Choriocarcinoma is an aggressive, highly vascular tumor. When it is associated with gestation, it is often considered part of the spectrum of gestational trophoblastic disease; it is then termed gestational choriocarcinoma. When it occurs in the absence of preceding gestation, it is termed non-gestational choriocarcinoma (these occur most often in the ovary or testis).
Depends on the site of origin of the tumor. In females, it may occur during or outside of pregnancy; non-gestational choriocarcinoma of the ovary typically occurs in prepubertal girls and postmenopausal women. Testicular choriocarcinomas usually present in male patients between ages 15 and 30 9.
In the classic case of gestational choriocarcinoma, the tumor is derived from chorionic epithelium.
Typically arises in association with reproductive organs:
- uterus: choriocarcinoma of the uterus
- cervix 8
- ovary: choriocarcinoma of the ovary
- testes: testicular choriocarcinoma
Primary occurrence outside the reproductive system has been reported but is extremely rare. Such sites include:
- brain: primary intracranial choriocarcinoma
- lung: primary pulmonary choriocarcinoma (PPC)
- pulmonary arteries 5
- stomach 6-7
- the small intestine
- pancreas 6
Trophoblastic cells have an affinity for blood vessels and therefore the tumors have a tendency to metastasize through the hematogenous route.
Choriocarcinoma is one of the causes of cannonball metastases to the lungs.
High levels of βhCG are usually seen in cases of choriocarcinoma.
Imaging features of a primary tumor are dependent on location: see individual subtypes under "location" above.
Treatment and prognosis
The tumor is aggressive in its behavior and metastases are frequent, with the lungs being a common site of metastasis. Despite its aggressiveness, it is generally highly chemosensitive and carries a much better cure rate than other comparable malignancies.
A significant proportion of the complications arises from hemorrhage due to high vascularity in either a primary tumor or its metastases.
- 1. Bazot M, Cortez A, Sananes S et-al. Imaging of pure primary ovarian choriocarcinoma. AJR Am J Roentgenol. 2004;182 (6): 1603-4. AJR Am J Roentgenol (full text) - Pubmed citation
- 2. Allen SD, Lim AK, Seckl MJ et-al. Radiology of gestational trophoblastic neoplasia. Clin Radiol. 2006;61 (4): 301-13. doi:10.1016/j.crad.2005.12.003 - Pubmed citation
- 3. Takeuchi M, Matsuzaki K, Uehara H et-al. Pathologies of the uterine endometrial cavity: usual and unusual manifestations and pitfalls on magnetic resonance imaging. Eur Radiol. 2005;15 (11): 2244-55. doi:10.1007/s00330-005-2814-x - Pubmed citation
- 4. Green CL, Angtuaco TL, Shah HR et-al. Gestational trophoblastic disease: a spectrum of radiologic diagnosis. Radiographics. 1996;16 (6): 1371-84. Radiographics (abstract) - Pubmed citation
- 5. Trübenbach J, Pereira PL, Huppert PE et-al. Primary choriocarcinoma of the pulmonary artery mimicking pulmonary embolism. Br J Radiol. 1997;70 (836): 843-5. Br J Radiol (abstract) - Pubmed citation
- 6. Coşkun M, Ağildere AM, Boyvat F et-al. Primary choriocarcinoma of the stomach and pancreas: CT findings. Eur Radiol. 1998;8 (8): 1425-8. Eur Radiol (link) - Pubmed citation
- 7. Bateman HE, Kasimis BS, Yook CR et-al. Case report: primary choriocarcinoma of the stomach. N J Med. 1995;92 (7): 459-62. - Pubmed citation
- 8. Yahata T, Kodama S, Kase H et-al. Primary choriocarcinoma of the uterine cervix: clinical, MRI, and color Doppler ultrasonographic study. Gynecol. Oncol. 1997;64 (2): 274-8. doi:10.1006/gyno.1996.4541 - Pubmed citation
- 9. Tannenbaum M, Madden JF, eds. Testicular tumors. In: Diagnostic Atlas of Genitourinary Pathology. Philadelphia, Pa: Churchill Livingstone Elsevier; 2006:95.