Pure nongestational uterine choriocarcinoma in postmenopausal women: a case report with literature review

Nongestational choriocarcinoma is rare, especially in postmenopausal women. It may be derived from the transformation of germ cells or dedifferentiation of other tumor tissue cells. It is usually found in the ovaries but rarely in the uterus. Pure nongestational uterine choriocarcinoma in postmenopausal women is exceptional. Thirty-four cases of choriocarcinoma have been found during the past 25 y at the Tianjin Medical University General Hospital. We retrospectively reviewed the medical records of these 34 cases and found only two cases of nongestational uterine choriocarcinoma, both of which were postmenopausal women. We also reviewed 19 other cases previously reported during the past 50 y (from 1970 to 2018) that were identified as uterine choriocarcinoma in postmenopausal women. Analysis of these combined data indicates that nongestational choriocarcinoma is a rare neoplasm in postmenopausal patients. It genetically originates entirely in the patient, and short tandem repeat (STR) analyses are usually required to differentiate gestational and nongestational choriocarcinoma. Although nongestational choriocarcinoma shows some response to chemotherapy, sensitivity is much poorer than that in gestational choriocarcinoma. The prognosis for nongestational choriocarcinoma is poor and the long-term survival rate is low.

Endometrial Carcinoma With Trophoblastic Components: Clinicopathologic Analysis of a Rare Entity

Somatic endometrial carcinomas with trophoblastic components have only rarely been described. To better characterize this distinctive combination of histotypes, we report herein 4 new cases, representing the largest cohort reported thus far, and review previously reported cases. The 4 new patients ranged in age from 61 to 77 yr (mean, 68 yr). The first patient had a grade 2 endometrioid carcinoma, surgical International Federation of Gynecology and Obstetrics stage IA, that recurred 5 months later at the vaginal apex with purely choriocarcinoma elements, suggestive of unsampled trophoblastic areas in the uterus. The 3 other patients were all International Federation of Gynecology and Obstetrics stage III, and included 2 cases of dedifferentiated endometrial carcinoma with 40% and 20% choriocarcinoma components, and 1 case of grade 1 endometrioid carcinoma with a 40% choriocarcinoma component. Postoperative serum β-human chorionic gonadotropin was elevated in all patients. All received adjuvant combination chemotherapy, but all were dead of disease with distant metastases at an average of 11.75 mo (range, 7-16 mo) after primary staging. Data from our cases were combined with those from 24 cases that had previously been reported in the literature between 1972 and 2016. Analysis of this combined data indicates that endometrial carcinoma with trophoblastic component is a rare neoplasm that occurs primarily in postmenopausal patients. The trophoblastic component is most commonly a choriocarcinoma and the somatic component is most commonly an endometrioid carcinoma or an adenocarcinoma/carcinoma reported without further specification; the somatic component may be a diverse array of histotypes or histotype admixtures. Serum and/or urine β-human chorionic gonadotropin is elevated in almost all patients, and fluctuations of β-human chorionic gonadotropin generally correlated with tumor relapses or recurrences. The stage distribution and patient outcomes in the current and previously reported patients suggests that trophoblastic differentiation usually, but not invariably denotes clinical aggressiveness.

Renal choriocarcinoma: gestational or germ cell origin?

Choriocarcinoma is a rare, highly malignant trophoblastic tumor with gestational or, rarely, germ cell origin. Primary extragenital localization is extremely rare. This report describes a choriocarcinoma case clinically mimicking a primary renal cell carcinoma with multiplex pulmonary metastases. Differentiation from a sarcomatoid renal cell carcinoma with trophoblastic differentiation and identification of the exact origin, namely gestational or germ cell origin by molecular genetic methods is of great importance as it helps determine the prognosis and the most effective therapy of the disease. The Investigator Hexaplex ESS Kit was used for DNA polymorphism studies. This showed foreign alleles in the tumor DNA that confirmed the presence of paternal DNA and the gestational origin of the tumor.

Molecular genetic analysis of nongestational choriocarcinoma in a postmenopausal woman: a case report and literature review

Choriocarcinoma is a highly malignant tumor of trophoblastic origin. Most cases occur in association with preceding gestational events. However, on very rare occasions, nongestational choriocarcinoma arises from germ cell or trophoblastic differentiation in different types of carcinoma. This article reports the case of a 58-year-old woman with primary nongestational choriocarcinoma of the uterus that developed 19 years after her final pregnancy and 4 years after menopause. A total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed. Histopathological examination showed choriocarcinoma of the uterus without components of other germ cell tumors. Karyotype analysis of the tumor cells demonstrated XX. We confirmed its nongestational origin by DNA polymorphism analysis at 15 short tandem repeat loci. After surgery, the patient was given four courses of combination chemotherapy. She is still alive and there has been no evidence of recurrence 3 years after surgery.