Primary non-gestational choriocarcinoma of the uterine cervix: A case report

Maestá, Izildinha; Michelin, Odair Carlito; Traiman, Paulo; Hokama, Paula de Oliveira Montandon; Rudge, Marilza Vieira Cunha

doi:10.1016/j.ygyno.2005.03.045

Cited by 19 publications

(21 citation statements)

References 5 publications

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“…Germ cell choriocarcinoma confirmed by DNA analysis is extremely rare and has previously only been reported in women of child bearing age [3,23]. In our patient's case, we do not rule out the possibility of a non-gestational choriocarcinoma, but the response to chemotherapy with histology, immunohistochemistry and serum tumor markers suggested a gestational origin.…”

Section: Discussioncontrasting

confidence: 65%

Choriocarcinoma in a 73-year-old woman: a case report and review of the literature

et al. 2010

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IntroductionChoriocarcinoma is a highly malignant tumor of trophoblastic origin. Most cases present within one year of the antecedent pregnancy (molar or non-molar). However, very rarely, choriocarcinoma can develop from germ cells or from dedifferentiation of endometrial carcinoma into choriocarcinoma. This article concerns a case of choriocarcinoma developing 38 years after the patient's last pregnancy and 23 years after menopause.Case presentationA 73-year-old African-American woman presented with a three-week history of vaginal bleeding. A vaginal mass was seen on pelvic examination. Ultrasonography showed a thickened complex endometrial echo. Her β-human chorionic gonadotrophin level was found to be elevated (2,704,040 mIU/mL). Vaginal and uterine biopsies were suggestive of choriocarcinoma. Immunohistochemistry tests were positive for β-human chorionic gonadotrophin as well as cytokeratin and negative for octamer binding transcription factor 3/4 and α-fetoprotein, supporting the diagnosis of choriocarcinoma. A combination of etoposide, methotrexate, and dactinomycin, followed by cyclophosphamide and vincristine (the so-called EMA/CO regimen) was initiated. After seven cycles of chemotherapy, her β-human chorionic gonadotrophin level dropped below 5 mIU/mL. Our patient is being followed up at our oncology institute.ConclusionsWe report an extremely rare case of choriocarcinoma arising 23 years after menopause. A postmenopausal woman presenting with vaginal bleed from a mass and β-human chorionic gonadotrophin elevation should be evaluated by immunohistochemical analysis to rule out the possibilities of a germ cell origin of the tumor or dedifferentiation of an epithelial tumor. Absence of octamer binding transcription factor 3/4, α-fetoprotein and CD-30 staining helps in exclusion of most germ cell tumors. DNA polymorphism studies can be used to differentiate between gestational and non-gestational tumor origin. These require fresh tissue samples and are time consuming. Finally, the effective first-line therapy for β-human chorionic gonadotrophin-producing high-risk gestational as well as non-gestational trophoblastic tumors is combination chemotherapy (the EMA/CO regimen). Therefore, treatment should be commenced when a potential diagnosis of metastatic trophoblastic tumor is being considered.

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Section: Discussioncontrasting

confidence: 65%

Choriocarcinoma in a 73-year-old woman: a case report and review of the literature

et al. 2010

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“…Vaginal bleeding is the most common presenting symptom, 2 but as such often mimics other more common disease entities. Primary extrauterine choriocarcinoma has been misdiagnosed as ectopic pregnancy, 2,4 dysfunctional uterine haemorrhage, 5 and cervical polyp. 6 This can often lead to a delay in proper management.…”

Section: Discussionmentioning

confidence: 99%

“…1 This is in accordance with the characteristic hypervascularity of choriocarcinoma. 5,6 The multiple nodular opacities on chest X-ray most likely represented lung metastases, although histological confirmation was not performed. Interval shrinkage of these nodules was observed on chest X-ray following initiation of treatment.…”

Section: Discussionmentioning

confidence: 99%

Primary gestational choriocarcinoma of the vagina: magnetic resonance imaging findings

Wong¹,

Fung²,

Yung³

2016

Hong Kong Med J

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A 33-year-old nulligravid Filipino woman was admitted to the gynaecology ward of Princess Margaret Hospital in April 2014, with lower abdominal pain and recurrent retention of urine. Her pregnancy test was positive. Per-vaginal examination revealed a 4-cm firm, fixed, and wide-based vaginal mass with smooth wall over the upper anterior vagina. Bedside transabdominal ultrasonography confirmed a 4.5-cm solid mass in the anterior vagina and a 3. <5.0 IU/L for non-pregnant women), and repeated checking 3 days later was 253 957 IU/L. Alphafetoprotein, carcinoembryonic antigen, and Ca-125 were negative. A urologist was consulted and the patient underwent flexible cystoscopy that revealed indentation of the urinary bladder by an external mass. Mild erythematous changes were visualised at the right urinary bladder base. Biopsy revealed inflammation but no malignant cells.Magnetic resonance imaging (MRI) of the pelvis revealed a 4.8 cm x 5.2 cm x 4 cm (craniocaudal x anteroposterior x transverse) mass located at the anterior aspect of the vagina. It was hypointense with a faint hyperintense rim on T1-weighted images (Fig 1a) and heterogeneously hyperintense CASE REPORT

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“…Gestational choriocarcinoma has a very good prognosis even in advanced stages, because it is a chemosensitive type of tumor . In rare cases, however, resistance to chemotherapy, and also fatality have been reported in cervical choriocarcinoma of non‐gestational origin . A highly malignant choriocarcinoma of non‐placental origin, such as mixed germ cells of the uterine corpus or ovary, can produce high hCG and can metastasize throughout the bloodstream to the lungs, brain, liver, bone, and other viscera by the time of diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Primary cervical choriocarcinoma during viable intrauterine pregnancy

Park¹,

Han²,

Lee³

et al. 2015

J of Obstet and Gynaecol

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A 31-year-old multigravida woman at 27 weeks' gestation was admitted with vaginal bleeding and a hypervascular mass near the cervix on ultrasonography. After discharge with improvement, she was readmitted the next day for uncontrolled, heavy vaginal bleeding and underwent emergency cesarean section at 29 weeks' gestation. A 3-cm friable mass found near the cervix was removed surgically; this lesion was shown to be primary cervical choriocarcinoma. On the 17th postoperative day the patient underwent total abdominal hysterectomy with preservation of both ovaries and biopsy was performed on the right ovary. The International Federation of Gynecology and Obstetrics (FIGO) stage was I and her World Health Organization prognostic score was 9, representing high risk. The patient received three rounds of chemotherapy until achieving three consecutive normal human chorionic gonadotropin levels with two additional courses to address risk of relapse. DNA genotyping on short tandem repeat polymorphism confirmed the gestational choriocarcinoma.

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Primary non-gestational choriocarcinoma of the uterine cervix: A case report

Cited by 19 publications

References 5 publications

Choriocarcinoma in a 73-year-old woman: a case report and review of the literature

Choriocarcinoma in a 73-year-old woman: a case report and review of the literature

Primary gestational choriocarcinoma of the vagina: magnetic resonance imaging findings

Primary cervical choriocarcinoma during viable intrauterine pregnancy

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