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within gastric adenocarcinomas rather than true germ cell tumors is a subject of controversy, but most authors favor the concept of unusual differentiation within adenocarcinoma over that of true gastric germ cell primary. 1,3,7,8 Grossly, gastric choriocarcinomas are exophytic. They are generally more beefy red and hemorrhagic than typical gastric adenocarcinomas, given their striking vascularity. Histologically, there is usually a combination of malignant cytotrophoblast and syncytiotrophoblast, generally admixed with areas of typical glandular differentiation. Less than 25% of cases are pure choriocarcinoma. Intratumoral hemorrhage, necrosis, and vascular invasion are common. [1][2][3][4][5][6] All trophoblastic cell types, as well as areas of glandular differentiation, are strongly cytokeratin positive. Trophoblastic tumor cells typically show strong immunoreactivity, with HCG and weaker immunoreactivity for human placental lactogen. [6][7][8] The major entity in the differential diagnosis is metastatic trophoblastic tumor from other sites, particularly gonadal or gestational primaries in women of reproductive age. Gastrectomy with lymph node dissection, followed by postoperative chemotherapy, is the treatment of choice. Chemotherapy regimens used successfully for gonadal choriocarcinoma have not had the same success in the treatment of gastric choriocarcinomas. [1][2][3][4][5] If the tumor is metastatic at time of surgery, partial gastrectomy is sometimes performed for palliation and control of bleeding, as in this case. The number of reported cases of choriocarcinoma is insufficient to perform a meaningful survival analysis as compared to typical gastric adenocarcinoma, but most pa-tients have a very poor prognosis with early metastases to lung, liver, and regional nodes.

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