Serous Carcinoma of the Endometrium with Choriocarcinomatous Differentiation

Abstract

Nongestational choriocarcinomas rarely occur outside the gonads or teratomas. We report a serous carcinoma of the endometrium with a choriocarcinomatous component and review of the literature. A 61-year-old woman underwent hysterectomy and bilateral salpingo-oophorectomy for a serous carcinoma with choriocarcinomatous component. Immunohistochemistry showed a strong p53 staining of the serous component and the cytotrophoblastic cells of the choriocarcinomatous component; the syncytiotrophoblast was negative. The initial serum human chorionic gonadotropin (hCG) was 225,000 IU/L. Postoperatively, the patient developed diffuse pulmonary metastatic disease. Despite chemotherapy, the patient died 2 months after initial diagnosis. Abstracting the data from the reported cases and from the literature, it can be assumed that 2 different tumor types exist. The first one is morphologically and clinically more related to the gestational choriocarcinoma with strongly elevated serum hCG levels, early onset of (distant) metastatic disease, and consecutively rapid and often fatal clinical course. The second type presents as an endometrial carcinoma with single syncytiotrophoblast-like cells, associated with low serum hCG, no distant metastatic disease, and, consequently, a better prognosis. The prognostically relevant component for long-time survival in the latter variant is the nontrophoblastic component.

Endometrioid Adenocarcinoma with High-Grade Transformation with Serous and Choriocarcinomatous Differentiation - A Case Report

“…The combination of choriocarcinoma and other histological types has been reported in association with some human cancers, predominantly with the female genital tract 1-3 and rarely with carcinomas of the esophagus 4, bladder or renal pelvis 5, 6, stomach 7, rectum 8, lung 9, and breast 10. In gynecological cases, an endometrioid adenocarcinoma with a choriocarcinoma component is a rare event with a highly aggressive clinical course 2, 3.…”

“…In gynecological cases, an endometrioid adenocarcinoma with a choriocarcinoma component is a rare event with a highly aggressive clinical course 2, 3.…”

“…Several studies have found that the endometrioid adenocarcinoma cell line contains a subpopulation of tumor initiating cells with stem-like properties. It is likely that the bulk of cells within a tumor consist of stem/progenitor cells and more differentiated cells 3, 14, 15.…”

“…Non-gestational choriocarcinoma is relatively rare. Endometrioid adenocarcinoma of the uterine corpus with another histological type is usually squamous cell carcinoma, serous or clear cell adenocarcinoma and sarcoma, and there have been a few reports of choriocarcinoma 1-3. We report a patient who had mixed cancer with three distinct histological types: endometrioid adenocarcinoma with squamous differentiation, choriocarcinoma in the uterine body and a disseminated peritoneal nodule showing papillary serous adenocarcinoma.…”

Endometrioid adenocarcinoma with choriocarcinomatous differentiation: A case report and review of the literature

“…A choriocarcinomatous component is rarely present in carcinomas of certain sites, including the lung (1), breast (2), esophagus (3), stomach (4,5), colon (6,7) and urinary system (8). Furthermore, uterine corpus carcinomas with choriocarcinomatous differentiation have rarely been reported (9–17). The present study describes a case of endometrioid adenocarcinoma of the uterine corpus with choriocarcinomatous differentiation and discusses the clinicopathological features of this rare tumor.…”