Non-gestational primary choriocarcinoma of the ovary. Presentation of a clinical case

Background: Ovarian germ cell tumors are derived from the primordial germ cells of the ovary, they can be benign or malignant. Non-gestational ovarian choriocarcinoma is extremely rare and aggressive that are of gestational or non-gestational origin, its prevalence is less than 0.6% of all ovarian germ cell tumors. Due to the rarity of the tumor, there is a lack of information on the clinical-pathological characteristics, diagnosis and treatment. Objective: present a case of non-gestational ovarian choriocarcioma and review of the literature Clinical case: We present the case of a 20-year-old woman who presented with an acute abdomen, due to abdominal pain and distention, with scant vaginal bleeding and pain on cervical mobilization; An ultrasound was performed with a right annex with a lesion measuring 114 x83x79mm and a total volume of 394cc, heterogeneous with linear images inside punctiform and human chorionic beta-gonadotropin levels, elevated 112.337 mUI/mL, the patient underwent an exploratory laparotomy with the finding of an ovarian tumor; performing salpingo-oophorectomy and the histopathological report of the definitive surgical specimen and immunohistochemical study, the diagnosis of non-gestational ovarian choriocarcinoma was made. Conclusion: Non-gestational choriocarcinoma is an extremely rare malignant neoplasm that can present clinically in different ways, even as an acute abdomen, which requires differential diagnoses and management is the combination of surgery and adjuvant chemotherapy.

Coriocarcinoma gestacional primario de cuello uterino. Presentación de un caso

Choriocarcinoma represents a type of malignant tumor of gestational trophoblastic disease. It can develop after a molar pregnancy, miscarriage, normal or ectopic pregnancy. Generally its seat site is the uterine body; infrequent places such as the cervix have been described. We report the case of a 37-year-old patient is reported, VI gestations IV deliveries I cesarean section I molar pregnancy, with abnormal uterine bleeding, which is referred to the Hospital Oncology Service. On gynecological examination, an exophytic mass is observed in the cervix. A biopsy was taken that reported: Gestational choriocarcinoma and plasma levels of β-hCG were verified: 13805 IU / L. A total abdominal hysterectomy was performed with preservation of the ovaries. It was concluded as stage I of the International Federation of Gynecology and Obstetrics and 8, according to the score of the World Health Organization (ST I: 8), for which adjuvant was indicated. Currently no evidence of disease. Keywords: Choriocarcinoma, gestational trophoblastic disease, cervix.

Transcriptomic Characterization of Postmolar Gestational Choriocarcinoma

The human placenta shares properties with solid tumors, such as rapid growth, tissue invasion, cell migration, angiogenesis, and immune evasion. However, the mechanisms that drive the evolution from premalignant proliferative placental diseases—called hydatidiform moles—to their malignant counterparts, gestational choriocarcinoma, as well as the factors underlying the increased aggressiveness of choriocarcinoma arising after term delivery compared to those developing from hydatidiform moles, are unknown. Using a 730-gene panel covering 13 cancer-associated canonical pathways, we compared the transcriptomic profiles of complete moles to those of postmolar choriocarcinoma samples and those of postmolar to post-term delivery choriocarcinoma. We identified 33 genes differentially expressed between complete moles and postmolar choriocarcinoma, which revealed TGF-β pathway dysregulation. We found the strong expression of SALL4, an upstream regulator of TGF-β, in postmolar choriocarcinoma, compared to moles, in which its expression was almost null. Finally, there were no differentially expressed genes between postmolar and post-term delivery choriocarcinoma samples. To conclude, the TGF-β pathway appears to be a crucial step in the progression of placental malignancies. Further studies should investigate the value of TGF- β family members as biomarkers and new therapeutic targets.

Choriocarcinoma Presenting as a Metastatic Pancreatic Mass: a Cytopathologic Diagnostic Challenge

Introduction/Objective Choriocarcinoma is a malignant tumor of trophoblasts, with gestational choriocarcinoma as the most common type. It commonly presents with vaginal bleeding and uterine mass; occasionally, hemorrhage due to metastatic disease to the lung, liver, brain, and gastrointestinal tract may be the first presentation. We describe an unusual case of metastatic gestational choriocarcinoma presenting as a pancreatic head mass mimicking a pancreatic neuroendocrine tumor (PanNET). The concern for choriocarcinoma was raised by fine-needle aspiration (FNA) cytology. Methods/Case Report A 32-year-old woman, 16 months status-post caesarian delivery of healthy twins, presented with progressive right upper quadrant and epigastric pain, nausea, and marked elevation of Beta-hCG, lipase, ALT, and AST levels. Abdominal CT revealed a hypoenhancing 2.6 cm pancreatic head mass and multiple liver nodules, suggestive of PanNET with liver metastasis. Endoscopic ultrasound and FNA of the pancreatic mass revealed a poorly differentiated tumor composed of bizarre large malignant cells with marked cytologic atypia, focal spindle cell change, and rare multinucleated cells. By immunohistochemistry, the tumor cells were positive for pancytokeratin, CAM5.2, and CD56 (focally), while negative for synaptophysin, chromogranin, inhibin, P63 and P40. While pancreatic adenocarcinoma and PanNET couldn’t be completely ruled out, metastatic choriocarcinoma was also considered; however, inconclusive immunostaining warranted a tissue biopsy. Follow-up liver biopsy and FNA showed that tumor cells were positive for Beta-hCG and negative for SALL4, placenta lactogen, HepPar1, and TTF1 immunostains, compatible with choriocarcinoma. Molecular analysis using short tandem repeat supported a gestational origin of the tumor. The patient underwent chemotherapy with marked improvement in her status and beta-hCG levels. Results (if a Case Study enter NA) NA Conclusion Although highly aggressive, gestational choriocarcinomas show good treatment response, necessitating accurate diagnosis in cases of an atypical presentation. Choriocarcinoma presenting as metastatic pancreatic mass is extremely rare and poses a diagnostic cytopathologic and radiologic challenge that requires comprehensive correlation with clinical and laboratory data.

Genetic Screening of Susceptible Women to Recurrent Molar Pregnancy for Prevention of Gestational Choriocarcinomas

Hydatidiform mole is an abnormal pregnancy characterized by hyper-proliferation of trophoblastic cells (both cytotrophoblast and syncytiotrophoblast). If the proliferation phenomenon not well controlled, e.g. due to poor medical health care system, mole can become invasive and lead to gestational choriocarcinomas. Gestational choriocarcinoma by strong metastatic potentiality, as one of the most aggressive, malignant form of gestational trophoblastic disease, could be spread through directly vascular and the middle layer of the uterine wall (Myometrium‎) and would involve distant sites such as the lungs, spleen, intestines, kidney, and liver. When a hydatidiform mole occurs once, it is known as sporadic hydatidiform mole; if it happens again, the condition is known as recurrent hydatidiform mole. In recurrent form, the gestational choriocarcinoma occurrence risk increased up to a 100-fold. Therefore, early onset identify of susceptible women to recurrent molar pregnancy is clinical importance because of the increased risk of developing neoplasia. Due to the role of maternal homozygous and compound heterozygous recessive gene, mutations have been reported in hydatidiform mole occurrence, women screening can be improved by molecular genotyping methods.

Ovarian non-gestational choriocarcinoma: a case report and review of current literature

Background: Non-gestational ovarian choriocarcinoma is an extremely rare malignant tumor without established treatment. Because of the rarity of Non-gestational ovarian choriocarcinoma, limited information is available in the literature.Thus, we presented our case and reviewed other cases concerningtheir clinical characteristics, diagnosis, therapeutic effects, and prognoses using the PubMed database.Case presentation: We present a rare case of a patient with Non-gestational ovarian choriocarcinoma with a dysgerminoma. Moreover, we performed a subsequent literature review.An 11-year-old Chinese girl presented with pain persisting for 20 days and a lump in her lower abdomen. Exploratory laparotomy was performed, and postoperative pathological sampling revealed a mixed germ-cell tumor comprising choriocarcinoma and dysgerminoma. Following six cycles of bleomycin, etoposide, and cisplatin, the patient remained recurrence-free after16 months from surgery.Conclusions: The analysis of our and previously reported cases indicated that fertility-sparing surgery combined with postoperative chemotherapy might be beneficial for Non-gestational ovarian choriocarcinoma treatment in adolescent and young female individuals. Longer follow-up periods and further management data are necessary.

Three atypical presentations of choriocarcinoma, occurring during and shortly after a coexistent viable pregnancy

Gestational choriocarcinoma is a malignant tumour originating from the trophoblastic tissue that can arise during or after any type of pregnancy, but most of the time follows a molar pregnancy. Characteristic for this tumour is its rapid haematogenous spread to various organs, causing atypical presentations often attributable to metastatic disease. We review three cases that occurred during and shortly after a coexistent intrauterine pregnancy. The patient of Case 1 presented with neurological symptoms due to hypercalcaemia, in Case 2 there was initially suspicion of appendicitis and the third patient presented with acute respiratory insufficiency. This case series illustrates that, although highly effective chemotherapy is available, choriocarcinoma can be life-threatening and accurate diagnosis is challenging but critical.