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Uterine choriocarcinomas typically occur in women of childbearing age as a gestational choriocarcinoma. Most such cases present within one year of an antecedent pregnancy 2. Presentation beyond reproductive age as a non-gestational choriocarcinoma is a rare occurrence 2,3.
As with choriocarcinomas in general, it is a highly vascular neoplasm. The tumor comprises of trophoblastic cells. On histology, there is an absence of chorionic villi (cf. other forms of gestational trophoblastic disease).
In the case of gestational choriocarcinoma, approximately 5% of cases of complete hydatidiform mole are followed by choriocarcinoma.
Regardless of the imaging modality used, choriocarcinoma often appears as a mass enlarging the uterus. Sometimes it manifests as a discrete, central, infiltrative mass. Its heterogeneous appearance correlates with necrosis and hemorrhage that characterize these lesions.
Choriocarcinoma can have variable sonographic appearances, but customarily presents as an infiltrative heterogeneous mass invading myometrium and beyond. The uterus may be enlarged. Cystic areas from necrosis and hemorrhage may be present.
The ovaries can be shown enlarged due to cysts secondary to increased levels of β-hCG (see case 3).
Treatment and prognosis
Those cases that arise after complete hydatidiform mole are nearly all cured by chemotherapy (in contrast to the others, which have a less favorable prognosis).