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https://upload.medbullets.com/topic/116040/images/choriocarcinoma_-_high_mag.jpg
https://upload.medbullets.com/topic/116040/images/cannonball_xr_chorio..jpg
Snapshot
  • A 28-year-old woman presents to the emergency department after coughing blood. Her symptom is associated with progressively worsening shortness of breath. She has a past medical history of bilateral theca-lutein ovarian cysts. A radiagraph of the chest demonstrates multiple radiopaque pulmonary lesions. Laboratory studies are remarkable for highly elevated β-hCG.
Introduction
  • Overview
    • a type of gestational trophoblastic neoplasia 
      • made up of cytotrophoblasts and syncytiotrophoblasts without villi 
      • most commonly of placental origin
      • most commonly spreads to the lungs, leading to shortness of breath and hemoptysis
      • can follow a molar pregnancy or can arise from the ovaries and testes as a germ cell tumor
  • Epidemiology
    • incidence
      • extremely rare (<1% of ovarian tumors)
  • Associated conditions
    • theca-lutein ovarian cysts
    • molar pregnancy (more common after a complete than a partial mole)
Presentation
  • Symptoms
    • shortness of breath and hemoptysis
      • suggests metastasis to the lung
  • Physical exam
    • pelvic mass
Imaging
  • Radiography of the chest
    • indication
      • to evaluate cause of shortness of breath or hemoptysis
    • findings
      • "cannonball" metastases 
Studies
  • Serum labs
    • ↑ β-hCG
  • Histology 
    • trophoblasts and cytotrophoblasts with syncytiotrophoblast
    • central hemorrhage with necrosis
    • cytologic atypia
Differential
  • Dysgerminoma
    • differentiating factors
      • associated with elevated lactic acid dehydrogenase (LDH)
Treatment
  • Medical
    • chemotherapy 
      • indication
        • mainstay of treatment
          • highly sensitive to chemotherapy
      • medications
        • methotrexate 
Complications
  • Hemorrhage
    • secondary to its high vascularity

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