Nongestational Ovarian Choriocarcinoma Research Articles

Choriocarcinoma of the ovaries: the role of molecular-genetic testing in the differential diagnosis of gestational and non-gestational forms

The treatment approach for gestational and non-gestational ovarian choriocarcinoma has several differences, and their differential diagnosis requires special attention. The implementation of molecular-genetic testing which determines the presence of paternal genetic material in the tumor allows for a reliable determination of the origin of ovarian choriocarcinoma. The presented clinical case demonstrates the importance of this method in the differential diagnosis of gestational and non-gestational forms of ovarian choriocarcinoma.

Non-gestational ovarian choriocarcinoma (a clinical case)

Non-gestational ovarian choriocarcinoma (a clinical case)

Nongestational ovarian choriocarcinoma with bilateral teratoma: A rare case report and literature review.

Trophoblastic neoplasms are often associated with pregnancy, and nongestational trophoblastic neoplasms are extremely rare. Nongestational ovarian choriocarcinoma (NGCO) is a highly aggressive germ cell-derived tumor frequently presenting with early hematogenous metastasis. Herein, we report a case of a 28-year-old unmarried woman with regular menstruation who experienced vaginal bleeding 1 week after her last menstrual cycle. Doppler ultrasound revealed bilateral adnexal masses and elevated serum human chorionic gonadotropin (hCG) levels. The patient was initially misdiagnosed as presenting an ectopic pregnancy. The final pathology confirmed an International Federation of Gynecology and Obstetrics stage IA NGCO with bilateral mature teratoma of the ovary. This is an extraordinary instance of ovarian choriocarcinoma which emerged without any prior gestation, and the patient's lack of a history of pregnancy made the diagnosis ignored. After initial surgery and 1 cycle of bleomycin, etoposide, and cisplatin (BEP) chemotherapy, a laparoscopic fertility-preserving comprehensive staging surgery was performed. Two cycles of chemotherapy with BEP were administered as supplemental therapy postsurgery, and leuprorelin was administered to protect ovarian function. Menstruation resumed 4 months after chemotherapy completion, and tumor indicators were within the normal range. No signs of recurrence were observed at the 36-month follow-up. NGCO should be considered if a female patient exhibits irregular vaginal bleeding and masses in the adnexal area. The present case and our literature review also highlighted that fertility-sparing surgery and multidrug chemotherapy are effective methods for treating NGCO.

Non-Gestational Ovarian Choriocarcinoma: A Rare Ovarian Cancer Subtype.

Non-Gestational Ovarian Choriocarcinoma (NGOC) is an extremely rare ovarian tumor, with an incidence of less than 0.6% of malignant ovarian germ cell tumors. Its close pathologic resemblance to Gestational Ovarian Choriocarcinoma (GOC), however, requires special attention as the treatments differ greatly. NGOC typically affects patients in late adolescence or early reproductive years. As a result, NGOCs are often misdiagnosed as ectopic pregnancies due to their common presentation of bleeding, abdominal pain, adnexal mass, and positive serum beta-HCG. On pathologic examination, the tumor is indistinguishable from GOC, and only after review of tissue for paternal genetic components can the diagnosis of NGOC be made. Imaging studies often show highly vascular lesions with further investigation with computer topography (CT) sometimes showing metastatic lesions in the lungs, pelvis, vagina, and liver. These lesions are often hemorrhagic and can lead to catastrophic bleeding. Treatment is vastly different from GOC; NGOC requires treatment with both surgical resection and chemotherapy, with Bleomycin, Etoposide, and Cisplatin (BEP) being the most used regimen. With correct diagnosis and treatment, patients can often receive fertility sparing treatment with long term survival.

Non-gestational primary choriocarcinoma of the ovary presentation of a clinical case

Background: Ovarian germ cell tumors are derived from the primordial germ cells of the ovary, they can be benign or malignant. Non-gestational ovarian choriocarcinoma is extremely rare and aggressive that is of gestational or non-gestational origin, its prevalence is less than 0.6% of all ovarian germ cell tumors. Due to the rarity of the tumor, there is a lack of information on the clinical-pathological characteristics, diagnosis and treatment. Objective: A case of non-gestational ovarian choriocarcinoma and a review of the literature are presented. Clinical case: We present the case of a 20-year-old woman who presented with an acute abdomen, due to abdominal pain and distention, with scant vaginal bleeding and pain on cervical mobilization; An ultrasound was performed with a right annex with a lesion measuring 114x83x79mm and a total volume of 394cc, heterogeneous with linear images inside punctiform and human chorionic beta-gonadotropin levels, elevated 112.337 mUI/mL, the patient underwent an exploratory laparotomy with the finding of an ovarian tumor; performing salpingo-oophorectomy and the histopathological report of the definitive surgical specimen and immunohistochemical study, the diagnosis of non-gestational ovarian choriocarcinoma was made. Conclusion: Non-gestational choriocarcinoma is an extremely rare malignant neoplasm that can present clinically as an acute abdomen and requires differential diagnoses. Management is the combination of surgery and adjuvant chemotherapy, our patient responded.

Non-gestational primary choriocarcinoma of the ovary. Presentation of a clinical case

Background: Ovarian germ cell tumors are derived from the primordial germ cells of the ovary, they can be benign or malignant. Non-gestational ovarian choriocarcinoma is extremely rare and aggressive that are of gestational or non-gestational origin, its prevalence is less than 0.6% of all ovarian germ cell tumors. Due to the rarity of the tumor, there is a lack of information on the clinical-pathological characteristics, diagnosis and treatment. Objective: present a case of non-gestational ovarian choriocarcioma and review of the literature Clinical case: We present the case of a 20-year-old woman who presented with an acute abdomen, due to abdominal pain and distention, with scant vaginal bleeding and pain on cervical mobilization; An ultrasound was performed with a right annex with a lesion measuring 114 x83x79mm and a total volume of 394cc, heterogeneous with linear images inside punctiform and human chorionic beta-gonadotropin levels, elevated 112.337 mUI/mL, the patient underwent an exploratory laparotomy with the finding of an ovarian tumor; performing salpingo-oophorectomy and the histopathological report of the definitive surgical specimen and immunohistochemical study, the diagnosis of non-gestational ovarian choriocarcinoma was made. Conclusion: Non-gestational choriocarcinoma is an extremely rare malignant neoplasm that can present clinically in different ways, even as an acute abdomen, which requires differential diagnoses and management is the combination of surgery and adjuvant chemotherapy.

Non-gestational choriocarcinoma of the ovary complicated by dysgerminoma: a case report

Background: Non-gestational ovarian choriocarcinoma (NGOC) is a highly malignant tumor derived from germ cells, accounting for <0.1% of ovarian germ cell tumors. Mixed germ cell tumor (MGCT) containing a choriocarcinoma component is extremely rare. Dysgerminoma is one of the most common malignant primordial germ cell tumors, accounting for 3–5% of all malignant tumors of the ovary. The coexistence of these two tumors is even rarer.

Imaging in gynecological disease (22): clinical and ultrasound characteristics of ovarian embryonal carcinomas, non-gestational choriocarcinomas and malignant mixed germ cell tumors.

To describe the clinical and ultrasound characteristics of three types of rare malignant ovarian germ cell tumor: embryonal carcinoma, non-gestational choriocarcinoma and malignant mixed germ cell tumor. This was a retrospective multicenter study. From the International Ovarian Tumor Analysis (IOTA) database, we identified patients with a histological diagnosis of ovarian embryonal carcinoma, non-gestational choriocarcinoma or malignant mixed germ cell tumor, who had undergone preoperative ultrasound examination by an experienced ultrasound examiner between 2000 and 2020. Additional patients with the same histology were identified from the databases of the departments of gynecological oncology in the participating centers. All tumors were described using IOTA terminology. Three examiners reviewed all available ultrasound images and described them using pattern recognition. One patient with embryonal carcinoma, five patients with non-gestational ovarian choriocarcinoma and seven patients with ovarian malignant mixed germ cell tumor (six primary tumors and one recurrence) were identified. Seven patients were included in the IOTA studies and six patients were examined outside of the IOTA studies. The median age at diagnosis was 26 (range, 14-77) years. Beta-human chorionic gonadotropin levels were highest in non-gestational choriocarcinomas and alpha-fetoprotein levels were highest in malignant mixed germ cell tumors. Most tumors were International Federation of Gynecology and Obstetrics (FIGO) Stage I (9/12 (75.0%)). All tumors were unilateral, and the median largest diameter was 129 (range, 38-216) mm. Of the tumors, 11/13 (84.6%) were solid and 2/13 (15.4%) were multilocular-solid; 9/13 (69.2%) manifested abundant vascularization on color Doppler examination. Using pattern recognition, the typical ultrasound appearance was a large solid tumor with inhomogeneous echogenicity of the solid tissue and often dispersed cysts which, in most cases, were small and irregular. Some tumors had smooth contours while others had irregular contours. A unilateral, large solid tumor with inhomogeneous echogenicity of the solid tissue and with dispersed small cystic areas in a young woman should raise the suspicion of a rare malignant germ cell tumor. This suspicion can guide the clinician to test tumor markers specific for malignant germ cell tumors. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

A poor prognostic metastatic nongestational choriocarcinoma of the ovary: a case report and the literature review

BackgroundPure ovarian choriocarcinoma can be gestational or nongestational in origin. Nongestational pure ovarian choriocarcinoma is extremely rare and the prognosis is thought to be worse than that of the gestational type in patients with metastatic disease. We present a case of metastatic pure ovarian choriocarcinoma with poor prognosis in which the origin was identified as nongestational by DNA short tandem repeat (STR) analysis.Case presentationA nulliparous woman in her thirties with metastatic choriocarcinoma was referred to our hospital after initial treatment proved unsuccessful. Two months earlier, she had undergone brain tumor resection and histological examination confirmed choriocarcinoma. Serum human chorionic gonadotropin (hCG) concentration at initial diagnosis was 5030 IU/L. Two cycles of a combination chemotherapy regimen of methotrexate, etoposide, and actinomycin-D (MEA therapy), which is commonly used for gestational choriocarcinoma, was administered. However, the disease could not be controlled. Imaging modalities at presentation revealed tumor present in the left ovary and left lung, but not in the uterus, which led us think that the choriocarcinoma was nongestational. Bleomycin, etoposide, and cisplatin (BEP therapy) which is commonly used for nongestational choriocarcinoma (malignant germ cell tumor) and surgical resection of the uterus, bilateral ovaries, and an affected part of the left lung led to the nadir level of hCG, but the tumor relapsed and levels of hCG again increased. To investigate the origin of choriocarcinoma, we performed DNA STR analysis of tumor cells and oral mucosal cells. Analysis revealed the origin of the choriocarcinoma as nongestational, as the genotype of tumor cells entirely corresponded with that of oral mucosal cells. BEP therapy and chemotherapy regimens administered for nongestational choriocarcinoma and gestational choriocarcinoma proved ineffective, and the patient died 21 months after diagnosis of metastatic choriocarcinoma.ConclusionMetastaic nongestational pure choriocarcinoma of ovary is an extremely rare and an aggressive disease, frequently resulting in poor outcome.

Clinicopathological factors and prognosis analysis of 39 cases of non-gestational ovarian choriocarcinoma.

Non-gestational ovarian choriocarcinoma (NGOC) is a rare malignant germ cell tumor. Through literature review and cases collection, we aim to analyze prognostic factors for NGOC and summarize its clinicopathological characteristics to guide the individualized treatment. We searched PubMed database, Cochrane library, and Google Scholar for cases published between January 1, 1967 and July 31, 2018 using various search terms. We retrieved patients' clinicopathological characteristics, treatment, and prognosis information from included studies. These patients were divided into two groups: died (case group) or alive (control group) group. We summarized and compared their clinical (age, symptoms, R0 resection, serum HCG levels, chemotherapy regimen) and pathological (pure vs non-pure type, tumor size, tumor location, metastasis sites, stage) features by statistical analysis. Only 39 patients were retrieved from 36 studies in total. The median age was 30years (range 12- to 65-years old). The peak incidence was in the adolescent age 12-25years. Median follow-up was 20.3months (range 1-84months). 9 (23%) patients died; 24 (62%) patients were alive; 6 (15%) were lost to follow-up. Upon univariate analysis, we found age had a poor impact on overall survival (OS) in NGOC, HR -0.057, 95% CI -0.111 to -0.004. Pure type NGOC has a better OS than mixed type, HR -2.621, 95% CI -4.577 to -0.666. R0 resection is a good prognostic factor for OS, HR 2.967, 95% CI 0.709-5.224. Clinicians should try to achieve R0 resection to improve the prognosis for NGOC patients even among advanced patients.

Primary Nongestational Ovarian Choriocarcinoma Mistaken for Ectopic Pregnancy: A Case Report

Trigeminal neuralgia (TN) or tic douloureux is one of the commonest cause of fascial pain after 50 years of age. It is characterized by recurrent, episodic, lancinating pain over the distribution of trigeminal nerve. There is a lack of certainty regarding the aetiology and pathophysiology of TN. Evidence suggests that the likely etiology is vascular compression of the trigeminal nerve leading to focal demyelination and aberrant neural discharge. Secondary causes such as multiple sclerosis or brain tumors can also produce symptomatic TN. The treatment of TN can be very challenging despite the numerous options patients and physicians can choose from. This multitude of treatment options poses the question as to which treatment fits which patient best. For patients refractory to medical therapy, Gasserian ganglion percutaneous techniques, gamma knife surgery and microvascular decompression are the most promising invasive treatment options. Among them three common interventions commonly carried out by interventional pain physician to provide pain relief are balloon compression, Glycerol rhizolysis and RF rhizotomy.&#x0D; J Shaheed Suhrawardy Med Coll, June 2019, Vol.11(1); 73-77

Pure non-gestational ovarian choriocarcinoma

Abstract We present a case of a 9-year-old female child who we are managing for pure non-gestational ovarian choriocarcinoma at Kenyatta National Hospital. It is an extremely rare germ cell tumor and quite aggressive. Sub-total hysterectomy, bilateral salpingo-oophorectomy, partial omentectomy and appendicectomy was done. The child is currently undergoing adjuvant chemotherapy. Prognosis is however reported to be dismal.

Primary Pure Non-Gestational Ovarian Choriocarcinoma: A Case Report

Introduction: Pure non-gestational ovarian choriocarcinoma is a rare malignant condition with aggressive behavior. The tumor arises from germ cells of ovarian. Few cases have been reported in the literature. We present a case of pure ovarian choriocarcinoma with disseminated tumor in pelvic. Case Presentation: A 16-year-old girl was referred to Ghaem hospital, Mashhad University of Medical Sciences, Mashhad, Iran in April 2016 with acute abdominal pain, abdomino pelvic mass and vaginal bleeding. In addition, an extremely high level of sub unit of human chorionic gonadotropin β-hCG was detected. Based on the emergency condition, she underwent laparotomy and left salpingo-oophorectomy with suboptimal resection of the tumor. Histopathology revealed a tumor compatible with pure non-gestational ovarian choriocarcinoma. Adjuvant chemotherapy was performed based on 4 courses of bleomycin-etoposide-cisplatin (BEP) regimen. She is now under chemotherapy. Conclusions: We recommend the use of minimally invasive, fertility-preserving surgeries in patients with non-gestational ovarian choriocarcinomas.

A case of primary non-gestational ovarian choriocarcinoma confirmed by DNA polymorphism analysis

A case of primary non-gestational ovarian choriocarcinoma confirmed by DNA polymorphism analysis

Clinicopathological analysis of non-gestational ovarian choriocarcinoma: Report of two cases and review of the literature.

The aim of the present study was to analyze the clinicopathological features of two cases of non-gestational ovarian choriocarcinoma (NGCO). The histopathological, immunohistochemical and clinical features of two cases of NGCO in the left ovaries of two 13 year-old female patients were investigated and the relevant literature was reviewed. In both cases, the tumor masses exhibited cribriform, papillary and nested cellular growth patterns, and hemorrhage and necrosis were evident. In case one, the patient also exhibited a sex cord tumor with annular tubules (SCTAT) in the right ovary. To the best of our knowledge, the synchronous occurrence of these two tumor types has not been reported previously. Immunohistochemically, the tumor cells of choriocarcinoma in both cases were positive for human chorionic gonadotropin and cytokeratin, while those of SCTAT were positive for CD56 and CD99. NGCO is an extremely rare germ cell tumor of high-grade malignancy, and STCAT is even rarer. Early metastasis of NGCO is common and the disease has a poor prognosis. In the present study, one patient succumbed within 4 months of diagnosis with NGCO and the other patient was lost to follow-up after 12 months.

A pure non-gestational ovarian choriocarcinoma with delayed solitary brain metastases: Case report and review of the literature

ABSTRACT Choriocarcinoma is the most malignant tumour of gestational trophoblastic origin. Most ovarian choriocarcinomas are gestational in origin and usually metastasize to the ovary from uterine or tubal choriocarcinoma. Non gestational choriocarcinoma (NGOC) of the ovary is exceedingly rare and usually seen along with other germ cell tumors. Non gestational choriocarcinoma has been found to be resistant to single-agent chemotherapy and has a worse prognosis than gestational choriocarcinoma. We are reporting long term follow up of published rare case of pure non gestational ovarian choriocarcinoma (NGOC) with concurrent metastases to the spleen and adrenal glands, who developed a delayed solitary brain metastases, two years after completion of primary treatment. Surgery along with triple agent chemotherapy and radiotherapy was found to give good remission in this aggressive disease.

Nongestational primary choriocarcinoma of the ovary: A case report

Nongestational primary choriocarcinoma of the ovary is an extremely rare tumour which occurs usually in the reproductive age group. It is extremely difficult to diagnose as it often mimics torsion ovarian cyst, ectopic pregnancy etc. As choriocarcinoma alone is an extremely rare entity, a thorough search for uterine or tubal origin should be undertaken. We present a case of a 15yr old girl having nongestational primary ovarian choriocarcinoma.

Pure nongestational choriocarcinoma of the ovary: a case report

Pure ovarian choriocarcinoma can be gestational or nongestational in origin. Nongestational choriocarcinoma of the ovary is extremely rare, and its diagnosis is very difficult during the reproductive years. We present a case of a 33-year-old woman diagnosed with pure nongestational ovarian choriocarcinoma. Following surgery, multiple courses of a chemotherapy regimen of etoposide, methotrexate, and actinomycin-D (EMA) were effective.

Ovarian Choriocarcinoma with Concurrent Metastases to the Spleen and Adrenal Glands: First Case Report

Background: Pure nongestational ovarian choriocarcinoma (NGOC) is very rare tumor and has a poor prognosis. NGOC usually spreads to the lungs, liver, and brain. Metastases to the spleen and adrenal glands are rare, but simultaneous metastases to the spleen and adrenal glands have not been reported so far in the English literature. A case of NGOC with metastases to the splenic parenchyma and right adrenal gland is reported. Case: A 25-year-old woman presented with abdominal pain and was found to have a right ovarian mass and metastatic deposit in the right adrenal gland and spleen. She underwent optimal cytoreduction including excision of a right ovarian tumor, a partial splenectomy by radiofrequency ablation, and a right adrenalectomy. In view of her youth, her uterus and left adnexa were spared. Following these procedures, the patient received chemotherapy. Results: This patient is now in complete remission. Her β–human chorionic gonadotrophin levels post-treatment have reached normal levels. Conclusions: Aggressive surgery combined with chemotherapy may improve the prognosis of individuals with ovarian choriocarcinoma. Fertility-sparing surgery in such young individuals is possible, and may be psychologically beneficial. (J GYNECOL SURG 28:153)

Clinical analysis of 15 cases of malignant ovarian germ cell tumors with lung metastasis

To investigate the clinical characteristics, diagnosis, treatment and prognosis of malignant ovarian germ cell tumors (MOGCT) with lung metastasis. Fifteen patients of MOGCT with lung metastasis treated in Peking Union Medical College Hospital from Jan. 1982 to Dec. 2010 was retrospectively analyzed. (1) Clinical characteristics: the average onset age of these 15 patients is (23 ± 11) years old (6 - 48 years). The majority of these patients presented with abdominal pain (8/15) or irregular vaginal bleeding (4/15) as their initial symptoms. The primary tumor located in the left ovary in 8 cases, right ovary in 6 cases, and both sides in only 1 case. Metastatic lesions were confined to the lung in 12 patients, while the other 3 patients were found to have multi-site distant metastasis. (2) DIAGNOSIS:all 15 cases included 9 pure non-gestational ovarian choriocarcinoma (NGOC), 3 MOGCT containing choriocarcinoma component (one mature teratoma with choriocarcinoma component, one endodermal sinus tumor with embryonal carcinoma and choriocarcinoma components, one choriocarcinoma with dysgerminoma component), 2 embryonal carcinoma, one immature teratoma. Only one patient in these 15 cases was correctly diagnosed before surgery. (3) Time of lung metastasis:of 12 MOGCT with choriocarcinoma component, 11 patients were found to have lung metastasis in the course of their primary treatment, only 1 had lung metastasis 2 months after the synthetic treatment finished. Three MOGCT patients without choriocarcinoma component were all found to have lung metastasis when tumor relapsed in the advanced stages of the disease. (4) TREATMENT:all 15 patients received multi-agent chemotherapy combined with surgery. The mean courses of chemotherapy for these patients were 16 courses (5 - 43 courses). (5) PROGNOSIS: of these 15 cases, complete remission was obtained in 10 patients of NGOC or mixed ovarian germ cell tumors with choriocarcinoma component, 3 patients (one NGOC, one endodermal carcinoma and one immature teratoma, respectively) died in the course of treatment as result of tumor progression, 2 progressed cases (one NGOC and one endodermal carcinoma respectively) abandoning therapy were lost to follow up. MOGCT with lung metastasis are more often to found in NGOC patients. These patients could obtain high complete remission rate after standard multi-agent chemotherapy combined with surgery. The prognosis of MOGCT with lung metastasis containing choriocarcinoma component are better than that of those without containing choriocarcinoma component.