranged in age from 28 to 38 (mean: 31) years. They were gravida 2. para 1, G2.P0, G1.P0, G2.P1 and G4.P2. No patients had any past history of gestational trophoblastic diseases. All patients, at the gestational week of 8 to 11, had a dilation and curettage for vaginal bleeding and the absence of intrauterine fetus. No macroscopic abnormalities were noted in any cases. However, histologically, all four CCISs were characterized by localized nodules measuring 3 to 10 mm composed of atypical cytotrophoblasts, syncytiotrophoblasts and intermediate trophoblasts. The nodules appeared to arise directly from normal stem villi and projected into the intervillous space. Fetal elements were not observed in any cases. All of them were diploid by flow cytometry. Urinary beta-hCG levels were within normal range at the diagnosis in all CCISs. Radiographic studies showed no metastatic lesions in any patients. Follow-up study ranging from 1 to 3.5 years showed that all patients were free from disease without therapy. The remaining patient had elevated levels of urinary and serum beta-hCG and developed lung metastases. A dilation and curettage exhibited a proliferation of atypical and mitotically active cytotrophoblasts, syncytiotrophoblasts and intermediate trophoblasts in a large sheet pattern, hemorrhagic necrosis, minimal placental site reaction and the lack of villi. The patient has been treated with chemotherapy.
Conclusions: These results suggest an origin of CCIS from trophoblasts of a stem villus and CC may arise at any stage of pregnancy. It is assumed that almost all CCs at early gestational stage have been expelled as a spontaneous abortion or curettaged. Most of CCs at a first trimester would be unrecognized clinically and pathologically and many patients with CC would have uneventful clinical courses. This study indicates the need to perform thorough microscopic examination of the products of conception submitted, especially in the absence of a fetus or fetal parts.
Category: Gynecologic & Obstetrics
Wednesday, March 21, 2012 9:30 AM
Poster Session V # 162, Wednesday Morning