Ovarian carcinomas with choriocarcinomatous differentiation

Abstract

Background. Ovarian carcinomas may produce human chorionic gonadotropin (HCG) or HCG‐like substances and may even contain syncytiotrophoblast cells, but a true choriocarcinomatous component has not been described in these tumors. Methods. Two cases of poorly differentiated ovarian carcinoma with choriocarcinomatous components are reported. Pathologic findings were correlated with immunohistochemical stains, hormonal effects, and clinical behavior. Results. Each tumor contained a circumscribed, extensively necrotic and hemorrhagic brown nodule. Microscopically, the nodules exhibited a mixture of cytotrophoblast and syncytiotrophoblast. The syncytiotrophoblast capped cytotrophoblast and was strongly positive for β‐HCG. In one of the cases, a transformation zone composed of poorly differentiated carcinoma with occasional β‐HCG‐positive cells was observed between a mucinous cystadenoma and the choriocarcinomatous elements. The two cases exhibited activation of the ovarian stroma in the form of condensation and luteinization. Extra‐abdominal metastases developed early in both patients and, despite multiagent chemotherapy, they died shortly post‐operatively. Conclusions. Choriocarcinoma may rarely develop as a result of dedifferentiation of common epithelial ovarian tumors. Recognition of choriocarcinomatous components in ovarian carcinomas is important because of its association with aggressive behavior.

Uterine Carcinoma With Serous and Choriocarcinomatous Differentiation

“…The presence of these transition zones has been reported by Wurzel and Brooks [9], Grammatico et al. [12], and Oliva et al [23] and supports the theory of dedifferentiation or retrodifferentiation of the associated or preexisting carcinoma.…”

“…In relation to the ovary carcinoma cases, they arose in a well-differentiated cystadenocarcinoma, two papillary adenocarcinomas, a malignant mixed mesodermal tumor, an undifferentiated carcinoma, and a benign mucinous cystadenoma. The trophoblastic representation in all of them was the presence of multinucleated cells resembling syncytial cells with strong beta-HCG staining, except in the two most recent cases reported [23] wherein syncytiotrophoblastic and cytotrophoblastic areas were observed. Similar features were present in the current case, with a clear predominance of the trophoblastic component.…”

“…In this way, it has been reported in esophagus [8], stomach [9][10][11], kidney [12], lung, liver [13], breast, intestine, prostate, and bladder. TWelve cases have been described of a similar tumor in the female genital tract, six in the endometrium [15][16][17] and six in the ovary [15,22,23]. Histologically, three of the endometrial carcinomas were undifferentiated and the other two were well-differentiated adenocarcinomas.…”

Anaplastic Carcinoma in Mucinous Ovarian Tumors

“…One case had foci of choriocarcinoma with the characteristic biphasic arrangement of cytotrophoblast and syncytiotrophoblast. 16 This finding was confirmed by human chorionic gonadotropin immunostaining. Representative slides from extraovarian metastases were available in 3 cases.…”

Choriocarcinoma involving the pancreas as first manifestation of a metastatic regressing mixed testicular germ cell tumor

“…It is worth noting, however, that many gastrointestinal carcinomas, including cholangiocarcinoma, gastric, and pancreatic adenocarcinoma may have positive immunohistochemical staining of the b-HCG antibody, 26 and/or elevated serum HCG levels. 27,28 Furthermore, overt choriocarcinomatous differentiation has been reported in rare cases of carcinomas of the stomach, 29 lung, 30 colon, 31 renal pelvis, 32 urinary bladder, 33 endometrium, 34 ovary, 35 and pancreas. 7 In these reported cases, exhaustive sectioning of the tumor to demonstrate an associated unequivocal primary carcinomatous component was required for the diagnosis, and a metastasis from a primary germ cell tumor was excluded clinically.…”