Makindo Medical Notes

🌸 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.