Choriocarcinoma in situ at a first trimester

Abstract

Two cases of choriocarcinoma in situ arising in a first trimester placenta are reported in a 28-year-old gravida 2, para 1, Japanese woman and a 38-year-old gravida 2, para 0. Both had a dilation and curettage (D and C) for vaginal bleeding and the absence of intrauterine fetus. No macroscopic abnormalities were noted in either case. However, histologically, localized nodules of neoplastic trophoblastic proliferation measuring 5 mm in the first case, and 6 mm in the second appeared to arise directly from normal stem villi and project into the intervillous space. Both tumours were composed of biphasic cytotrophoblast and syncytiotrophoblast. Fetal elements were not observed in either case. Radiographic studies showed no metastatic lesions in either patient. Urinary human chorionic gonadotropin levels were within normal range in both patients. The first patient had a normal full-term spontaneous vaginal delivery 22 months after the D and C and was free from disease without therapy at 32 months. The second patient was free from disease without therapy with a limited follow-up. These tumours provide evidence for an origin of choriocarcinoma from trophoblast of a stem villus. This report illustrates the need to perform thorough microscopic examination of the products of conception especially in the absence of a fetus or fetal parts.

Intraplacental Choriocarcinoma: Rare or Underdiagnosed? Report of 2 Cases Diagnosed after an Incomplete Miscarriage and a Preterm Spontaneous Vaginal Delivery

“…Microscopically, the focal proliferation of both cyto- and syncytiotrophoblast (biphasic) in the stem villi that project to the intervillous space, with significant necrosis in the centre, is the typical pattern. Some reports describe stromal or vascular invasion [6, 8, 9]. In both our cases, there was microscopic proliferation of both cytotrophoblast and syncytiotrophoblast, occupying the intervillous space with no stromal or vascular invasion.…”

“…The first report was in 1963 when Driscoll described an “incidental finding of a choriocarcinoma within a term placenta” [12]. Fukunaga and Nomura also defined it as a “neoplastic trophoblast proliferation localized on the placenta that implies the absence of metastases” [8]. However, other authors described associated maternal or fetal metastatic lesions, particularly to the lungs, that may be fatal to both.…”

“…Regarding the pathological findings, usually the lesions are not macroscopically visible or have an inconspicuous appearance, being often mistaken for an infarct [6, 8, 9]. Liu and Guo reviewed the different gross appearance of the lesions and identified single or multiple nodules similar to infarctions [13].…”

“…However, treatment of nonmetastatic disease is controversial. Some authors describe cases of success with only surveillance [1, 3, 8, 14, 15]. Some authors suggested that “patients with choriocarcinoma confined to the placenta with rapid decrease of serum hCG after the removal of the placenta do not need chemotherapy, but only fetal and maternal close follow-up” [16].…”

“…The reported cases in the literature describe different outcomes. In some cases, the authors describe fatal outcomes associated with maternal or fetal/infant metastatic disease (particularly to the lungs) [6, 7], while in others there were no implications for the mother and infant [8]. Complications as intrauterine growth restriction, premature birth, fetal anaemia, and transplacental haemorrhage have also been reported [1–3].…”