Choriocarcinoma is an aggressive highly vascular tumour. When it is associated with gestation, it is often considered part of the spectrum of gestational trophoblastic disease. It is then termed a gestational choriocarcinoma. When it occurs in the absence of preceding gestation, it is termed a non gestational choriocarcinoma (these occur most often in the ovary or testes).
Depends on the site of origin of the tumour. In females, it may occur during or outside of pregnancy; non-gestational choriocarcinoma of the ovary typically occurs in prepubertal girls and postmenopausal women. Testicular choriocarcinomas usually present in male patients between the ages of 15-30 9.
In the classical case of gestational choriocarcinoma in females, the tumour is derived from chorionic epithelium.
Typically arises in association with reproductive organs such as:
- uterus: choriocarcinoma of the uterus
- cervix 8
- ovary: choriocarcinoma of the ovary
- testes: testicular choriocarcinoma
Primary occurrence outside the reproductive system has been reported but is extremely rare. Such sites include:
- brain: primary intracranial choriocarcinoma
- lung: primary pulmonary choriocarcinoma (PPC)
- pulmonary arteries 5
- stomach 6-7
- small intestine
- pancreas 6
Trophoblastic cells have an affinity for blood vessels and therefore the tumours have a tendency to metastasise through the haematogenous route.
Choriocarcinoma is one of the (more common) causes of cannonball metastases to the lung.
High levels of βhCG are usually seen in cases of choriocarcinoma.
Imaging features of the primary tumour is dependent on location and it is more meaningful to refer to each individual subtypes.
Treatment and prognosis
The tumour is aggressive in its behaviour and metastases are often frequent (lungs are common metastatic site). Despite this aggressiveness, it is generally highly chemosensitive and carries a much better cure rate than other comparable malignancies.
A significant proportion of the complications arise from haemorrhage due to high vascularity in either primary tumour or metastases.
- 1. Bazot M, Cortez A, Sananes S et-al. Imaging of pure primary ovarian choriocarcinoma. AJR Am J Roentgenol. 2004;182 (6): 1603-4. AJR Am J Roentgenol (full text) - Pubmed citation
- 2. Allen SD, Lim AK, Seckl MJ et-al. Radiology of gestational trophoblastic neoplasia. Clin Radiol. 2006;61 (4): 301-13. doi:10.1016/j.crad.2005.12.003 - Pubmed citation
- 3. Takeuchi M, Matsuzaki K, Uehara H et-al. Pathologies of the uterine endometrial cavity: usual and unusual manifestations and pitfalls on magnetic resonance imaging. Eur Radiol. 2005;15 (11): 2244-55. doi:10.1007/s00330-005-2814-x - Pubmed citation
- 4. Green CL, Angtuaco TL, Shah HR et-al. Gestational trophoblastic disease: a spectrum of radiologic diagnosis. Radiographics. 1996;16 (6): 1371-84. Radiographics (abstract) - Pubmed citation
- 5. Trübenbach J, Pereira PL, Huppert PE et-al. Primary choriocarcinoma of the pulmonary artery mimicking pulmonary embolism. Br J Radiol. 1997;70 (836): 843-5. Br J Radiol (abstract) - Pubmed citation
- 6. Coşkun M, Ağildere AM, Boyvat F et-al. Primary choriocarcinoma of the stomach and pancreas: CT findings. Eur Radiol. 1998;8 (8): 1425-8. Eur Radiol (link) - Pubmed citation
- 7. Bateman HE, Kasimis BS, Yook CR et-al. Case report: primary choriocarcinoma of the stomach. N J Med. 1995;92 (7): 459-62. - Pubmed citation
- 8. Yahata T, Kodama S, Kase H et-al. Primary choriocarcinoma of the uterine cervix: clinical, MRI, and color Doppler ultrasonographic study. Gynecol. Oncol. 1997;64 (2): 274-8. doi:10.1006/gyno.1996.4541 - Pubmed citation
- 9. Tannenbaum M, Madden JF, eds. Testicular tumors. In: Diagnostic Atlas of Genitourinary Pathology. Philadelphia, Pa: Churchill Livingstone Elsevier; 2006:95.