Ovarian choriocarcinoma: about one case

We report the case of a woman, 43 years old, presenting with an ovarian choriocarcinoma. This patient, addressed for a right-side suspicious pelvic mass, had an exploratory laparotomy. Frozen section found an ovarian cancer. The patient had total hysterectomy, left annexectomy and a complete staging surgery. Histology concluded to an ovarian gestational choriocarcinoma. It is a rare germinal tumour, the treatment of which was medical, with radical exeresis and complete staging surgery associated with polychemotherapy.     

Could ovarian choriocarcinoma be detected by maternal serum screening for Down syndrome?

The incidence of ovarian malignancies during gestation ranges from 1 in 8000 to 1 in 20,000 deliveries. Ovarian malignancies that produce human chorionic gonadotropin (hCG) are limited to germ cell tumors, of which dysgerminoma is the most frequent (45%) malignant type encountered in pregnant patients, the others being ovarian choriocarcinoma and mixed germ cell tumors (Boulay and Podczaski, 1998). In women of childbearing age, it is hard to distinguish between metastatic choriocarcinoma on a complete mole and primary ovarian choriocarcinoma. Treatment is based on adnexectomy followed by chemotherapy. Given the extreme rarity of these tumors, the long-term prognosis is difficult to establish. Had the diagnosis for our patient been made during pregnancy, the therapeutic approach would have been discussed in terms of gestational age. In the last trimester, we could have suggested cesarean section followed by adnexectomy, and then chemotherapy. In the second-trimester, chemotherapy could have been discussed, although the fetal toxicity of cisplatin chemotherapy is not firmly defined (Ferrandina et al., 2005). This treatment is an alternative to termination of pregnancy. We retrospectively studied maternal serum biochemistry so as to assess the possibility of a diagnosis of ovarian choriocarcinoma at the time of maternal serum screening for Down syndrome.     

Successful Treatment of Nongestational Choriocarcinoma in a 15-Year-Old Girl: A Case Report

BackgroundNongestational choriocarcinoma is a rare ovarian malignancy with a prognosis worse than that of gestational choriocarcinoma. Debulking surgery is the primary treatment for ovarian carcinoma. However, fertility preservation is important in young women.CaseA 15-year-old girl with no sexual experience was admitted for abnormal uterine bleeding. Ultrasonography showed a solid mass in the right ovary and her serum β-human chorionic gonadotrophin levels were markedly elevated. We performed right oophorectomy, omentectomy, and peritoneal washing cytology. The uterus and left adnexa were preserved. She was diagnosed with nongestational choriocarcinoma, stage IIA. She received adjuvant chemotherapy (etoposide, methotrexate, actinomycin, cyclophosphamide, and oncovin regimen) and has been disease-free for more than 5 years.Summary and ConclusionFertility-sparing surgery combined with chemotherapy is an acceptable treatment option for young patients with locally advanced nongestational choriocarcinoma.     

A rare case of gestational ovarian choriocarcinoma coexistent with intrauterine pregnancy

ObjectiveTo report the rare case of gestational primary ovarian choriocarcinoma coexistent with intrauterine pregnancy, successfully treated with surgery and systemic chemotherapy. We also describe the utility of short tandem repeat (STR) genotyping in the diagnosis of choriocarcinoma.Case reportA 38-year-old woman at 17 gestational weeks presented with an ovarian tumor rupture in the left ovary. Left salpingo-oophorectomy was performed and the patient was diagnosed with gestational ovarian choriocarcinoma via histopathology and STR genotyping. After artificial abortion, the patient underwent 8 cycles of chemotherapy. Abdominal hysterectomy was performed because of the presence of low levels of human chorionic gonadotropin and the tumor that developed behind the uterus. However, no viable choriocarcinoma cells were found in the residual tumor, suggesting that the patient achieved full remission.ConclusionsEarly detection is crucial in treating choriocarcinomas; thus, clinicians should consider the possibility of choriocarcinoma at the presence of an ovarian tumor during pregnancy. Gestational and non-gestational choriocarcinomas differ in prognosis and sensitivity to chemotherapy due to their different etiologies. Therefore, STR genotyping may be beneficial in predicting the patient's prognosis or selecting the appropriate regimen.     

Analysis of TH1 and TH2 cells by intracellular cytokine detection with flow cytometry in patients with ovarian cancer

OBJECTIVE: Our aim is to assess the immune status of patients with ovarian cancer by analyzing the ratio of T helper type 1 (TH1) to T helper type 2 (TH2) populations in peripheral blood lymphocytes (PBL). METHODS: We examined TH1/TH2 ratios in PBL obtained from 21 ovarian cancer patients who had just received postoperative chemotherapy, by detecting the intracellular IFN-gamma and IL-4 production with 3-color flow cytometry. Additionally, we evaluated the influence of a granulocyte-colony stimulating factor (G-CSF) injection on TH1 and TH2 populations for a rescue of granulocytopenia due to the chemotherapy. RESULTS: We could not find any significant difference of the TH1/TH2 ratios in terms of age, International Federation of Gynecology and Obstetrics (FIGO) clinical stage and clinical tumor status. As for the clinical tumor status, however, the patients with residual cancer had a higher TH1/TH2 ratio, though it was not statistically significant (p = 0. 15). Anticancer chemotherapy is also considered to lead to the immunosuppressive state of the patients. TH1 and TH2 populations of PBL in the patients during chemotherapy showed an unfavorable imbalance that was shifted from TH1 to TH2 10 days after anticancer drug administration (p = 0.049). G-CSF administration, on the other hand, was likely to induce a cell population shift from TH2 to TH1 assessed by the intracellular cytokine assay (p = 0.051), and never induced an unfavorable imbalance from TH1 to TH2 in the T cell population by a 1-day injection of G-CSF. CONCLUSION: Together, these data indicate that the TH1/TH2 ratio analyzed by intracellular cytokine flow cytometry seems to be a good indicator to assess the immune status in cancer.     

Effect, toxicity and tissue concentration in the clinical use of cis-diamminedichloroplatinum (II)

The tissue cis-diamminedichloroplatinum (II) (CDDP) concentration was measured in autopsies treated with CDDP therapy for gynecological malignancies. These cases consisted of 10 of ovarian tumor and one of choriocarcinoma. Total CDDP doses administered were from 55mg to 560mg and among them three cases were treated with more than 500mg (525mg, 555mg in ovarian cancer and 560mg in choriocarcinoma). We found moderate renal impairment with this drug by serum functional test and histopathology, although these changes did not correspond with the total doses. In liver, kidney and residual tumor measured for CDDP, the tissue concentration was highest in liver. When total doses administered were compared with the tissue concentration in liver, kidney, residual tumor and the decrease in creatinine clearance value, there were statistically significant differences only in residual tumor at p less than 0.01.     

Hyperglycosylated hCG in gestational implantation and in choriocarcinoma and testicular germ cell malignancy tumorigenesis

OBJECTIVE: Hyperglycosylated human chorionic gonadotropin (hCG-H) is a carbohydrate variant of hCG with double-sized oligosaccharide side chains. While hCG-H is produced exclusively by stem cytotrophoblast cells in gestational choriocarcinoma, by pregnancy cytotrophoblast at implantation and by the cytotrophoblast produced in testicular malignancies, regular hCG is produced only by differentiated syncytiotrophoblast cells. STUDY DESIGN: hCG-H was measured using the Nichols Advantage hCG-H assay (Nichols Institute Diagnostics, San Clemente, California). RESULTS: hCG-H has a function separate from regular hCG. hCG-H, but not regular hCG, acts in vivo and in vitro to promote invasion, whether invasion through membranes or tumor formation. Invasion or tumorigenesis is completely blocked by administration of specific antibody to hCG-H. The same hCG-H-modulated invasion mechanisms are observed in early pregnancy, gestational choriocarcinoma and testicular cancers. CONCLUSION: hCG-H is a cytokinelike molecule, produced by cells different from those that make regular hCG and having a completely separate function. It appears to be the modulator of invasion as in implantation of pregnancy, gestational choriocarcinoma and testicular cancer malignancy.     

Gestational choriocarcinoma of Fallopian tube diagnosed with a combination of p57KIP2 immunostaining and short tandem repeat analysis: case report

Tubal choriocarcinoma is an extremely rare condition and can be of gestational or non-gestational origin. The appropriate management of choriocarcinoma begins with the categorization of the tumor. However, it is difficult to discriminate the two types by routine histological examination. We report the first case of gestational choriocarcinoma of the Fallopian tube to be confirmed by a combination of p57(KIP2) immunostaining and DNA polymorphism analysis at 15 short tandem repeat loci, along with X and Y chromosome markers. The patient had no detectable metastasis or evidence of recurrence 15 months after treatment, which involved surgery without adjuvant chemotherapy. This case demonstrates the usefulness of a combination of p57(KIP2) immunostaining and DNA polymorphism analysis in determining the origin of extrauterine choriocarcinoma (i.e. gestational or non-gestational), which helps to determine the strategy for treatment of the disease.     

The endocrinologic evaluation of a 45,X true hermaphrodite

A 13-year-old 45,X girl presented with spontaneous menses and the acute onset of progressive hirsutism. Complete endocrinologic evaluation of hirsutism was unremarkable. An exploratory laparotomy revealed a gonad containing ovarian and testicular tissue. Chromosome analysis from four different tissues confirmed the karyotype to be 45,X. She was H-Y antigen positive.     

Primary ovarian choriocarcinoma mimicking ectopic pregnancy managed with laparoscopy -- case report

Nongestational ovarian choriocarcinomas are extremely rare and pose diagnostic challenges in reproductive-aged patients because of elevated human chorionic gonadotrophin (hCG). A 23-year-old nulliparous Chinese woman with nongestational ovarian choriocarcinoma escaped diagnostic testing and was initially treated for an ectopic pregnancy. Three months after her first visit, a diagnostic laparoscopy demonstrated a nongestational ovarian choriocarcinoma. Comprehensive surgical staging was performed by laparoscopy. The tumor was confined to the left ovary. The patient was categorized as FIGO Stage IA. She was given four courses of combined chemotherapy after laparoscopic surgery and has been disease-free for 36 months.     

45,X complete hydatidiform mole

This paper describes the clinical history and chromosomal analyses of a patient with a 45,X molar pregnancy and reviews the literature regarding cytogenetic studies of complete hydatidiform moles. The reported patient with a 45,X complete mole developed postmolar choriocarcinoma. Complete molar pregnancy appears to be the morphologic expression of a wide variety of chromosomal patterns. The risk of developing postmolar choriocarcinoma may be related to the chromosomal pattern of the molar tissue.     

卵巢恶性生殖细胞肿瘤合并肺转移15例临床分析

目的 探讨卵巢恶性生殖细胞肿瘤(MOGCT)合并肺转移的临床特点、诊断、出现肺转移时间、治疗及预后.方法 对北京协和医院1982年1月至2010年12月收治的15例MOGCT合并有肺转移患者的临床资料进行回顾性分析.结果(1)临床特点:患者平均发病年龄为(23±11)岁(6 ～48岁).首发临床表现以腹部疼痛和不规则阴道流血为主,分别为8、4例.原发灶位于卵巢左、右侧者分别为8、6例,双侧者1例.转移灶仅为肺者12例,其他3例为多部位转移.(2)诊断:15例患者中,单纯性卵巢非妊娠性绒毛膜癌(绒癌;NGOC)9例,含有绒癌成分的卵巢混合性生殖细胞肿瘤3例(包括卵巢成熟性畸胎瘤合并绒癌1例、卵黄瘤为主伴绒癌及胚胎癌成分1例、绒癌伴无性细胞瘤1例),不含绒癌成分的卵巢恶性生殖细胞肿瘤3例(包括内胚窦瘤2例、未成熟性畸胎瘤1例).其中,仅1例于术前明确诊断.(3)出现肺转移时间:12例NGOC或含绒癌成分的混合性生殖细胞肿瘤患者中,11例在初始治疗的过程中即出现肺转移,1例为肿瘤复发后出现肺转移;3例不含绒癌成分的卵巢恶性生殖细胞肿瘤患者,均为肿瘤复发后在疾病晚期出现肺转移.(4)治疗:15例MOGCT合并有肺转移患者均采用手术联合化疗的综合治疗,平均化疗疗程数为16个(5 ～ 43个).(5)预后:10例(10/15)完全缓解,其病理类型均为NGOC或含绒癌成分的混合性生殖细胞肿瘤;3例患者在治疗过程中病情进展死亡(1例NGOC,1例内胚窦瘤,1例未成熟性畸胎瘤),2例肿瘤进展(1例NGOC,1例内胚窦瘤)放弃治疗后失访.结论 MOGCT发生肺转移以含绒癌成分者多见.MOGCT合并肺转移患者给予手术联合化疗的结合治疗,多数可获完全缓解,病理类型为NGOC或是含绒癌成分的混合生殖细胞肿瘤肺转移患者的预后远较其他类型的恶性生殖细胞肿瘤合并肺转移者为好.     

Co-existent ovarian mucinous cystadenocarcinoma and ovarian choriocarcinoma

We present the case of a 63-year-old woman with an ovarian neoplasm in which mucinous cystadenocarcinoma and choriocarcinoma coexisted. Blood levels of β-hCG were elevated and bilateral ovarian stromal luteinization was seen. The rarity of this association and its clinical and pathologic implications are discussed. Received: 15 February 2001 / Accepted: 29 May 2001     

Pure nongestational choriocarcinoma of ovary

Introduction Primary ovarian choriocarcinoma arising presumably from a germ cell is extremely rare. Besides arising gestationally or nongestationally, it may be pure or mixed with other germ cell tumors like immature teratoma, dysgerminoma, polyembryoma.Case report and discussion We present a case of a 22-year-old woman diagnosed with pure nongestational choriocarcinoma of the ovary with a review of the literature and discussion of its origin.     

Mixed ovarian germ cell tumor in a BRCA2 mutation carrier.

BRCA2 germ-line mutations confer an increased risk of developing breast and ovarian cancer. We report the occurrence of a mixed ovarian germ cell tumor (GCT) (50% embryonal carcinoma, 20%-25% choriocarcinoma, 10%-15% dysgerminoma, and 10%-15% immature teratoma) in a 33-year-old Ashkenazi Jewish woman, carrier of the BRCA2:6174delT mutation. The mutation is also present in the patient's father, who was diagnosed with breast cancer at age 59 and with prostate cancer at age 69. This is the first report of a GCT in a BRCA2 mutation carrier; there was one previous report of an ovarian dysgerminoma in a BRCA1 carrier. Molecular analysis of the proband's tumor DNA revealed there was no loss of heterozygosity of the wild-type allele in the tumor, as is usually the case for epithelial BRCA-related ovarian tumors. This suggests either that biallelic inactivation of BRCA2 is not required for GCT development or that this is a chance event unrelated to the presence of the mutation.     

Improved short-term survival for advanced ovarian, tubal, and peritoneal cancer patients operated at teaching hospitals

Abstract.   Paulsen T, Kjærheim K, Kærn J, Tretli S, Tropé C. Improved short-term survival for advanced ovarian, tubal, and peritoneal cancer patients operated at teaching hospitals. Int J Gynecol Cancer 2006; 16(Suppl. 1): 11–17.
The aim of this study was to study the impact of hospital level and surgical skill on short-term survival of advanced ovarian, tubal, and peritoneal cancer patients in a prospective population-based study. All 198 women with a diagnosis of advanced epithelial invasive ovarian, tubal, and peritoneal cancer in Norway who underwent surgery during 2002 were included in this study. The data were derived from notifications to the Norwegian Cancer Registry and from medical, surgical, and histopathologic records. The hospitals were grouped into teaching and nonteaching hospitals (NTH), and the operating physicians were classified according to specialty (specialist gynecologist, gynecologist, and surgeon). The follow-up period was from 455 to 820 days. The short-term survival at 450 days was 79% for women operated at teaching hospitals (TH) and 62% at NTH ( P = 0.02). After simultaneous adjustment for seven prognostic factors and residual disease, the risk of death within 600 days at NTH was unchanged compared to TH, hazard ratio 1.83. The women operated on by specialist compared to general gynecologists had a 20% increased short-term survival ( P < 0.0001). TH and specialist gynecologists achieved better short-term survival of patients operated for advanced ovarian, tubal, and peritoneal cancer. Centralization and specialization of ovarian cancer surgery might improve the outcome for this patient group.     

Premature Ovarian Failure and Ovarian Dysgenesis Associated with Balanced and Unbalanced X-6 Translocations, Respectively: Implications for the Investigation of Ovarian Failure

Summary: This study reports the effect of an inherited (X;6) translocation which has not previously been described. The proband was intellectually delayed and had ovarian dysgenesis. Karyotyping revealed an unbalanced karyotype: 46, X, der(X)t{X;6)(q22; p11.2). Her mother was shown to be a carrier of an apparently balanced translocation between the X chromosome and chromosome 6: 46, X, t(X;6)(q22;p11.2). This finding in the mother raises to 7 the number of cases reported which involve a break within the X chromosome 'critical region', at band Xq22, without causing ovarian dysgenesis, although it was associated with premature ovarian failure. These cases aim to highlight to clinical specialists the range of gonadal and other phenotypic anomalies (apart from those associated with Turner syndrome) which can occur due to partial deletions of the X chromosome. These findings have implications for the investigation of both ovarian dysgenesis and premature ovarian failure.     

Characterization of immunoreactive hCG beta-subunit in cultured fluids of the cell lines derived from gynecologic malignant tumors]

We characterize the hCG beta-like materials in cultured fluids from 12 different cell lines derived from gynecologic malignant tumors (SKG-1, -2, -3a and -3b cervical squamous carcinoma, SNG-M and -2 endometrial adenocarcinoma, SKN uterine sarcoma, RTSG ovarian undifferentiated adenocarcinoma, RMUG ovarian mucinous adenocarcinoma, RKN ovarian sarcoma, RMG ovarian clear cell carcinoma and NJG gestational choriocarcinoma) by three kinds of enzyme immunoassay (EIA) which were specific for whole hCG, free hCG beta and beta-core fragment, respectively. Of eleven nontrophoblastic cell lines, nine secreted hCG beta-like immunoreactive substance. The above-mentioned three EIAs for each fractionated specimens with gel chromatography on Sephadex G-100 revealed that the immunoreactivity in the SKG-2 and RTSG cultured fluids were totally attributable to free hCG beta but neither to whole hCG nor beta-core fragment. On the other hand, the NJG choriocarcinoma cell line secreted both whole hCG and free hCG beta, no beta-core fragment could be detected in the cultured fluid. The present results suggested that ectopically produced hCG beta-like material may represent the free hCG beta molecule, and that the beta-core fragment may not be a cellular secretory product.     

Measurement of Cu/Zn SOD in placenta, cultured cells, various fetal tissues, decidua and semen by ELISA.

The concentration of copper/zinc-containing superoxide dismutase (Cu/Zn SOD) was measured in placental villous tissues (8-20 weeks' gestation), decidual tissues, cultured cells from chorionic villi and amniotic fluid cells, various fetal tissues (8-11 weeks' gestation), spermatozoa, seminal plasma and ovarian follicular fluid using a sensitive enzyme-linked immunosorbent assay (ELISA). The isoenzyme was expressed in all samples expect ovarian follicular fluid. Cu/Zn SOD was also detected in hydatidiform mole and choriocarcinoma. In placental villous tissues the concentration of the enzyme increased with gestation between 8 and 20 weeks of pregnancy (n = 69, r = 0.34, P < 0.005).