ovarian choriocarcinoma

A poor

prognostic metastatic nongestational choriocarcinoma of the ovary: a case report and the literature review. a Magnetic resonance imaging of the brain. Findings from contrast-enhanced T1-weighted magnetic resonance imaging of the brain. A tumor (4 cm in diameter) is seen causing midline shift in the left occipital lobe. The ridge of the tumor is enhanced. b Contrast-enhanced CT of the abdomen and pelvis. Contrast-enhanced CT of the abdomen and pelvis, showing a solid left ovarian tumor (5.5 cm in diameter) and enhanced with a ridge. c Chest CT Chest CT reveals metastatic choriocarcinoma in the left lung

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Ovarian choriocarcinoma is a rare sub type of ovarian germ cell tumor.

Epidemiology

They account for less than 1% of ovarian tumors.

Clinical presentation

In pre-menarchal patients, the tumors manifest with iso-sexual precocity (approximately 50% of cases) and other symptoms associated with excessive hormone production.

Pathology

Choriocarcinoma arising in association with the ovary can occur in a number of situations. The tumors may occur during or outside of pregnancy.

Gestational ovarian choriocarcinoma may represent metastasis from uterine choriocarcinoma or much rarely arise from an ovarian ectopic pregnancy .

Primary ovarian choriocarcinoma (non gestational ovarian choriocarcinoma) arises presumably from a germ cell and is extremely rare. These may be mixed with other germ cell tumors like immature teratoma, dysgerminoma or rarely occur in a pure form - pure primary choriocarcinoma of the ovary.

The tumors are formed from placental trophoblastic elements. While most gestational choriocarcinomas show haematogenous spread, the non gestational choriocarcinoma tends to follow the lymphatic system.

Markers

Serum β-HCG levels are often elevated

Radiographic features

General

On imaging, choriocarcinomas appear as vascular solid tumors with cystic, hemorrhagic, and necrotic areas.

Staging

The staging depend on the original site of the tumor

for metastatic gestional uterine choriocarcinoma - standard choriocarcinoma staging applies.
from primary non gestational choriocarcinoma - staging ovarian cancer staging applies

Treatment and prognosis

As with choriocarcinoma in general, the tumors are capable of widespread metastases.

Choriocarcinoma is however extremely sensitive to chemotherapy, which is the mainstay of treatment. Since the disease is associated with a high incidence of metastasis and recurrence, the recommended management of primary extrauterine choriocarcinoma is often complete surgical resection followed by chemotherapy