Gestational choriocarcinoma of Fallopian tube diagnosed with a combination of p57^KIP2 immunostaining and short tandem repeat analysis: Case report

Abstract

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.

Is chemotherapy always necessary for patients with nonmetastatic gestational trophoblastic neoplasia with histopathological diagnosis of choriocarcinoma?

“…With expectant management, we were able to avoid chemotherapy exposure to over half of our patients without the development of more advanced disease, greater need of multi-agent chemotherapy or in any case of death or relapse. While withholding immediate chemotherapy from women with a histologic diagnosis of choriocarcinoma may contravene current FIGO guidelines [9], our observation of the safety of this approach is similar to other reports [12][13][14][15][16][17][18][19][20]. Pathological diagnosis of GCC in specimens from uterine evacuations following molar pregnancies or abortions, salpingectomies in suspected ectopic pregnancies, or even placentas of preterm or term deliveries are not promptly available for Brazilian patients and physicians in the public health systemtaking generally 6-7 weeks for the final pathological results.…”

“…The choice to treat these patients could be viewed as an over-treatment, since they do not show signs of active disease. Several small reports describing expectant management of patients with close clinical and hCG surveillance suggest that women with surgically evacuated choriocarcinoma may enter remission without receiving chemotherapy [12][13][14][15][16][17][18][19][20].…”

A Poor Prognostic Metastatic Nongestational Choriocarcinoma of the Ovary: A Case Report and the Literature Review.

“…DNA STR analysis is frequently used in forensic genetics (13) and population genetics (14) to match DNA pro les to an individual. Recently, STR analysis has been utilized to clarify the origin of choriocarcinoma and to differentiate gestational and pure nongestational choriocarcinoma when de nitive evidence has not been forthcoming from pathological or other clinical ndings (7,(15)(16)(17)(18)(19)(20). Because the genome in nongestational choriocarcinoma comprises only a maternal (patient) allele, whereas gestational choriocarcinoma contains a paternal allele, DNA STR analysis can precisely distinguish these two types of choriocarcinoma.…”

Primary tubal choriocarcinoma

“…There are reports demonstrating the usefulness of combination of P57KIP2 immunostaining and DNA polymorphism analysis determining the origin of tubal choriocarcinoma (gestational and non-gestational). 10…”