Intraplacental Choriocarcinoma Associated with Viable Pregnancy: Pathologic Features and Implications for the Mother and Infant

Abstract

Choriocarcinoma arising in the placenta, or intraplacental choriocarcinoma, has seldom been reported, particularly in the absence of maternal metastases. Reluctance to diagnose choriocarcinoma in the presence of chorionic villi can delay diagnosis; however, timely diagnosis of choriocarcinoma is prognostically important, both for the mother and infant. We report the clinicopathologic findings in five mothers and infants in whom choriocarcinoma was identified in the placenta. None of the mothers had a history of gestational trophoblastic disease in previous pregnancies. Three placentas were similar with a single small lesion grossly suggesting a small infarct; microscopically these consisted of infarcted areas surrounded by choriocarcinoma. These three mothers were unusual in that none had metastatic choriocarcinoma; two were treated with chemotherapy and remained disease-free; the third was lost to follow-up shortly following delivery. The remaining two mothers had known pulmonary metastases at time of delivery. One of these latter two placentas contained a large marginal lesion microscopically identified as choriocarcinoma. The fifth placenta had rare microscopic foci of choriocarcinoma, and sheets of necrotic choriocarcinoma were identified in "blood clot" submitted with the placenta. In four of the five cases the choriocarcinoma appeared to be arising from otherwise normal chorionic villi, and in no case was there invasion of the villous stroma. All of the infants survived, and none had evidence of choriocarcinoma. These cases support the concept that choriocarcinoma associated with otherwise normal pregnancy arises in the placenta and may be more common than reported.

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

“…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].…”

Fetomaternal hemorrhage caused by an intraplacental choriocarcinoma

“…The malignant trophoblastic cells showed the characteristic biphasic pattern of cytotrophoblast and syncytiotrophoblast, with marked pleomorphism, prominent nucleoli and frequent mitoses [8]. Jacques et al [11] described that intraplacental choriocarcinoma represents a primary malignancy arising from the trophoblast of the placenta. And they said it is supported by the histologic fi nding of malignant trophoblasts transition from benign trophoblast [11].…”

“…Jacques et al [11] described that intraplacental choriocarcinoma represents a primary malignancy arising from the trophoblast of the placenta. And they said it is supported by the histologic fi nding of malignant trophoblasts transition from benign trophoblast [11].…”

3D color and power Doppler in the diagnosis and assessment of gestational trophoblastic disease

“…(3) Intraplacental choriocarcinoma is found in the placenta mainly after delivery. Its cases were reported to be associated with viable pregnancy [22].…”