Intra-operative cytodiagnosis of primary ovarian choriocarcinoma with Ki67 immunoexpression

Abstract

Primary ovarian choriocarcinoma is a rare neoplasm that can be gestational and non-gestational in origin. It accounts for one in 369 million pregnancies. Both types present with similar clinical, histomorphological and ultrastructural findings. But, it is essential to differentiate the two because the gestational type has a better clinical course and responds to single-agent chemotherapy. Usually, the gestational ovarian choriocarcinoma is metastatic from uterine choriocarcinoma and follows antecedent pregnancy and is seen in females of 40 years or older. DNA polymorphism analysis showing the presence of paternal genes in the tumor establishes the gestational origin of choriocarcinoma. We present the intra-operative cytological findings of a case of primary ovarian choriocarcinoma in a 25-year-old lady arising from ectopic pregnancy with Ki67 immunostain.

Non-Gestational Ovarian Choriocarcinoma: A Rare Ovarian Cancer Subtype

“…The aggressive nature of NGOC makes metastatic disease a concern, with hematologic and local spread occurring early in the disease process [44]. Local spread appears to follow the embryological pathway of germ cell migration [45]. In the largest chart review of 39 patients with NGOC, 80% of patients had metastatic disease to the lungs, 30% to the pelvis, 20% to the vagina, and 10% to the liver [13,46].…”

Primary Ovarian Choriocarcinoma: One Case in 20 Years at INCA and Literature Review

“…The gestational type is defined as the result of the proliferation of an uterine or tubal trophoblastic disease to the ovary or, more rarely, the anomalous development of a gravid ovary. However, the non-gestational form results from the anomalous development of the ovary's own germinative cells without gestation [6][7][8][9][10]. However, the distinction between Ovarian choriocarcinoma presentation forms is extremely difficult due to immunohistochemical similarity [8].…”

“…However, the distinction between Ovarian choriocarcinoma presentation forms is extremely difficult due to immunohistochemical similarity [8]. Some authors establish tumor DNA analysis as the ideal method for this distinction [2][3][4][5][6][7], however, this technique is little used due to its high cost [2][3][4][5][6][7][8][9].…”