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ChoriocarcinomaAka: Chorioblastoma, Trophoblastic Tumor, Chorioepithelioma, Gestational Trophoblastic Neoplasia, Invasive Mole, Malignant Mole

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  1. See Also
    1. Trophoblastic Neoplasia
  2. Pathophysiology
    1. Malignant transformation of trophoblast
    2. Villus formation absent
    3. Trophoblast cells invade myometrium and blood vessels
  3. Etiology: Origin of neoplasm
    1. Molar Pregnancy (50%)
    2. Spontaneous or Elective Abortion (25%)
    3. Postpartum delivery of viable fetus (20%)
    4. Ectopic Pregnancy (5%)
      1. Represents 5x the risk of intrauterine pregnancy
  4. Labs
    1. See Hydatidiform Mole
  5. Radiology
    1. See Hydatidiform Mole
  6. Management
    1. Surgery (risk of metastases)
      1. Suction Curettage while Oxytocin administered
      2. Hysterectomy if >40 years old
    2. Chemotherapy
      1. Methotrexate 15-30 mg IV x5 days every 2weeks
      2. Actinomycin D 10 ug/kg x5 days every 2weeks
      3. Combination therapy for metastases
    3. Radiation Therapy
      1. Indicated for Liver or CNS metastases
  7. Monitoring: Serum Quantitative bhCG
    1. bHCG every 2 weeks for 2 months then
    2. bHCG every month for 3 months then
    3. bHCG every 2 months for 6 months then
    4. bHCG every 6 months
  8. Course: Dissemination
    1. Local Spread
      1. Vagina
      2. Pelvic organs
    2. Distant Metastases
      1. Liver
      2. Lungs
  9. Prognosis
    1. Low Risk Patients: 100% five year survival
      1. Under 4 month history suggesting metastatic disease
      2. Serum HCG <50 mIU/ml
      3. No signs of Liver or CNS metastases
    2. High Risk Patients: 50% five year survival
      1. Over 4 month history of metastatic disease
      2. Serum HCG >50 mIU/ml
      3. Liver or CNS metastases
      4. Tumor development follows term pregnancy
      5. Chemotherapy failure

Hydatidiform Mole, Invasive (C0008493)

Definition (MSH)A uterine tumor derived from persistent gestational TROPHOBLASTS, most likely after a molar pregnancy (HYDATIDIFORM MOLE). Invasive hyadatiform mole develops in about 15% of patients after evacuation of a complete mole and less frequently after other types of gestation. It may perforate the MYOMETRIUM and erode uterine vessels causing hemorrhage.
Definition (NCI)This term is used when a complete mole or very rarely a partial mole invades the myometrium. Microscopically, villi of hydatidiform mole are present within the myometrium or the myometrial vessels. Patients have persistent or rising hCG levels.
ConceptsNeoplastic Process (T191)
ICD9236.1
MSHD002820
EnglishChorioadenoma, Chorioadenoma destruens, Chorioadenomas, IM - Invasive mole, Invasive Gestational Trophoblastic Neoplasm, Invasive hydatidiform mole, Invasive Hydatidiform Moles, Invasive Mole, Invasive mole - placenta, Invasive Moles, Malignant hydatid mole, Malignant hydatidiform mole, Molar pregnancy with chorioadenoma, Molar pregnancy with chorioadenoma destruens, Molar pregnancy with invasive hydatidiform mole, Molar pregnancy with invasive mole, Molar pregnancy with malignant hydatidiform mole
Spanishcorioadenoma, corioadenoma destruens, embarazo molar con coriocarcinoma destruens, embarazo molar con mola hidatiforme invasiva, embarazo molar con mola hidatiforme maligna, embarazo molar con mola invasiva, embrarazo molar con corioadenoma, mola hidatiforme invasiva, mola hidatiforme invasora, mola hidatiforme maligna, mola invasiva
Parent ConceptsHydatidiform Mole (C0020217), cellular diagnosis, gestational trophoblastic tumor (C0279906), Neoplastic disease of uncertain behavior (C0154129), Neoplasm, uncertain whether benign or malignant (C0677041), Gestational trophoblastic neoplasms (C1135868), Ambiguous concept (C1274012)
SourcesDXP, MSH, MTHICD9, NCI, NDFRT, PDQ, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Choriocarcinoma (C0008497)

Definition (MSH)A malignant metastatic form of trophoblastic tumors. Unlike the HYDATIDIFORM MOLE, choriocarcinoma contains no CHORIONIC VILLI but rather sheets of undifferentiated cytotrophoblasts and syncytiotrophoblasts (TROPHOBLASTS). It is characterized by the large amounts of CHORIONIC GONADOTROPIN produced. Tissue origins can be determined by DNA analyses: placental (fetal) origin or non-placental origin (CHORIOCARCINOMA, NON-GESTATIONAL).
Definition (CSP)malignant metastatic form of trophoblastic tumors, contains sheets of undifferentiated cytotrophoblasts and syncytiotrophoblasts; characterized by the large amounts of chorionic gonadotropin produced; tissue origins can be placental (fetal) or non-placental.
Definition (NCI)A rare cancer in women of childbearing age in which cancer cells grow in the tissues that are formed in the uterus after conception. Also called gestational trophoblastic disease, gestational trophoblastic neoplasia, gestational trophoblastic tumor, or molar pregnancy.
Definition (NCI)An aggressive malignant tumor arising from trophoblastic cells. The vast majority of cases arise in the uterus and represent gestational choriocarcinomas that derive from placental trophoblastic cells. Approximately half of the cases develop from a complete hydatidiform mole. A minority of cases arise in the testis or the ovaries. There is often marked elevation of human chorionic gonadotropin (hCG) in the blood. Choriocarcinomas disseminate rapidly through the hematogenous route; the lungs are most frequently affected.
ConceptsNeoplastic Process (T191)
ICD9181
MSHD002822
EnglishChoriocarcinoma, Choriocarcinomas, Chorioepithelioma, Chorionepithelioma, Syncytioma
Spanishcoriocarcinoma, corioepitelioma, sincicioma
Parent ConceptsCarcinoma (C0007097), Neoplasm of placenta (C0597249), Adenocarcinoma (C0001418), Trophoblastic Neoplasms (C0041182), Gestational trophoblastic neoplasms (C1135868), Germ Cell Cancer (C0740345), Primary malignant neoplasm (C1306459)
SourcesCOSTAR, CSP, LCH, MSH, MTH, MTHICD9, NCI, NDFRT, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Trophoblastic Neoplasms (C0041182)

Definition (MSH)Trophoblastic growth, which may be gestational or nongestational in origin. Trophoblastic neoplasia resulting from pregnancy is often described as gestational trophoblastic disease to distinguish it from germ cell tumors which frequently show trophoblastic elements, and from the trophoblastic differentiation which sometimes occurs in a wide variety of epithelial cancers. Gestational trophoblastic growth has several forms, including HYDATIDIFORM MOLE and CHORIOCARCINOMA. (From Holland et al., Cancer Medicine, 3d ed, p1691)
ConceptsNeoplastic Process (T191)
MSHD014328
EnglishNEOPL TROPHOBLASTIC, TROPHOBLAST NEOPL, Trophoblast Neoplasm, Trophoblast Neoplasms, Trophoblast Tumor, Trophoblast Tumors, TROPHOBLASTIC NEOPL, Trophoblastic Neoplasm, Trophoblastic Neoplasms, Trophoblastic Tumor, Trophoblastic tumors, Trophoblastic tumour
Spanishneoplasia trofoblastica, tumor trofoblastico
Parent ConceptsNeoplasms, Germ Cell and Embryonal (C0027658), Pregnancy Complications, Neoplastic (C0032966), Germ cell tumor (C0205851), Neoplasms (C0027651), Trophoblastic Neoplasms (C0041182), Duplicate concept (C1274013)
SourcesLCH, MSH, NCI, NDFRT, PDQ, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


chorioblastoma (C0598167)

ConceptsNeoplastic Process (T191)
Englishchorioblastoma
SourcesCSP
Derived from the NIH UMLS (Unified Medical Language System)



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