Diagnosis Of Gestational Choriocarcinoma Research Articles

Successful treatment of gestational choriocarcinoma in a low resource setting and literature review.

Aim: Gestational choriocarcinoma is a rare pregnancy related malignancy that we see about once in two years in our centre. It is an interesting malignancy because, although, it is rapidly fatal, it remains one of the few malignancies that can be cured even in advanced stages. Few cases we managed in the past did not show good outcome mainly because of noncompliance on the part of the patients. This case complied adequately with treatment and was cured with modified MAC III chemotherapy regimen with resultant successful reproductive outcome thereafter. Presentation: - Our patient was a 32-year-old para3+1 A3 at presentation. She presented with two months history of intermittent vaginal bleeding which started about seven weeks after the cessation of normal vaginal lochia following normal vaginal delivery. There was associated vulva lesion and hemoptysis. She was investigated and a diagnosis of gestational choriocarcinoma was made, and she was successfully cured of the malignancy with modified MAC III Chemotherapy regimen resulting in her having another successful reproductive outcome thereafter. Conclusion: Gestational choriocarcinoma may be fatal but it can be cured if there is adequate compliance from the patient and appropriate multiple chemotherapy is used for treatment.

Distinct genomic profiles of gestational choriocarcinoma, a unique cancer of pregnant tissues

Little is known about genomic alterations of gestational choriocarcinoma (GC), unique cancer that originates in pregnant tissues, and the progression mechanisms from the nonmalignant complete hydatidiform mole (CHM) to GC. Whole-exome sequencing (20 GCs) and/or single-nucleotide polymorphism microarray (29 GCs) were performed. We analyzed copy-neutral loss-of-heterozygosity (CN-LOH) in 29 GCs that exhibited androgenetic CN-LOHs (20 monospermic, 8 dispermic) and no CN-LOH (one with NLRP7 mutation). Most GCs (25/29) harboring recurrent copy number alterations (CNAs) and gains on 1q21.1-q44 were significantly associated with poor prognosis. We detected five driver mutations in the GCs, most of which were chromatin remodeling gene (ARID1A, SMARCD1, and EP300) mutations but not in common cancer genes such as TP53 and KRAS. One patient’s serial CHM/invasive mole/GC showed consistent CN-LOHs, but only the GC harbored CNAs, indicating that CN-LOH is an early pivotal event in HM-IM-GC development, and CNAs may be a late event that promotes CHM progression to GC. Our data indicate that GCs have unique profiles of CN-LOHs, mutations and CNAs that together differentiate GCs from non-GCs. Practically, CN-LOH and CNA profiles are useful for the molecular diagnosis of GC and the selection of GC patients with poor prognosis for more intensive treatments, respectively.

Demographics, natural history and treatment outcomes of non-molar gestational choriocarcinoma: a UK population study.

To investigate the demographics, natural history and treatment outcomes of non-molar gestational choriocarcinoma. A retrospective national population-based study. UK 1995-2015. A total of 234 women with a diagnosis of gestational choriocarcinoma, in the absence of a prior molar pregnancy, managed at the UKs two gestational trophoblast centres in London and Sheffield. Retrospective review of the patient's demographic and clinical data. Comparison with contemporary UK birth and pregnancy statistics. Incidence statistics for non-molar choriocarcinoma across the maternal age groups. Cure rates for patients by FIGO prognostic score group. Over the 21-year study period, there were 234 cases of non-molar gestational choriocarcinoma, giving an incidence of 1:66775 relative to live births and 1:84226 to viable pregnancies. For women aged under 20, the incidence relative to viable pregnancies was 1:223494, for ages 30-34, 1:80227, and for ages 40-45, 1:41718. Treatment outcomes indicated an overall 94.4% cure rate. Divided by FIGO prognostic groups, the cure rates were low-risk group 100%, high-risk group 96% and ultra-high-risk group 80.5%. Non-molar gestational choriocarcinoma is a very rare diagnosis with little prior detailed information on the demographics and natural history. The data in this study give age-related incidence data based on a large national population study. The results also demonstrated the widely varying natural history of this rare malignancy and the marked correlation of disease incidence with rising maternal age. National gestational choriocarcinoma database indicates a close association between increasing maternal age and incidence.

Gestational trophoblastic disease: histopathological diagnosis in the molecular era

Gestational trophoblastic disease is a heterogeneous group of proliferative disorders of the placental trophoblasts, often with challenging morphology, posing diagnostic problems for the general, even specialty pathologists. In this review we discuss characteristic histological features of complete- and partial hydatidiform moles, with special focus on the diagnosis of hydatidiform moles evacuated at early stage and their mimics. The diagnostic criteria and potential pitfalls in the diagnosis of gestational choriocarcinoma and two rare, unique neoplasms of the intermediate trophoblast – placental site trophoblastic tumour and epithelioid trophoblastic tumour – are presented, along with their differential diagnoses from two tumour-like conditions including exaggerated placental site and placental site nodule. We also review the current practice of immunohistochemistry, ploidy analysis and molecular genotyping in the diagnosis of gestational trophoblastic disease. Finally, how molecular testing may change the future diagnostic algorithm of gestational trophoblastic diseases is discussed.