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Updated: Aug 26 2019


  • 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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