Intraplacental choriocarcinoma in a term placenta with both maternal and infantile metastases: A case report and review of the literature

doi:10.1016/j.ygyno.2006.08.007

Gynecologic Oncology

Volume 103, Issue 3, December 2006, Pages 1147-1151

https://doi.org/10.1016/j.ygyno.2006.08.007 Get rights and content

Abstract

Background.

Intraplacental choriocarcinoma is rare, and usually results in maternal metastasis at the time of diagnosis. Intraplacental choriocarcinoma involves both mother and infant is extremely rare. There was only one case report of intraplacental choriocarcinoma with confirmed metastases involving both the mother and the infant.

Case.

We describe a second case of intraplacental choriocarcinoma in a term placenta with both maternal and infantile metastases. Grossly, the primary lesion of the placenta resembled an old infarct. Microscopically, clusters of malignant trophoblasts arose from residual normal chorionic villi and infiltrated into the intervillous spaces. Both the mother and the infant received chemotherapy and were alive without disease after one year's follow-up.

Conclusion.

The optimal treatment for intraplacental choriocarcinoma is controversial. However, aggressive chemotherapy is suggested for patients with metastatic disease.

Introduction

Gestational choriocarcinoma is a highly malignant trophoblastic neoplasm. Intraplacental choriocarcinoma, defined as choriocarcinoma in the placenta, is a rare variant of gestational choriocarcinoma, and is usually diagnosed after maternal metastasis has been identified. Intraplacental choriocarcinoma involves both mother and infant is extremely rare. Up to date, there is only one case report of intraplacental choriocarcinoma with definite both maternal and infantile metastases. We report a second case of intraplacental choriocarcinoma involving both the mother and the infant. The metastatic symptoms first appeared as infantle jejunal mass, and later on as maternal vaginal bleeding. Both of the mother and the baby were successfully treated, and had no evidence of recurrence one year after the treatment. To our knowledge, this is the first report of an infant survived metastatic intraplacental choriocarcinoma.

Section snippets

Clinical summary

A 35-year-old woman, gravida 5 para 2, gave birth to a 3250 g male infant at term pregnancy, via normal vaginal spontaneous delivery in a local hospital. Her past medical history included 3 induced abortions in 1999, 2000, 2003 and a spontaneous delivery of a female infant in 1996. The current delivery was uneventful. At the 24th, 29th and 37th day postpartum, the patient had unexplained vaginal bleeding (1000–2000 ml/per time). Diagnostic curettage was performed, and showed decidual tissue and

Pathologic finding

There was no initial pathological examination of the placenta. The placenta from the patient was preserved at − 20°C for 60 days by the request of her family, which is a local tradition. We examined the placenta after the choriocarcinoma had been diagnosed in the infant and the mother. The placenta was 410 g in weight and 18 × 17 × 3 cm in size. The fetal surface and umbilical cord were unremarkable. The maternal surface appeared to be intact with regular distribution of maternal cotyledons. There

Discussion

Intraplacental choriocarcinoma is a rare subtype of gestational choriocarcinoma [1]. After searching the literature available, we found only several cases reported since Driscoll first described this entity (Table 1).

In 1963, Driscoll first reported the “incidental finding” of a choriocarcinoma within a term placenta, without maternal or infantile metastasis. The term “choriocarcinoma in situ, within the placenta” was first introduced [2]. However, this term was not accurate, since it indicated

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Cited by (51)

Intraplacental choriocarcinoma in a term pregnancy: Is serial postpartum hCG assessment necessary?
2023, Gynecologic Oncology Reports
Intraplacental choriocarcinoma (IC), or choriocarcinoma in situ, is a rare disease on the gestational trophoblastic disease (GTD) spectrum, with <100 case reports available in the literature. We propose that many patients with IC are likely to be missed as the majority of patients do not present with metastases. Currently, there are no standardized protocols in existence for postpartum monitoring of these patients. We present a case of IC identified in the term placenta of a 21-year-old who delivered by primary cesarean due to concern for fetal intolerance of labor. Subsequently, we review the recommendations available on postpartum monitoring of this likely under-diagnosed condition.
Gestational Trophoblastic Disease: Contemporary Diagnostic Approach
2022, Surgical Pathology Clinics
Citation Excerpt :
On gross examination, the tumor forms a bulky, extensively hemorrhagic, and necrotic mass lesion within the uterus or in the fallopian tube or ovary if it is arising from an ectopic pregnancy.69,70 Intraplacental choriocarcinoma may rarely be identified as a small hemorrhagic lesion within a term placenta.71–73 Choriocarcinoma is composed of sheets of mononuclear trophoblastic cells rimmed by multinucleated syncytiotrophoblasts growing in a biphasic or triphasic pattern.
Nonfetal Imaging During Pregnancy: Placental Disease
2020, Radiologic Clinics of North America
Citation Excerpt :
They can also present as hyperechoic masses, whereas some may have cystic changes.55 Retroplacental hemorrhage with placental abruption can develop, which is responsible for the associated fetomaternal hemorrhage.56 Metastases to both mother and fetus can be present.56
Precision genotyping diagnosis of lung tumors with trophoblastic morphology in young women
2019, Modern Pathology
Trophoblastic differentiation has been previously described in somatic carcinomas at different primary sites, including the lung. Lung carcinomas with trophoblastic morphology presenting in women during the reproductive years pose a unique diagnostic challenge due to their overlapping microscopical and immunophenotypical features with metastatic choriocarcinoma of gestational origin. Distinction between the two entities is paramount as they require different chemotherapeutic regimens and have a markedly different prognostic outlook. Here we report a series of three female patients (ages 37–48 years) presenting with lung masses. Two of the three patients were noted to have elevated serum beta-hCG levels at the time of their presentation, while serum beta-hCG was not evaluated preoperatively in the third patient. None of them had a clinical history of molar pregnancy or gestational trophoblastic neoplasia. Core biopsies of the lung masses were performed in two patients and one patient underwent a wedge resection, showing poorly differentiated carcinoma in all cases with scattered multinucleated giant cells, hemorrhage, and necrosis. Beta-hCG immunostain was performed in two cases and showed diffuse immunoreactivity. Clinical history and imaging studies were not conclusive in any of the cases to rule out a gestational origin. Short tandem repeat genotyping analysis was performed to compare the allelic patterns between tumor and normal tissues and revealed identical profiles in one case, consistent with somatic origin, and unique paternal alleles in two cases, confirming metastatic gestational choriocarcinoma. The patient with primary somatic lung carcinoma died of disease within 15 months despite chemotherapy, while both patients with gestational choriocarcinoma responded well to chemotherapy and are alive without evidence of disease. Our cases illustrate the diagnostic pitfalls of lung tumors with trophoblastic differentiation in young women. Genotyping analysis offers precise diagnostic distinction between primary lung carcinoma and gestational choriocarcinoma with major therapeutic and prognostic implications for the patients.
Placental pathology
2017, Reproductive and Developmental Toxicology
Term pregnancy with choriocarcinoma presenting as severe fetal anemia and postpartum hemorrhage
2016, Taiwanese Journal of Obstetrics and Gynecology
Term pregnancy with choriocarcinoma is a rare condition that can be a serious health threat to both the mother and the fetus. We present a rare case of term pregnancy with choriocarcinoma presenting as severe fetal anemia and postpartum hemorrhage.
A 34-year-old woman, gravida 3 para 2, was admitted for profuse vaginal bleeding 2 weeks after cesarean delivery of a full-term anemic baby. Transvaginal sonography revealed a 4.7-cm × 10.6-cm heterogenous lesion in the endometrial cavity. Dilatation and curettage was done and a pathologic report revealed choriocarcinoma. Metastatic workup showed lung metastasis. The patient achieved remission after eight cycles of chemotherapy in the form of etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine. There was no evidence of recurrence in the subsequent 3 years of regular follow up.
Although fetomaternal hemorrhage is a rare form of presentation of choriocarcinoma, its presence should alert the physician to investigate the cause further. This chemotherapy regimen was effective in our case and the patient needed to be followed up carefully.

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Case ReportIntraplacental choriocarcinoma in a term placenta with both maternal and infantile metastases: A case report and review of the literature

Abstract

Background.

Case.

Conclusion.

Introduction

Section snippets

Clinical summary

Pathologic finding

Discussion

Gynecol. Oncol.

J. Am. Acad. Dermatol.

Placenta

Gynecol. Oncol.

Gynecol. Oncol.

Cancer Genet. Cytogenet.

Placenta

Gestational trophoblastic disease

Choriocarcinoma: an incidental finding within a term placenta

Obstet. Gynecol.

Transplacental hemorrhage associated with placental neoplasms

Pediatr. Pathol.

Intraplacental choriocarcinoma: a report of two cases

J. Clin. Pathol.

Markedly elevated maternal serum alpha-fetoprotein associated with a normal fetus and choriocarcinoma of the placenta

Obstet. Gynecol.

Choriocarcinoma in a term placenta: pathologic diagnosis of tumor in an asymptomatic patient with metastatic disease

Int. J. Gynecol. Pathol.

Case Report
Intraplacental choriocarcinoma in a term placenta with both maternal and infantile metastases: A case report and review of the literature