Primary non-gestational uterine cervical choriocarcinoma with metaplastic transformation from squamous cells

Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand. E-mail
Asian Pacific journal of cancer prevention: APJCP (Impact Factor: 2.51). 01/2007; 8(4):642-4.
Source: PubMed


Primary non-gestational uterine cervical choriocarcinoma is very unusual and although it has been hypothesized that it can arise by metaplastic transformation of cervical epithelium, solid evidence has been lacking.
Primary non-gestational uterine cervical choriocarcinoma was diagnosed in a 47-year-old, woman undergoing tubal resection 17 years previously. A histologically- and immunohistochemically-confirmed, non-gestational cervical choriocarcinoma could be diagnosed in which there was metaplastic transformation from squamous cells . The patient underwent 5 courses of an actinomycin-D chemotherapeutic regimen and radical hysterectomy with bilateral pelvic lymphadenectomy.
Primary non-gestational uterine cervical choriocarcinoma may indeed arise from metaplastic transformation of epithelial tissue.

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    • "These findings would rule out dedifferentiation within an endometrial carcinoma. A report from Chumworathayi et al. described cervical choriocarcinoma with metaplastic transformation from squamous cells [11]. The authors discussed the possibility of in situ squamous cell carcinoma, which may not be initially diagnosed on small tissue biopsy. "
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    ABSTRACT: Choriocarcinoma 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. A 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. We 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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    ABSTRACT: Choriocarcinoma is a highly malignant epithelial tumor originating from trophoblast. It primarily occurs during the fertile period. Postmenopausal uterine choriocarcinoma is very rare. We present a case of choriocarcinoma in a postmenopausal lady developing 5 years after menopause. She presented with heavy postmenopausal bleeding along with passage of vesicles per vaginum. Serum beta-hCG was 96,484 mIU/ml. Emergency abdominal hysterectomy with bilateral salpingo-ooperectomy was done due to intractable bleeding following suction and evacuation. Histopathology revealed uterine choriocarcinoma. She was treated with EMACO regimen following which her beta-hCG returned to normal in five cycles. The patient is under regular follow-up and is doing well.
    07/2014; 5(3):159-61. DOI:10.4103/0976-7800.141229


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