Choriocarcinoma

cancer of the chorionic epithelium

1. CHORIOCARCINOMA

2. Choriocarcinoma is a highly malignant tumor arising from the chorionic epithelium. About 50 percent of all patients with molar pregnancies/ hydatidiform mole develop choriocarcinoma. 30 percent occur after a miscarriage or an ectopic pregnancy 20 percent after an apparently normal pregnancy.

3. PATHOLOGY The primary site is - Anywhere in the uterus. Rarely, it starts in the tube or ovary.

4. Naked Eye Appearance DIFFUSE AND LOCALIZED The lesion is usually localized nodular type. The nodular type may be located deep in the myometrium with overlying endometrium intact. It looks red, hemorrhagic and necrotic. At times, the lesion is diffuse involving the entire endometrium.

5. Microscopic Appearance There are anaplastic sheets or columns of trophoblastic cells invading the uterine musculature. Evidences of necrosis and hemorrhage . Villus pattern is completely absent.

6. Spread Local spread common Vascular erosion takes place early and hence distant metastases occur rapidly. The common sites of metastases are lungs (80%), anterior vaginal wall (30%), brain (10%), liver (10%)

7. Clinical Features Symptoms : Persistent ill health. Irregular vaginal bleeding, at times brisk. Continued amenorrhea. Other symptoms due to metastatic lesions are: Lung: Cough, breathlessness, hemoptysis . Vaginal: Irregular and at times brisk hemorrhage. Cerebral: Headache, convulsion, paralysis or coma. Liver: Epigastric pain, jaundice.

8. Signs: Patient looks ill. Pallor of varying degrees. Bimanual examination reveals subinvolution of the uterus. There may be a purplish red nodule in the lower-third of the anterior vaginal wall

9. FIGO STAGING