Gestational Ovarian Choriocarcinoma: A Review of the Literature and Presentation of a Perplexing Case
International Journal of Clinical Oncology and Cancer Research
Volume 3, Issue 6, December 2018, Pages: 72-77
Received: Mar. 22, 2019; Accepted: Apr. 28, 2019; Published: May 27, 2019
Views 664      Downloads 97
Authors
Emily Bryer DO, Department of Internal Medicine, Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
David Henry MD, Department of Hematology and Oncology, Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
Article Tools
Follow on us
Abstract
Gestational trophoblastic tumors are a heterogeneous and aggressive group of neoplasms. Choriocarcinoma, an extremely rare subset of gestational trophoblastic tumor, is often metastatic at diagnosis and typically follows a pregnancy that is either ectopic or molar. We present a critical review of choriocarcinomas with an emphasis on choriocarcinomas of ovarian origin which are even more uncommon with an incidence estimated at 1 per 369 million. This manuscript also includes a case of a woman with polycystic ovarian syndrome who required assisted conception to conceive her daughter and then developed a rare extrauterine gestational ovarian choriocarcinoma eighteen months following her antecedent healthy pregnancy with uncomplicated delivery. Many aspects of this presentation are unique, even for such an extraordinary tumor; some of these include the absence of vaginal bleeding, the presence of unilateral pulmonary metastases, and an overwhelmingly positive serum β-hCG with a negative urine β-hCG. While such a discrepancy in urine and serum β-hCG has been reported in gestational trophoblastic disease following molar pregnancies, to our knowledge it has not yet been reported in choriocarcinomas following a normal pregnancy.
Keywords
Gestational Trophoblastic Disease, Ovarian Choriocarcinoma, Beta-Human Chorionic Gonadotropin, Pulmonary Metastases
To cite this article
Emily Bryer DO, David Henry MD, Gestational Ovarian Choriocarcinoma: A Review of the Literature and Presentation of a Perplexing Case, International Journal of Clinical Oncology and Cancer Research. Vol. 3, No. 6, 2018, pp. 72-77. doi: 10.11648/j.ijcocr.20180306.11
Copyright
Copyright © 2018 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
[1]
Shen X, Kuang Y-P. The Clinical Outcomes of In Vitro Fertilization/Intracytoplasmic Sperm Injection Treatments in 43 Women with a History of Gestational Trophoblastic Disease. Reprod Dev Med. 2018; 2 (1): 38. doi: 10.4103/2096-2924.232879.
[2]
Stockton L, Green E, Kaur B, De Winton E. Non-Gestational Choriocarcinoma with Widespread Metastases Presenting with Type 1 Respiratory Failure in a 39-Year-Old Female: Case Report and Review of the Literature. Case Rep Oncol. 2018; 11 (1): 151-158. doi: 10.1159/000486639.
[3]
Mahantappa H, Belur S, Agarwal A. Gestational ovarian choriocarcinoma: A case report. Arch Clin Exp Surg. 2018; 8 (1): 1. doi: 10.5455/aces.20180314041954.
[4]
Lurain JR. Gestational trophoblastic disease I: Epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of hydatidiform mole. Am J Obstet Gynecol. 2010; 203 (6): 531-539. doi: 10.1016/j.ajog.2010.06.073.
[5]
Cole LA. O-glycosylation of proteins in the normal and neoplastic trophoblast. Trophobl Res 1987; 2: 139–48.
[6]
Cole LA et al. Gestational trophoblastic diseases: Pathophysiology of hyperglycosylated hCG. Gynecologic Oncology. 2006; 102: 145-150. doi: 10.1016/j.ygyno.2005.12.047.
[7]
Seibre NJ, Seckl MJ. Gestational trophoblastic disease. Management of Unintended and Abnormal Pregnancy. 2009. Blackwell Publishing. ISBN: 9781405176965.
[8]
Kohorn E. Negotiating a staging and risk factor scoring system for gestational trophoblastic neoplasia. A progress report. J Reprod Med. 2002. 47 (6): 445-50.
[9]
May T, Goldstein DP, Berkowitz RS. Current Chemotherapeutic Management of Patients with Gestational Trophoblastic Neoplasia. Chemother Res Pract. 2011; 2011: 1-12. doi: 10.1155/2011/806256.
[10]
El-Helw LM, Hancock BW. Treatment of metastatic gestational trophoblastic neoplasia. Lancet Oncol. 2007; 8 (8): 715-724. doi: 10.1016/S1470-2045 (07) 70239-5.
[11]
Sakamoto Y, Takei Y, Fujiwara H, Machida S, Taneichi A, Suzuki M. Gestational choriocarcinoma with uterine serosal metastasis mimicking ruptured ectopic pregnancy: A case report. Oncol Lett. 2015; 9 (5): 2185-2188. doi: 10.3892/ol.2015.2999.
[12]
Hariharan C, Jajoo SS, Khemka AS. A rare case of choriocarcinoma following a normal pregnancy and delivery. International Journal of Recent Surgical and Medical Sciences. 2017; 3 (1): 64-66.
[13]
Dilek S, Pata O, Tok E, Polat A. Extraovarian nongestational choriocarcinoma in a postmenopausal woman. Int J Gynecol Cancer. 2004 Sep–Oct; 14 (5): 1033–5.
[14]
Gerson RF, Lee EY, Gorman E. Primary extrauterine ovarian choriocarcinoma mistaken for ectopic pregnancy: Sonographic imaging findings. Am J Roentgenol. 2007; 189 (5): 1164. doi: 10.2214/AJR.05.0814.
[15]
Elliott MM, Kardana A, Lustbader JW, Cole LA. Carbohydrate and peptide structure of the alpha- and beta-subunits of human chorionic gonadotropin from normal and aberrant pregnancy and choriocarcinoma. Endocrine 1997; 7: 15.
[16]
Exman P et al. Primary ovarian choriocarcinoma: individual DNA polymorphic analysis as a strategy to confirm diagnosis and treatment. Rare Tumors. 2013; 5 (24): 89-92.
[17]
Mangla M, Singla D, Kaur H, Sharma S. Unusual clinical presentations of choriocarcinoma: A systematic review of case reports. Taiwan J Obstet Gynecol. 2017; 56 (1): 1-8. doi: 10.1016/j.tjog. 2015.05.011.
[18]
Chen M, Yang J, Lin M. An unusual gestational choriocarcinoma occurring primarily on the surface of a subserous leiomyoma. BJOG: An International Journal of Obstetrics and Gynaecology. 2004; 111 (7): 188-19.
[19]
Jia N, Chen Y, Tao X, Ou E, Lu X, Feng W. A gestational choriocarcinoma of the ovary diagnosed by DNA polymorphic analysis: A case report and systematic review of the literature. J Ovarian Res. 2017; 10 (1): 1-8. doi: 10.1186/s13048-017-0334-3.
[20]
Witzleben C, Bruninga G. Infantile choriocarcinoma: a characteristic syndrome. J Pediatr. 1963; 73: 374–8.
[21]
Gerson RF, Lee EY, Gorman E. Primary extrauterine ovarian choriocarcinoma mistaken for ectopic pregnancy: sonographic imaging findings. American Journal of Radiology. 2007; 189: W280-W283.
[22]
Dehner LP. Gestational and nongestational trophoblastic neoplasia. A historic and pathobiologic survey. Am J Surg Pathol. 1980; 4: 43–58.
[23]
Fox H. Gestational trophpoblastic disease. British Medical Journal. 1997; 314: 1363. Doi: 10.1136/bmj.314.7091.1363
[24]
Bates M, Everard J, Wall L, Horsman JM, Hancock BW. Is there a relationship between treatment for infertility and gestational trophoblastic disease? Hum Reprod. 2004; 19 (2): 365-367. doi: 10.1093/humrep/deh068.
[25]
Palmer JR. Advances in the epidemiology of gestational trophoblastic disease. J Reproductive Medicine. 1994. 39 (3): 155-162.
[26]
Palmer JR et al. Oral contraceptive use and risk of gestational trophoblastic tumors. J Natl Cancer Inst. 1999. 91 (7): 635-640.
[27]
Flam F, Lundstrom V, Lindstedt J, Silfversward C. Choriocarcinoma of the fallopian tube associated with induced superovulation in an IVF program; a case report. Eur J Obstet Gynecol Reprod Biol. 1989; 33 (2): 183-186. doi: 10.1016/0028-2243 (89) 90212-8.
[28]
Lin LH, Fushida K, Hase EA, et al. Gestational Tubal Choriocarcinoma Presenting as a Pregnancy of Unknown Location following Ovarian Induction. Case Rep Obstet Gynecol. 2018; 2018: 1-6. doi: 10.1155/2018/4705192.
[29]
Kállén B, Finnström O, Lindam A, Nilsson E, Nygren KG, Otterblad Olausson P. Malignancies among women who gave birth after in vitro fertilization. Hum Reprod. 2011; 26 (1): 253-258. doi: 10.1093/humrep/deq307.
[30]
Tsukamoto N et al. Choriocarcinoma occurring within the normal placenta with breast metastasis. Journal of Gynecologic Oncology. 1981; 11 (3): 348-363. doi: 10.1016/0090-8258 (81) 90049-4
[31]
Brewer JI, Mazur MT. Gestational choriocarcinoma. Its origin in the placenta during seemingly normal pregnancy. Am J Surg Pathol. 1981. 3: 267-277.
[32]
Hayashi S, Yoshiro A, Tomita S, et al. Primary non-gestational pure choriocarcinoma arising in the ovary: A case report and literature review. Oncol Lett. 2015; 9 (5): 2109-2111. doi: 10.3892/ol.2015.2985.
[33]
Vance RP, Geisinger KR. Pure nongestational choriocarcinoma of the ovary. Cancer. 1985: (56): 2321-2325.
[34]
Lurain JR, Sand PK, Brewer JI. Choriocarcinoma associated with ectopic pregnancy. Obstet Gynecol. 1986; 68: 286 – 287.
[35]
Rawal G, Ahluwalia C, Yadav AK, Dhawan I. Case Report Primary pure non-gestational choriocarcinoma of ovary: a rare case report. 2017; 6 (9): 4166-4169.
[36]
Lv L, Yang K, Wu H, Lou J, Peng Z. Pure choriocarcinoma of the ovary: A case report. J Gynecol Oncol. 2011; 22 (2): 135-139. doi: 10.3802/jgo. 2011.22.2.135.
[37]
Axe SR, Klein VR, Woodruff JD. Choriocarcinoma of the ovary. Obstet Gynecol 1985; 66: 111-4.
[38]
Lorigan PC, Grierson AJ, Goepel JR, Coleman RE, Goyns MH. Gestational choriocarcinoma of the ovary diagnosed by analysis of tumour DNA. Cancer Lett. 1996; 104 (1): 27-30. doi: 10.1016/0304-3835 (96) 04219-X.
[39]
Mood N, Samadi N, Rahimi-Moghaddam P et al. Pure ovarian choriocarcinoma: report of two cases. J Res Med Sci. 2009; 14 (5): 327-330.
[40]
Biswas S, Rodeck CH. Plasma prolactin levels during pregnancy. Br J Obstet Gynaecol. 1976; 83 (9): 683-687.
[41]
Brant WE, Helms C. Fundamentals of Diagnostic Radiology. Wolters Kluwer Health; 2012. https://books.google.com/books?id=uVeUWa3-1o8C.
[42]
Lloyd R V. Endocrine Pathology:: Differential Diagnosis and Molecular Advances. Springer New York; 2010. https://books.google.com/books?id=Je9QTWRH6s8C.
[43]
Brotherton J. Comparison of human chorionic gonadotrophin in human urine and amniotic fluid as estimated by a polyclonal and by a specific monoclonal assay in very early pregnancy. Hum Reprod. 1989; 4 (7): 837-842. doi: 10.1093/oxfordjournals.humrep.a136997.
[44]
Pang YP, Rajesh H, Tan LK. Molar pregnancy with false negative urine hCG: The hook effect. Singapore Med J. 2010; 51 (3) e58-e61.
[45]
Korevaar TIM, Steegers EAP, de Rijke YB, et al. Reference ranges and determinants of total hCG levels during pregnancy: The Generation R Study. Eur J Epidemiol. 2015; 30 (9): 1057-1066. doi: 10.1007/s10654-015-0039-0.
ADDRESS
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
U.S.A.
Tel: (001)347-983-5186