Malignant placental trophoblastic tissue neoplasm that is aggressive in natureand typically presents with distant metastases, with a predilection for the lung, vagina, brain, and liver
| Risk factors | • Advanced maternal age • Prior complete hydatidiform mole | | --- | --- | | Presentation | • <6 months after a pregnancy • Amenorrhea or abnormal uterine bleeding • Pelvic pain/pressure • Symptoms from metastases (lung, vagina) • Uterine mass | | Diagnostics | • Elevated β-hCG level helps confirm Dx upon suspicion • CXR→ multiple bilateral infiltrates of various shapes is consistent with metastasis | | Treatment | • Chemotherapy |
Most commonly follows a hydatidiform mole, choriocarcinoma can occur after a normal gestation or spontaneous abortion.
Most common site of metastatic spread is to the lungs causing symptoms of lung mets including chest pain and hemoptysis and dyspnea
The vagina is a common site of metastasis, presenting as a friable mass.
Symptoms are secondary to bleeding from the primary tumor or metastases, and thus include vaginal bleeding, hemoptysis, dyspnea, headache, seizures, stroke-like symptoms, jaundice, and abdominal pain.
The staging system for choriocarcinoma relies on chest x-ray, rather than chest CT scan, findings. Even among patients with choriocarcinoma who have a negative chest x-ray, the detection of metastasis on chest CT scan is not associated with worsened outcomes and does not alter management.
Physical examination may disclose an enlarged uterus and bilateral adnexal masses (eg, theca lutein cysts). Laboratory studies will show markedly increased β-hCG concentration, as in this patient. Pelvic ultrasonography is useful in diagnosis, with choriocarcinoma appearing as a hypervascular uterine mass. Chest x-ray is used to evaluate for lung metastases, and further imaging, such as CT scan of the abdomen and pelvis or MRI of the brain, is warranted based on clinical symptoms. It is treated with chemotherapy and surgical resection, and β-hCG concentration is serially measured to monitor for progression or recurrence.