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Pathology for Urologists

Choriocarcinoma


Image A
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Image B
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  • Pure choriocarcinoma is very rare and accounts for <1% of GCTs.
  • Usually is mixed with other GCT components (8% of mixed GCT).
  • May present with symptoms due to the metastatic lesions (hemoptysis, CNS symptoms) from hematogenous spread with subsequent detection of primary.
  • Marked elevation in serum hCG (usually >100,000 mIU/mL).
  • Gross: hemorrhagic nodule within the testicular parenchyma (image A); may only be a residual focus of scarring if the tumor has regressed.

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Image D
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  • Histology:
    • Classic choriocarcinoma
      • Mixture of cytotrophoblasts (polygonal cells with clear cytoplasm, bland nucleus and prominent cell border) and syncitiotrophoblasts (multinucleated degenerate-appearing cells with abundant eosinophilic cytoplasm) (image B) & (image C).
      • Syncytiotrophoblasts wrap or cap around mononuclear cytotrophoblastic cells and form villous configuration.
      • Almost invariable associated with hemorrhages (search in these area)
    • Monophasic choriocarcinoma
      • Very rare, usually in metastatic sites; squamous-like features.
    • Placental site trophoblastic tumor
      • Very rare, composed of intermediated trophoblasts
  • Immunohistochemistry: hCG+ (image D), HPL+, and glypican-3+ (only syncytiotrophoblasts).
  • Prognosis poorer than other GCTs, if pure.
  • Some patients do fairly well with chemotherapy; metastatic disease spreads hematogenously, especially to lungs, brain, and GI tract

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