A gestational choriocarcinoma of the ovary diagnosed by DNA polymorphic analysis: a case report and systematic review of the literature

Abstract

BackgroundChoriocarcinoma of the ovary is rare. This tumor can arise from gestational tissue or pure germ cells of the ovary, the former results in gestational choriocarcinoma. The clinical characteristics and histology of both tumor types are identical, differentiation of these tumors is necessary for effective treatment. One strategy for the differentiation of these tumors types is to identify the presence of paternal DNA by DNA polymorphic analysis.Case presentationIn the present case, a 27-year-old patient with a history of amenorrhea, lower abdominal pain and vaginal bleeding received a laparoscopic dissection of cystic mass of the right ovary according to an initial diagnosis of ectopic pregnancy. Primary choriocarcinoma of the ovary was diagnosed by pathology, but its origin was uncertain. DNA polymorphic analysis was then performed and a gestational origin was confirmed. The patient subsequently exhibited an excellent response to chemotherapy, achieved complete remission and gave birth to a healthy baby.ConclusionDifferentiation between two etiologies of primary choriocarcinoma can be achieved with DNA polymorphic analysis and it is necessary to distinguish between them to approach to an appropriate treatment of a patient.

Pure primary non-gestational choriocarcinoma originating in the ovary: A case report and literature review

“…The most important differential diagnosis of NGCO is GCO, and both gestational and non-gestational choriocarcinoma exhibit identical clinical manifestations and histology. 1 Additionally, although these authors observed no immunohistochemical differences between them, the chemotherapeutic regimens used are different. It is generally accepted that GCO can be treated with methotrexate, actinomycin D, or etoposide as a single agent; or in combinations such as EMA-CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine) when strong risk factors are present.…”

“…However, NGCO is generally treated with a BEP (bleomycin, etoposide, cisplatin) regimen. 1 Although both tumors tend to develop early hematogenous metastasis to several different sites that include the lung, liver, brain, bone, vagina, and other viscera, 14 NCGO more often invades the adjacent organs, more commonly metastasizes to distant organs such as the brain and lung, 12 and has been found to be resistant to single-agent chemotherapy—with a worse prognosis relative to GCO. 8 Therefore, it is necessary to distinguish NGCO from GCO.…”

“…The estimated incidence of GCO of the ovary is 1 in 369,000,000 pregnancies—while NGCO corresponds to less than 0.6% of ovarian germ cell tumors, making this neoplasm extremely rare. 1 – 3 NGCO of the ovary usually occurs as a component of a mixed-germ-cell tumor, and pure non-gestational choriocarcinoma is a primary germ-cell neoplasm that has been defined as a tumor without other germ-cell elements. 4 NGCO should be distinguished from GCO because the chemotherapeutic regimens are different, but both exhibit identical clinical manifestations and histology.…”

Hypothesis on the possible relevance of the immunogenic cell death in the treatment of gestational trophoblastic neoplasms

“…However, only the gestational choriocarcinoma has DNA of paternal origin in its genome. Indeed, in childbearing women, the gestational choriocarcinoma is differentiated from the (non-gestational) germ-cell subtype, by detecting the presence of paternal DNA in tumoral cells [10 , 11] . Consequently, gestational choriocarcinoma is a unique neoplasm in its genetic background.…”

“…Single-agent chemotherapy regimens (either methotrexate or actinomycin D) are widely used in low-risk GTN patients. On the other hand, high-risk GTN is usually treated with combination chemotherapies such as EMA-CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine) or EP-EMA (cisplatin, etoposide, methotrexate, and actinomycin-D); the latter in case of recurrent disease or if primary resistance to EMA-CO occurs [7 , 10 , 13 , 14] .…”