Choriocarcinoma - Malignant Gestational Trophoblastic Disease
🌸 Choriocarcinoma is a rare but highly malignant form of gestational trophoblastic disease.
It often follows abnormal gestational events such as molar pregnancies.
⚡ Prompt recognition and treatment are essential for survival and excellent outcomes.
🧬 Aetiology
- Risk Factors: 👩🍼 Extremes of maternal age (<20 or >40), prior molar pregnancy, previous abortions, and abnormal gestational events.
- Primary vs Secondary: 🔄 May arise de novo (primary) or evolve from a complete mole (secondary).
🔬 Pathogenesis
- 💥 Aggressive proliferation of trophoblastic cells with high malignant potential.
- May follow invasive hydatidiform moles or, rarely, occur spontaneously without prior molar disease.
🧫 Morphology
- Macroscopic: 🔴 Highly invasive, haemorrhagic lesions with areas of necrosis.
- Microscopic: 🚫 Absence of chorionic villi + extensive necrosis and haemorrhage are diagnostic hallmarks.
🩺 Clinical Features
- Irregular Vaginal Bleeding: 💧 Persistent, often refractory to standard treatments.
- Uterine Mass: 🎯 May present as asymmetric uterine enlargement or palpable mass.
- Pain: 🤕 Abdominal or pelvic pain in advanced disease.
- Metastasis: 🌬️ Common to lungs → haemoptysis, cough, or dyspnoea. Can also spread to brain or liver.
🧪 Diagnosis
- hCG: 📈 Markedly elevated or persistently rising serum hCG is a key diagnostic clue.
- Imaging: 🖥️ Ultrasound first-line; CT/MRI for staging and metastatic assessment.
💊 Treatment
- Chemotherapy: 💉 Methotrexate or multi-agent regimens. Highly effective in gestational cases.
- Surgery: ✂️ Reserved for resistant or localised disease (e.g. hysterectomy in select cases).
📈 Prognosis
- Gestational Type: 🌟 Excellent prognosis, nearly 100% cure rate with early chemotherapy.
- Non-Gestational (Gonadal): ⚠️ Rare (ovary/testis), not pregnancy-related, usually worse prognosis.
