- Definition
- A highly malignant gestational trophoblastic disease characterized by invasive, highly vascular, and anaplastic trophoblastic tissue without villi.
- Has the tendency to metastasize to the lungs, vagina, CNS, liver, pelvis, GI tract, and kidneys
- Etiology: Choriocarcinoma is preceded by:
- Pathophysiology
- Malignant transformation of cytotrophoblastic and syncytiotrophoblastic tissue
- Destructive growth into myometrium without chorionic villi → risk of hemorrhage and early metastasis (lung, vagina, brain, liver)
- Clinical features: depend on disease extension and metastases location
- Postpartum vaginal bleeding and inadequate uterine regression after delivery
- Additional symptoms according to the site of metastasis e.g.:
- Dyspnea, cough, or hemoptysis from metastases in the lungs
- Seizures, headaches from metastases in the brain
- Visible vascular lesions from metastases to the vagina
- β-hCG-mediated endocrine conditions (e.g., hyperthyroidism, theca lutein cysts)
- Diagnostics
- β-HCG levels: very high (initial test of choice)
- Chest x-ray
- Asses for lung metastases
- “Cannonball metastases” (hematogenous spread → multiple nodules in the lung)
