Choriocarcinoma

Choriocarcinoma is an aggressive malignant tumor arising from trophoblastic tissue. It is a form of gestational trophoblastic neoplasia that most often develops after a pregnancy-related event, including molar pregnancy, abortion, or normal delivery, but it can also occur without a prior gestation in men as testicular choriocarcinoma or in rare extragonadal locations. The disease is notable for rapid growth and early spread through the bloodstream.

Histologically, choriocarcinoma consists of malignant cytotrophoblasts and syncytiotrophoblasts with little or no residual chorionic villi. It typically overproduces human chorionic gonadotropin (hCG), which is a key biomarker used for diagnosis and monitoring. The uterus is the most common primary site, but metastases are frequent, most often to the lungs; brain, liver, and vaginal metastases can occur.

Patients may present with abnormal vaginal bleeding, uterine enlargement, or signs of metastasis such as cough, dyspnea, neurologic symptoms, or headaches. Very high hCG levels can cause hyperemesis gravidarum and preeclampsia-like symptoms. Diagnosis relies on markedly elevated hCG levels, imaging to assess the uterus and metastatic sites, and histologic confirmation in uncertain cases. Differential diagnosis includes other gestational trophoblastic neoplasms and non-trophoblastic metastases.

Treatment is primarily chemotherapy. Low-risk disease may respond to single-agent methotrexate or dactinomycin, whereas high-risk or metastatic choriocarcinoma typically requires multi-agent regimens such as EMA-CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine). Surgical options, including hysterectomy or resection of metastatic lesions, may be considered in selected patients. Prognosis is favorable with early detection; cure rates exceed 90% for low-risk disease and remain high for most high-risk cases when treated promptly. Serial hCG testing is used to monitor response.