Nongestational choriocarcinomas have been observed in the ovaries but rarely the uterus in postmenopausal women. Choriocarcinomas of gestational and nongestational origin have distinct prognoses but cannot be distinguished with routine histologic examination. We report a case of nongestational uterine choriocarcinoma in a 62-year-old Chinese woman that was confirmed with short tandem repeat analysis.
Choriocarcinoma is a trophoblastic neoplasm that is most commonly gestational but can also be nongestational in origin. Tumors of gestational and nongestational origin have a distinct immunogenicity, sensitivity to chemotherapy, and prognosis ; however, distinguishing them is difficult with routine histologic methods. Primary nongestational choriocarcinoma of the female genital tract has been described in the ovaries, but intrauterine tumors are very rare, especially after menopause. We report a case of pure nongestational uterine choriocarcinoma with multiple metastases in a 62-year-old postmenopausal Chinese woman that was confirmed with short tandem repeat (STR) genotyping.
Case Report
A 62-year-old Chinese woman (gravida 3, para 2, induced abortion 1) whose last menstrual period was 10 years ago and who had a history of irregular vaginal bleeding, cough, blood-stained sputum, chest pain, and fever. Her full-term pregnancies were followed by normal vaginal deliveries; her last pregnancy was 36 years earlier. Pelvic examination revealed the uterus was enlarged to a size that corresponded to 8 weeks gestation. A pelvic ultrasound scan revealed a bulky uterus and uterine fibroid tumor. Pelvic magnetic resonance imaging showed that a uterine mass had invaded into the myometrium. Computed tomography examination suggested metastatic lesions in the lung, spleen, bilateral adrenal gland, and brain. Biopsy of soft tissue within the uterus revealed choriocarcinoma. Serum β-human chorionic gonadotropin (β-hCG) level was 2992 mIU/mL. The patient was diagnosed with choriocarcinoma, which was classified as International Federation of Gynecology and Obstetrics stage IV. The prognostic index score was 15 (high-risk group) according to the International Federation of Gynecology and Obstetrics 2000 staging and risk factor scoring system.
The patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy after 3 cycles of preoperative chemotherapy. The postoperative serum β-hCG level decreased to 501 mIU/mL. The patient received a total of 4 cycles of postoperative chemotherapy. She died 8 months later of respiratory failure.
The uterus measured 9.6 × 7.2 × 5.5 cm, with 3 subserous myomas located in the anterior wall and fundus of the uterus. A dark brown tumor without obvious necrosis or hemorrhage that was found in the endometrium of the lower uterine body measured 6 × 4 × 4 cm in diameter ( Figure 1 , A and B). There were no specific findings in the bilateral adnexa ( Figure 1 , C). The tumor comprised poorly differentiated cytotrophoblasts and syncytiotrophoblasts without other germ cell components and had invaded into the myometrium ( Figure 1 , D). Immunohistochemical analysis of tumor cells revealed positive immunostaining for hCG ( Figure 1 , E) and human placental lactogen ( Figure 1 , F).
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